Your DNA dictates more than just the color of your hair. The genes you inherit can play a role in nearly every aspect of your health. Genetics is a young field; the Human Genome Project, which shaped our modern understanding of DNA, wasn’t completed until 2003. But nurses are increasingly on the front lines of research on the topic, and are putting their knowledge to work to improve and personalize care for patients.
Having an understanding of genetics can help patients and their providers prevent, anticipate or manage health conditions that they might otherwise be unaware of, explains Kathleen Hickey, EdD, FNP-BC, ANP-BC, FAAN, a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar (2009-2012) and assistant professor at the Columbia University School of Nursing. She saw the link early in her career, when she was a nurse practitioner working with cardiac patients. Many of her young patients had family members with cardiac arrhythmias, or had lost loved ones to cardiac arrest. As scientists learned more about genetics and that certain cardiac conditions were inherited, what she had seen in the clinical setting was confirmed.
“Nursing plays a unique role because we’re really on the front line, taking care of patients, where we might recognize that someone has an underlying, inherited genetic-based condition,” says Hickey, who is president-elect of the International Society of Nurses in Genetics.
Hickey was selected in 2009 to attend the National Institute of Nursing Research’s Summer Genetic Institute, a two-month, intensive genetics training at the National Institutes of Health. The training, which laid the foundation for her research as an RWJF Nurse Faculty Scholar, also allowed her to join an interdisciplinary team that works closely with patients and families at greater risk for cardiovascular disease because of genetic mutations.
“I think it also goes well beyond identifying a condition. We’re here to support patients emotionally; we really try to recognize and deal with bereavement that can come with many of these conditions,” Hickey says. “As a nurse I’m able to support patients in a different way than other members of my team. The art of nursing—our caring and compassion in dealing with these difficult outcomes—is really going to be a big part of genetics. As genetics becomes integrated into daily clinical practice, nursing is ideally suited to take on a major role.”
Cardiac nurses aren’t the only ones using genetics. In a forthcoming study in Nursing and Health Sciences, Hickey found that the Summer Genetic Institute training benefited a wide array of nursing professionals. The paper examines the demographics of Institute attendees and offers an assessment of how the training is being put to use in practice, education and research.
RWJF Executive Nurse Fellows program alumna (2005-2008) Ann Cashion, PhD, RN, FAAN, also attended the Summer Genetic Institute in 2000. Cashion is a professor and chair of the department of acute and chronic care at the College of Nursing at the University of Tennessee Health Science Center in Memphis.
“It was my first introduction to genetics,” she says, and it came as she was beginning her research career. “Without that fellowship I wouldn’t have been able to incorporate molecular genetics into my research. Studying genetics was a natural outgrowth of working with transplant recipients and conducting research in that area.”
Cashion’s research looks at clinical outcomes of organ transplantation, including biomarkers of rejection for pancreas transplantation, and the genetic and environmental factors associated with obesity after transplant. Cashion also teaches a foundational genetics course at the University of Tennessee Health Science Center, which has been a required course for nursing students—and a popular one, she says—for several years.
“As personalized medicine becomes more predominant in our health care system, genetics will allow nurses to tailor specific therapies for patients based on their genetic makeup,” Cashion says. “Genetics education is important to practicing nurses too. Continuing education is very important as we move into this era of personalized health care.”
Expanding the Field
“People are always a bit surprised when they find out what I study,” says Lorraine Frazier, PhD, RN, MS, FAAN, dean of the University of Arkansas for Medical Sciences College of Nursing and an RWJF Executive Nurse Fellow (2009-2012). “A lot of people don’t understand that nurses lead or are involved in research. I think even some nurses don’t know that research is an option for them in their careers or that nurses are doing that.”
Frazier, who studied cardiovascular disease as a doctoral student, realized early in her career that genetics were at play in the disease process and completed a two year post-doctoral study at the University of Texas Human Genetics Center. She has since received several prestigious research grants, and helped found TexGen Research, a nonprofit company that manages a centralized database of patients’ blood and tissue samples at the multi-institutional Center for Clinical and Translational Sciences biobank, which she directed for six years.
The biobank repository houses more than 10,000 samples, which includes her research samples on the link between genetic predisposition for depression and myocardial infarctions (heart attacks), and provides experts in a variety of health care fields with data and samples for research.
Nursing research is important to the understanding of disease and health, Frazier says. “I can impact patients, one by one, over a career in patient care, but I can impact a lot more patients if I have carefully crafted research that can impact health.”
Hickey agrees. “We’re not just doing lab work. Nurses are taking what they learn about genetics and working with diverse teams to improve patient care, and we’re educating patients, other researchers, community leaders and policy-makers.”
“We need to be out there talking to high school students and young nursing students about what they can do and encouraging them to increase their education and take advantage of these research opportunities,” Frazier adds. “We need to make a concerted effort to be that recruiter and mentor, in hospitals, communities, and our own universities. It’s up to us to educate the next generation and the public on what nurses do and can accomplish.”