Decision-making about prenatal genetic testing among pregnant Korean-American women.

OBJECTIVE: to understand the prenatal genetic testing decision-making processes among pregnant Korean-American women. DESIGN: a qualitative, descriptive research design. PARTICIPANTS: referrals and snowball sampling techniques were used to recruit 10 Korean-American women who had been recommended for amniocentesis during pregnancy in the United States (U.S.). All participants were born in Korea and had immigrated to the U.S. The number of years living in the U.S. ranged from 4 to 11 (M=5.7). SETTING: various regional areas of the U.S. MEASUREMENTS AND FINDINGS: the researchers conducted face-to-face or phone interviews using semi-structured interview guides. The interviews were conducted in the Korean language and lasted approximately 50-100minutes. The interview guides focused on the decision-making process and experiences with prenatal genetic testing, as well as reflections on the decisions. Four core themes emerged related to the participants' decision-making processes, according to their descriptions. These themes are (1) facing the challenges of decision-making, (2) seeking support, (3) determining one's preferred role in the decision-making process, and (4) feeling uncomfortable with the degree of patient autonomy in U.S. health care. KEY CONCLUSION: researchers concluded that many distinctive factors influence the decision-making processes used by pregnant Korean-American women. The results have the potential to improve shared decision-making practices regarding prenatal genetic testing. IMPLICATIONS FOR PRACTICE: clinicians need to understand the sociocultural underpinnings of pregnant Korean-American immigrants regarding prenatal genetic screening and testing as an initial step to engage these patients in shared decision-making.

Genomic Competencies for Nursing Practice: Implications for Nursing Leadership.

Nurses must have appropriate knowledge and skills to provide safe and effective nursing care in recognition of evolving science. Knowledge of genomics is required to ensure appropriate referral and education of patients who would benefit from genetic services. This article describes the process the Veterans Healthcare Administration's (VHA's) Office of Nursing Services used to determine the nursing genomic competencies appropriate for VHA nurses and identify available resources for educating nurses on these nursing competencies and a strategic plan for long-term implementation.

Genomics for Nursing Education and Practice: Measuring Competency.

BACKGROUND: Nurses lack genome literacy, skill, and self-confidence in applying genomics to health care. Standardized curricula and evaluation tools are needed for wide spread uptake and application of genome science in nursing education, practice, and research. AIM: To determine whether psychometrically robust survey instruments exist to assess knowledge, skills, attitudes, and self-confidence in applying genomic nursing competency among students and registered nurses. DESIGN: Psychometric systematic review. DATA SOURCES: Medline, CINAHL, Academic Search Elite, Web of Science, and ProQuest Dissertations were searched from 1995 to 2014, with an English language restriction. PROCEDURES: Critical analysis of the study elements and psychometric attributes was conducted after data were abstracted into analysis and synthesis tables. The synthesis assessed the design, methods, and measurement properties with a focus on reliability and validity using 16 criteria on a 4-point grading scale. FINDINGS: Twelve studies were included in a detailed review that focused on assessment of genomic nursing core competencies. Six studies met the inclusion criteria. In terms of psychometric quality of the instruments, one study scored high, two moderate, two low, and one very low. LINKING EVIDENCE TO ACTION: Most instruments assess self-perceived rather than objectively assessed competency. The highest quality instrument lacks clinical application. Knowledge-focused test questions based on up-to-date genome science that are relevant to practice need to be developed.

Nurse residency programs: an evidence-based review of theory, process, and outcomes.

