Developing Policy Infrastructure to Guide Genomics-Informed Oncology Nursing in Canada: An Interpretive Descriptive Study.

BACKGROUND: Genomic technologies such as genetic testing and precision treatments are rapidly becoming routine in oncology care, and nurses play an increasingly important role in supporting the growing demands for genomics-informed healthcare. Policy infrastructure such as competencies, standards, scope of practice statements, and education and curriculum frameworks are urgently needed to guide these practice and education changes. PURPOSE: This study is part of a larger three-phase project to develop recommendations and catalyze action for genomics-informed oncology nursing education and practice for the Canadian Association of Nurses in Oncology and the Canadian Association of Schools of Nursing. This phase aimed to enhance understanding of policy needs and action drivers for genomics-informed oncology nursing education and practice through the perspectives of Canadian oncology nurses and patient partners. METHODS: Interpretive description methodology guided the study. Twenty semi-structured virtual interviews were conducted; 17 with oncology nurses in various domains of practice, and three with patient partner representatives. Data collection and analysis occurred concurrently. RESULTS: Our analysis identified three themes: 1) nurses and patients recognize that it is time for action, 2) nurses and patients see advantages to executing intentional, strategic, and collaborative policy development, and 3) leadership and advocacy are required to drive action. CONCLUSION: Nursing policy infrastructure is required to increase genomic literacy, support nurses in providing safe patient care, and establish clear roles, responsibilities, and accountabilities within the interdisciplinary team. Strong leadership and advocacy at the practice, organizational, and systems levels are vital to accelerating action.

Ethics Review of Projects (ERoP): A Conceptual Framework.

Ethical risks are routinely assessed and mitigated in research studies. The same risks can exist in program evaluations and quality improvement initiatives and yet may not be routinely and comprehensively addressed. The authors present a conceptual framework that can help organizations develop comprehensive ethics review processes for non-research knowledge-generating projects (NRKGPs). They provide strategies that can be implemented in three progressive domains and illustrate the framework's application using two examples of health organizations with existing NRKGP ethics review processes. They conclude the article by discussing some lessons learned.

Une analyse éthique appropriée s'impose.

Les leaders en santé gèrent de nombreux types de risques. Le risque éthique associé aux multiples projets et activités, réalisés régulièrement hors du secteur de la recherche, est probablement négligé (p. ex., évaluation de programmes, amélioration de la qualité et innovation en santé). La mise en application de l'éthique clinique, personnelle, professionnelle et organisationnelle peut contribuer à atténuer les risques, mais ensemble ou séparément, ces divers types d'éthique ne suffisent pas. Chaque type de projet ou d'activité doit être assorti d'une analyse éthique qui lui est adaptée. Les leaders en santé doivent d'abord prendre conscience du fait que de nombreuses activités réalisées au sein de leur organisation comportent un risque éthique, puis soutenir les divers types d'analyse éthique nécessaires pour bien protéger et respecter les individus et leurs renseignements personnels.

Appropriate ethics review is required.

Health leaders manage many types of risk. One type of risk that may be underrecognized is the ethical risk in the many projects and activities that are done regularly besides research (eg, program evaluation, quality improvement, and health innovation). Applying clinical, personal, professional, and organizational ethics can help address the risks but are insufficient by themselves or in combination. Each different type of project or activity requires an ethics review that is appropriate for that activity. Health leaders must first acknowledge that ethical risks exist in many of the activities occurring in their organization and then support the different types of ethics review required to adequately protect and respect people and their information.

"Ethics? But it's only quality improvement!".

Many people assume that quality improvement (QI) projects pose no ethical issues in relation to participants or their rights. However, members of the Alberta Research Ethics Community Consensus Initiative (ARECCI) submit that all projects that generate knowledge, including QI projects, can create risks to participants that need to be identified, assessed and addressed in the context of the kind of project. The possibility of risk raises the question of ethical conduct in QI projects. Ethical considerations, such as the rights to respect and privacy, protection from harm and voluntary consent, may apply to QI projects, even if the participants are not regarded as research subjects. In this article, we use a case example to illustrate potential ethical issues raised by a QI project, and argue for an ethics review approach that is distinct from that used with research projects. We propose six considerations with guidelines to help assess (and ultimately minimize and mitigate) the risk for participants in QI projects and assist in the appropriate ethical management of these projects.

