Ann Maradiegue

Knowledge, Perceptions, and Attitudes of Advanced Practice Nursing Students Regarding Medical Genetics

Purpose To describe the current medical genetic knowledge and perceptions of graduate advanced practice nursing (advanced practice nurse [APN]/nurse practitioner and nurse anesthetist) students using survey data for future integration of genetic topics, principles, and healthcare issues into curriculum. Data sources Survey data of APNs’ perceived knowledge of genetics and a review of the literature from past research studies of students and current articles from professional journals and organizations. Web sites were those of the National Coalition of Health Professions for Education in Genetics and National Institutes of Health, Human Genome Research Institute; professional organizations; and the authors’ professional, clinical, and educational experiences. Conclusions Most APN students perceived they had minimum knowledge and prior training regarding medical genetics. There is a need to integrate genetic concepts, principles, and medical conditions into advanced practice nursing curriculum and to provide clinical experiences in genetic conditions across the life span and throughout the health and illness spectrum. APN students have positive attitudes toward integrating genetics into graduate curricula. Potential methods for program integration include readings, small group discussion, standardized patients, and role‐play as measures to increase information. Implications for practice The National Coalition for Health Profession Education in Genetics, the American Nursing Association, and the American College of Nursing Education have recommended integration of genetics knowledge and skills into routine health care to provide effective interventions for individuals and families. However, previous research and data from this study have revealed that many nurses have minimal training in genetics. Advanced practice nurses must be knowledgeable on genetic principles, topics, and the ethical, legal, and social implications related to medical genetics to increase the ability to diagnose, prevent, and treat diseases and to provide effective care for individuals and families.

What's cooking with garlic: is this complementary and alternative medicine for hypertension?

Purpose To define complementary and alternative medicine (CAM); describe one type of CAM, garlic (Allium sativum L); and discuss its effects on blood pressure as a treatment for hypertension. Data sources Literature review from professional journals, abstracts, natural therapy books, and the World Wide Web (Internet). Information from the following professional organizations and agencies: The World Health Organization, Agency of Healthcare Research and Quality, National Cancer Institute, National Center for Complementary and Alternative Medicine, American Botanical Council, and Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Conclusion Garlic is widely used throughout the world as a CAM. It is one of the most popular herbal products sold in the United States. However, while some studies have shown small positive effects in reducing blood pressure, there are insufficient scientific data to draw conclusions regarding its efficacy on clinical blood pressure outcomes. Thus, healthcare providers should be cautious in recommending this herbal product as an antihypertensive CAM. Implications for practice CAMs may be used by clients for a variety of conditions including hypertension. Healthcare providers must be cognizant of the use, efficacy, adverse affects, and scientific evidence concerning CAM in order to provide safe and effective practice as well as appropriate and accurate information to their clients.

An overview of ethnicity and assessment of family history in primary care settings

Purpose: To discuss the importance of and the nurse practitioner’s (NP’s) role in the assessment of ethnicity/family of origin in conducting a multigenerational family history in primary care settings. Data sources: A review of the literature on past research results addressing racial and ethnic disparities and current articles from scientific journals exploring the relationship between race and genetics. Web sites were from the National Institutes of Health, the Human Genome Research Institute, the National Cancer Institute, and the Health and Human Services Minority Health and Disparities report. Conclusions: The family history has received renewed interest due to the sequencing of the human genome. A multigenerational family history is an important first step in screening for a multitude of disorders impacted by genetic susceptibility, shared environments, and common behaviors. Assessment of the patient’s ethnicity/family of origin is an integral part of the multigenerational family history, particularly in the diagnosis of chronic diseases and the assessment of risks for genetic disorders. The multigenerational family history is important in diagnosis, predictive genetic testing, disease prevention, and health promotion. Challenges facing NPs and the utilization of a multigenerational family history in the current U.S. health system include (a) training clinicians on the correct assessment and utilization of a multigenerational family history, (b) assessment of the subtleties of ethnicity and identifying multiple ethnic groups within a family, (c) collection of the family history in a manner that is sensitive to the cultural beliefs of individuals, and (d) avoidance of stereotyping Implications for practice: Significant advances in genetics and genetic testing requires that NPs be well versed in collecting and interpreting a multigenerational family history to include assessment of the patient/family’s ethnicity/family of origin. The ability to effectively conduct and evaluate the individual’s and family’s health risk through a multigenerational family history will be important in diagnosis, health promotion, disease prevention, and the determination for genetic counseling referral and predictive testing when appropriate. Assessment of risk and prevention of disease is also important in reducing health disparities.

Reducing Premature Osteoarthritis in the Adolescent Through Appropriate Screening

Osteoarthritis affects all ages. The etiology of this debilitating disease is multifactorial; however, several genes are linked to osteoarthritis. Sports participation, injury to the joint, obesity, and genetic susceptibility predispose adolescent athletes to the development of premature osteoarthritis. Assessment for the risk of osteoarthritis includes obtaining a family history to detect any genetic predisposition, obtaining body weight and body mass index, and identifying the patients exercise regime and sports participation. Strategies to prevent the development of osteoarthritis in the adolescent include patient education, exercises to build quadriceps strength, low-impact activities, and the maintenance of a healthy weight. The devastating effects of premature osteoarthritis can be reduced if an assessment for risk of the disease is performed during adolescence.