Nursing shortages exist worldwide while job stress, dissatisfaction, lack of peer support and limited professional opportunities still contribute to attrition. The aim of this systematic review is to describe and evaluate the quality of the science, report recommendations and lessons learned about implementing and evaluating nurse residency programs (NRPs) designed to improve new graduate transitioning. Databases were searched between 1980 and 2010 using five search terms: nurse, intern, extern, transition and residency programs. Twenty studies reporting programs for new RNs fit the inclusion criteria. Three major discoveries include: 1. Wide variation in content, teaching and learning strategies make comparison across programs difficult; 2. Lack of theory in designing the educational intervention has limited the selection and development of new instruments to measure program effectiveness; and 3. Well designed quasi-experimental studies are needed. As a major nursing education redesign, NRPs could be used to test the principles, concepts and strategies of organizational transformation and experiential-interactive learning theory. By focusing on fiscal outcomes, current administrators of NRPs are missing the opportunity to implement an organizational strategy that could improve workplace environments. Healthcare organizations need to envision NRPs as a demonstration of positive clinical learning environments that can enhance intra- and interprofessional education and practice.

Predictors of physician compliance with American Heart Association guidelines for acute myocardial infarction.

Strong evidence exists for American Heart Association guidelines for treatment of acute myocardial infarction, yet therapies are widely underutilized. Nurses are key players in leading uptake of these guidelines in clinical practice. To understand factors impacting guideline compliance, Ajzen's theory of planned behavior was used to explain the influence of beliefs, attitude, subjective norms, and perceived personal behavioral control on utilization behavior. Acute myocardial infarction database records were reviewed. An 11-question survey was created and sent to 45 physicians. The survey measured perceptions of public reporting, report cards, tools (order sets, pocket guides), and perceptions of their own compliance. Physician perceptions, specialty, patient variables age, gender, angiogram performance, and mortality were compared with guideline compliance (meeting >or=3 indicators). Ten hypotheses were tested. Results showed a correlation between guideline compliance and physician perception of report cards, as well as perception of their own performance. Interventional cardiologists were more compliant than noninterventional cardiologists or hospitalists/intensivists. Patient but not physician age mattered. Angiogram correlated with compliance; noncompliant physician group mortality was higher. The attitude construct of Ajzen's theory correlated most with compliant behavior. The American Heart Association guidelines impact mortality. Physicians view order sets and pocket guides positively. Compliance differs by specialty, providing opportunities for education.

Ethical preparedness and performance of gene therapy study co-ordinators.

Little is known about study co-ordinators of gene therapy clinical trials. The purposes of this study were to: (1) describe characteristics of co-ordinators of gene therapy (transfer) clinical trials; (2) assess differences between nurse and non-nurse study co-ordinators; and (3) identify factors indicative of study co-ordinators' role preparation that could affect their role performance. This exploratory correlational study employed a convenience sample of 118 co-ordinators in the USA (55 participants; 47% response rate). The researcher created the Study Coordinator Role Preparedness and Performance Survey to assess factors or correlates of study co-ordinator performance. Analysis of variance was used to compare nurses and non-nurses, and men versus women on their perceived preparedness, perceived quality of orientation, and satisfaction with educational opportunities. The findings contribute to knowledge by identifying present inadequacies in the training of study co-ordinators and in recognizing the need for more effective provision of orientation and continuing education with respect to ethical issues, knowledge of genetic science, and potential research integrity challenges.

Cardiovascular disease prevalence, associated risk factors, and plasma adiponectin levels among Filipino American women.

OBJECTIVES: This cross-sectional study was designed to examine the association between adiponectin and cardiovascular disease (CVD) among an understudied ethnic group of Filipino American women. METHODS: We recruited 266 Filipino women aged 40-86 years from the University of California, San Diego Filipino Women's Health Study (1995-1999). Plasma adiponectin was extracted from archive blood samples and measured by radioimmunoassay. CVD was defined as coronary heart disease, angina, myocardial infarction, or stroke by history, electrocardiogram (Minnesota coding), or Rose questionnaire. RESULTS: CVD prevalence among Filipinas was 20.7% (n=55), of which 85.5% were newly diagnosed. Filipinas with versus without CVD had more antihypertensive medication use (44.4% vs 26.7%), more parental history of myocardial infarction (38.2% vs 21.8%), higher proinsulin levels (13.2 vs 11.0 pmol/L), lower adiponectin levels (5.09 vs 6.15 microg/mL), and higher prevalences of the metabolic syndrome (34.6% vs 28.0%) and microalbuminuria (24.0% vs 12.2%). Adiponectin (adjusted OR .46, 95% CI .23-.89, P=.021) was independently associated with CVD in multivariate analysis that adjusted for age, exercise, family history, diabetes, hypertension, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and microalbuminuria. CONCLUSIONS: Independent of known risk factors, adiponectin was associated with CVD among Filipinas. This finding suggests that adiponectin may be a useful CVD indicator among this ethnic population.