The ethics of Foucault and Ricoeur: an underrepresented discussion in nursing.

Paul Ricoeur and Michel Foucault enjoy a privileged status in nursing academia as two thinkers who influence both nursing research and philosophical explorations of nursing practice. Most nurse authors, however, focus only on the earlier works of these two philosophers and, for example, base qualitative research methodologies on Foucault's genealogy and Ricoeur's hermeneutics. In their later years, both these writers talk more explicitly about being an ethical self. Ideas from their earlier writing is evident in their writing on ethics and both writers could not discuss ethics without also exploring their ideas of the self and the other. I suggest that some of their thoughts on ethics connect with or complement each other quite well. I will first give an overview of Foucault's ethics, self and the other, and then do the same with Ricoeur's thought. In the third part of the paper I will describe how Foucault and Ricoeur complement each other, and conclude the paper by briefly suggesting how these writers influence my own practice as a nurse educator.

Nursing theories as nursing ontologies.

By understanding the constructions of knowledge we currently label nursing theories as nursing ontologies, nurses can perceive these conceptualizations differently. Paul Ricoeur and Stephen White offer a conceptualization of ontology that differs from traditional, realist perspectives because they assume that a person's experience of a phenomenon (e.g., nursing) will change, but also maintain some stability. Discussing nursing ontologies, rather than nursing theories, might increase philosophy's status in nursing and may also more accurately reflect the experience of being a nurse.

Orality to literacy: effects on nursing knowledge.

BACKGROUND: Around the time of Plato and Aristotle, writing was introduced into the Western world and caused an epistemological revolution. Academics describe this change from pre-literacy to literacy as the alphabetization of a society. If societies have no written alphabet or words, knowledge transmission is oral. Words and ideas are fluid because they are always particularized to specific situations, rather than being written and available for scrutiny. With alphabetization, people record events, experiences and exchanges. Meanings no longer change slightly with each telling because writing solidifies knowledge as people attach increasingly limited meanings to words. Nursing experienced a similar revolution from orality to literacy with the proliferation of nursing journals beginning in the 1970's. Consequently, nurses and nurse educators also experienced an epistemological revolution resulting in knowledge from literacy usually being automatically valued higher than knowledge from orality. PURPOSE: I critically examine changes to knowledge that nurse educators value as a result of an alphabetized discipline. DISCUSSION: By comparing epistemological changes resulting from alphabetization in ancient Greece with similar changes in nursing education, I discuss three important dynamics: the sedimentation of words, the growth of criticism, and the new rationality. CONCLUSION: Some epistemological changes resulting from literacy are positive for nursing (eg, the growth of criticism) while some changes are negative (eg, devaluing sensorial and experiential knowledge).

Using nursing science does not guarantee nursing excellence.

Nursing excellence is usually defined in terms of having and applying more and more knowledge, especially from nursing science--the more nurses know, the better their practice. This conceptualization of nursing practice has similarities with the ancient Greek mode of reasoning called techne but cannot adequately deal with the ambiguities of everyday nursing. Nursing excellence does occur, however, with phronetic, ontological practice in which a nurse's morals, habits, and dispositions guide practice. Of course, nurses need a comprehensive knowledge and skill base, but phronetic nurses negotiate the "rough ground" of nursing practice because ontological dispositions are guiding practice rather than simply applying generalizable and communal knowledge from nursing science. Techne-ical practice leads to competent nursing, but only phronetic practice results in nursing excellence. Included in this article is a description of techne-ical practice, its limitations for nursing excellence, and rationale for adopting a phronetic conceptualization of nursing practice.