Scoping the family history: Assessment of Lynch syndrome (hereditary nonpolyposis colorectal cancer) in primary care settings—A primer for nurse practitioners

Purpose: To describe and discuss the characteristic features and red flags of Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer, that warrants referral for genetic cancer risk assessment (GCRA). A focus on the nurse practitioner’s (NP) role in familial risk assessment, physical examination, initiation of genetic referrals, and issues related to the genetic counseling process are also discussed. Data sources: A review and synopsis of professional guidelines, clinical articles, and research studies on Lynch syndrome and the genetics of inherited cancer syndromes associated with colorectal cancer. Online resources from the American Gastroenterological Association, American Medical Association, the American Nurses Association, the National Comprehensive Cancer Network, the National Cancer Institute, the National Cancer Institute—Physician Data Query, the National Coalition of Health Professional Education in Genetics, the National Human Genome Research Institute, the National Society of Genetic Counselors, International Society of Nurses in Genetics, and the Oncology Nursing Society. Conclusions: Approximately 5% of all colon cancers are because of a germ line mutation predisposing individuals and their family members to colorectal and other cancers. Although the efficacy of screening modalities is established, healthcare providers often fail to identify those at greatest risk for disease. The extended family history is the first step in recognition of individuals “suspect” for hereditary colon cancers such as Lynch syndrome. Early‐age onset of Lynch syndrome–associated cancers, an autosomal‐dominant pattern, multiple primary tumors in an individual or multiple family members with Lynch syndrome–associated cancers, characteristic pathological features of colon cancer, or a known germ line Lynch syndrome mutation in a family member are “red flags” that will aid NPs in identifying individuals who may benefit from GCRA. Implications for nurse practitioner practice: The importance of enhanced surveillance for early diagnosis and prevention of disease is a critical part of primary care. Thus, it is imperative that NPs obtain a minimum of a three‐generation pedigree, recognize hereditary cancer patterns, and provide referral counseling for consideration of genetic testing of individuals suspect for Lynch syndrome.

5-years later - have faculty integrated medical genetics into nurse practitioner curriculum?

Abstract Many genetic/genomic educational opportunities are available to assist nursing faculty in their knowledge and understanding of genetic/genomics. This study was conducted to assess advance practice nursing faculty members’ current knowledge of medical genetics/genomics, their integration of genetics/genomics content into advance practice nursing curricula, any prior formal training/education in genetics/genomics, and their comfort level in teaching genetics/genomic content. A secondary aim was to conduct a comparative analysis of the 2010 data to a previous study conducted in 2005, to determine changes that have taken place during that time period. During a national nurse practitioner faculty conference, 85 nurse practitioner faculty voluntarily completed surveys. Approximately 70% of the 2010 faculty felt comfortable teaching basic genetic/genomic concepts compared to 50% in 2005. However, there continue to be education gaps in the genetic/genomic content taught to advance practice nursing students. If nurses are going to be a crucial member of the health-care team, they must achieve the requisite competencies to deliver the increasingly complex care patients require.

Central American mothers report family history of depression and alcohol abuse as a predictor of teenage health risk behaviors.

Purpose: The purpose of this study was to explore the relationships of family history of depression and alcohol abuse as a predictor of health risk behaviors among Central American teenagers. Data sources: Demographic data were collected from a convenience sample of 101 Central American mothers with a teenage daughter ages 12–17 years who were living in Northern Virginia. The research questions assessed the family history of depression, alcohol abuse, and maternal depression. Scores were calculated to predict risk of teenage health risk behaviors. Conclusions: The Hispanic mothers in this study reported that their teenagers had significant health risk behaviors, including school dropout and expulsion, alcohol and substance use, pregnancy, and gang membership. Family history of depression and alcohol abuse in a first degree relative predicted teenage risk behavior 71% of the time. Clinical Implications: There is no consensus on a standard screening approach for depression in teenagers. Developing a standardized approach to gathering information from teenagers that includes genetic family traits may have significant effects on interventions for teenage health risk behavior and ways to provide the best services for vulnerable teenagers. The results of this study have implications for nurse practitioners caring for teenagers.

Using family history and health risk behaviors to determine predictors of depressive symptoms in Central American immigrant mothers

In this study, depressive symptomatology in Central American immigrant mothers with adolescent daughters living in the USA was explored. Using the Center for Epidemiologic Studies Depression Short Scale, the Family History Scale, an Acculturation Scale, and the core section of the Youth Conduct Disorder scale from the National Health and Nutrition Examination Survey, 101 Central American mothers were analyzed to identify predictors of depressive symptoms. Over one-third of the participants had depressive symptoms. There were no significant findings for acculturation as a predictor of depressive symptoms. Predictors that related to depressive symptomatology were a positive family history of depression, marital status (divorced), and having a daughter engaged in health risk behaviors. Clinicians working with mothers from Central America should consider risk of depression, whether there is a family history of depression; and additional stresses, such as the health risk behaviors of adolescents. Unprecedented levels of immigration around the world underscore the importance of meeting the healthcare needs of culturally-diverse groups.