Calling for international collaborative research in nursing, genetics and genomics: a discussion paper.

UNLABELLED: There is an explosion in the numbers of nurse authors exploring new and exciting opportunities to understand genomic medicine because of international success on The Human Genome Project. OBJECTIVES: The primary purpose of this paper is to spotlight and to promote collaborative interdisciplinary and international nursing research within genetics and genomics. DESIGN: Review of the literature. DATA SOURCES: Research in nursing pertaining to genetics and genomics, policy statements, and opinion papers. REVIEW METHODS: Synthesis of the literature in four areas: genetic nursing research, genomic medicine, barriers to international collaboration, and elements that foster international collaboration. RESULTS: Genetics and genomic medicine have implications for virtually all diseases in all health care settings in developed and still developing nations. Research in nursing, genetics and genomics is scarce. There is a gap in nursing literature about how to address barriers to foster international collaboration. CONCLUSIONS: The authors who have engaged in international collaboration offer a tentative road map for establishing and assessing the progress of research collaboration. New funding mechanisms to support international nursing research in this area are needed.

Breast cancer screening for Korean women must consider traditional risks as well as two genetic risk factors: genetic polymorphisms and inheritable gene mutations.

Asian women worldwide have increasing rates of breast cancer due to acculturation which may be altering, gene to gene and/or, genetic and environmental interactions at the cellular level. The purpose of this integrative review is to alert nurses and physicians to rising rates of breast cancer among Korean women and to a need for breast health screening programs in the United States that are more culturally responsive and attentive to the effects of acculturation and genetic risk factors. A comprehensive review of the English and Korean literature pertaining to rising incidence of breast cancer among Korean women in their homeland and in the United States is retraced since 1983. Korean women in Korea and in the United States face similar barriers to cancer screening services. Korean women need knowledge about the effect of acculturation on breast cancer risk and patterns of familial inheritance of breast cancer. Screening is especially important among younger women (younger than age 35), those with a strong family history, and women in community settings where acculturation has its greatest impact. Nurse clinicians and researchers who aim to improve breast cancer screening among minority women must pay closer attention to these risk factors and design culturally competent services and evaluation research. In the United States and Korea, Korean nurses are needed to specialize in breast cancer screening as well as cancer genetic risk assessment and genetic counseling.

Patient decision-making for clinical genetics.

Medicine is incorporating genetic services into all avenues of health-care, ranging from the rarest to the most common diseases. Cognitive theories of decision-making still dominate professionals' understanding of patient decision-making about how to use genetic information and whether to have testing. I discovered a conceptual model of decision-making while carrying out a phenomenological-hermeneutic descriptive study of a convenience sample of 12 couples who were interviewed while deciding whether to undergo prenatal genetic testing. Thirty-two interviews were conducted with 12 men and 12 women separately. Interviews were transcribed verbatim and all data were analyzed using three levels of coding that were sorted into 30 categories and then abstracted into three emergent meta-themes that described men's and women's attempts to make sense and find meaning in how to best use prenatal genetic technology. Their descriptions of how they thought about, communicated, and coped with their decision were so detailed it was possible to discern nine different types of thinking they engaged in while deciding to accept or decline testing. They believed that decision-making is a process of working through your own personal style of thinking. This might include only one or any combination of the following types of thinking: analytical, ethical, moral, reflective, practical, hypothetical, judgmental, scary, and second sight, as described in detail by these 12 couples.