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.

Regular exercise improves weight stability in patients with advanced heart failure.

OBJECTIVES: The purpose of this study was to determine if a progressive, prescribed home-based aerobic exercise program would alter the natural physiological processes that maintain fluid balance stability in patients with New York Heart Association (NYHA) class III/IV heart failure after medical optimization (titration of oral medical therapy with or without the infusion of an intravenous inotrope). METHODS: A total of 56 men and women from a large tertiary trauma I hospital were enrolled with 56 subjects contributing to baseline analysis and 42 subjects at 24 weeks. Subjects were diagnosed with heart failure via NYHA classification IV or III for at least 6 months and were hospitalized for a current acute decompensation exacerbation in which they were being medically optimized. The exercise intervention was a home-based, prescribed, progressive aerobic exercise program lasting for 24 weeks. The exercise participants had weekly phone calls to gather data and progress the exercise program and one 12-week follow up. The usual care participants received random phone calls to collect data and had one 12-week follow up visit to attain physical assessment values. RESULTS: Subjects were primarily female (59%), nonwhite (54%), and NYHA class IV (52%) versus class III (48%). The mean age was 58 years (±11.8 years). The subjects had a mean ejection fraction of 17.7 % (±7%) and mean maximal oxygen consumption of 12.1 (±3.4). Using a hierarchical multiple regression model, it was demonstrated that an exercise prescription (intensity, frequency, duration) significantly predicted 24 h weight fluctuations within a NYHA class III/IV heart failure population after medical optimization (R(2) linear = 0.713, F = 3.224, p = 0.015). CONCLUSION: This study demonstrated that exercise is a successful adjunctive therapy to managing the daily weight variability or fluid status instability of patients with NYHA class III/IV heart failure that is often a debilitating aspect of the syndrome.