Genomic Competency Initiative

1)虚拟临床环境下的个性化医疗决策：本研究招募了两个专业的家庭执业护士（FNP）学生，入门级硕士（N=122）包括61名对照组和61名干预学生，专业后混合（N=56）包括16名对照组和40名干预学生，共178名可评估学生。该研究评估了将药物基因组学（PGx）整合到FNP课程中的两种不同策略的有效性。校园1接受了包括标准PGx内容、补充课堂教育和PGx在线案例研究在内的干预。第二校区作为对照，接收标准的PGx课程内容。在FNP课程结束时，所有学生都接受了评估，包括通过沉浸式虚拟临床环境（VCE）与虚拟患者相遇，学生决定是否订购临床指示的PGx测试（是/否）。参与者被随机分为VCE黑人或白人患者来评估内隐偏倚。1 . PGx知识和能力数据分析完成。干预组与对照组在知识方面无统计学差异。在统计学上，干预组对遗传学的态度有显著改善。只有5/178（1名对照/4名干预）学生订购了PGx测试。总之，课程改进和案例研究回顾不足以增加基因组知识或导致学生在VCE中订购基于证据的PGx测试。尽管人们担心成本和潜在的歧视，但对基因组学的态度出现了积极的趋势。进一步的工作，以确定什么样的教育策略将导致适当的临床应用PGx是至关重要的护士从业人员谁将有规定的特权。描述这些发现的手稿正在准备中。2 .隐式偏见数据将由NHGRI的合作者进行分析，数据传输正在进行中。3 . VCE后的定性访谈已经记录下来，一旦记录得到核实，就准备开始定性数据分析。项目2)组学护理科学与教育网络（ONSEN）：该网站旨在通过促进合作、指导和获得培训机会来促进组学护理研究和教育，从而促进基因组护理科学蓝图研究重点的实现。ONSEN有3个部分：教育和培训提供指导信息、博士前/博士后机会和知识矩阵，以提高基因组护理科学的教育和技能；研究合作为进行组学护理研究的研究人员提供访问，他们对合作、共享样本和/或数据感兴趣；和公共数据要素（CDE）提供有关公共数据要素好处的信息和资源链接。ONSEN内容由基因组学、组学、教育、实践和护理研究方面的专家开发。发布了描述网站开发的出版物。PIA网站刚刚于2020年7月23日获得DHHS批准。由n研究院牵头的一项扩大的ONSEN宣传活动才刚刚开始。我们还将在ISONG 11/2020（虚拟）举办ONSEN会议。3)全球基因组学护理联盟（G2NA）： G2NA成立于2017年，由美国、英国和23位全球护理领导者领导，目前已发展到83位护理领导者。G2NA网站https://g2na.org/得到南威尔士大学（USW）的资助和支持；维持季度教育网络研讨会；发展所代表的国家；制定战略计划；通过列表服务器进行通信；已完成或正在进行下列研究项目；并从ACSC和NCI获得资金，为2020年4月27日至29日在护理教育和实践中实施基因组学全球会议提供资金。会议因疫情而推迟，改在2021年7月7日至9月举行。G2NA已完成或正在开展的研究项目：1-A基因组全球护理展望评估了护理领导者和组织在实践和教育中基因组整合的范围、挑战和障碍以及行动重点。数据收集和分析已经完成，结果用于成熟度矩阵（MM）和路线图项目。2 .完成现有全球基因组资源、来源、类型、可及性和资源缺口的资源评估（PMID:30007148）。建立和试点测试基因组容量评估工具MM。指标测量按成熟度阶段分组，创建一个从新到已建立的有序规模的细胞矩阵。开发使用了G2NA选区的迭代过程，经过改进、试点测试和发布。4 .建立护理基因组整合路线图。路线图用于医疗保健规划，以提供实现预期结果的框架，在本例中是护理基因组知识和能力。这建立在MM的基础上，指导用户使用可以使用MM测量的途径。5 .建立全球基因组护理科学蓝图。本项目从系统的证据审查开始。一个来自USW的博士生和我一起工作，已经建立了提案和搜索策略。我们正在等待图书管理员送来的第一批文件。这项审查将在2021年7月的会议上完成，会议后将召集一个小组来制定蓝图。接下来的步骤是为护士和助产士建立全球遗传和基因组能力。方法已经确定，该项目将于2020年秋季启动。这些能力将在2021年7月的会议上提交审查。4)遗传和基因组护理能力更新：遗传/基因组护理能力倡议于2005年开发并出版了《遗传和基因组护理要点：能力》。这些能力为护理人员提供称职的基因和基因组护理奠定了最低的基础。2009年的第二版包括结果指标，包括能力特定知识和临床表现指标。基因组技术的进步和基于证据的临床应用继续影响护理实践，但将能力整合到实践和教育中仍然不平衡。鉴于不断扩大的基因组应用，更新的能力至关重要。成立了一个咨询委员会来指导这一更新。德尔菲研究分4期进行。1 .建立一个由来自学术界、临床教育和实践、伦理学、政策、信息学、护理领导、组织领导和监管部门的个人组成的审查小组。这就完成了。2-A德尔福由审查小组完成。第一轮评估于2019年8月完成，对能力进行了修订，随后进行了第二轮评估，得出了共识。第三阶段包括小组对3个临床病例的审查，以确定缺失的能力。没有人被确认身份。咨询委员会增加了第4阶段，涉及征求公众意见。美国护士协会同意在2020年3月传播这些能力以征求公众意见。由于流感大流行，这一计划被推迟了。公众意见仍然悬而未决，但我们正在研究在2020年秋季推出这一计划。一旦完成，更新的能力将被发布并发布在美国护士协会和NHGRI的网站上，以取代现有的能力。

1) Personalized Medicine Decision Making in a Virtual Clinical Setting: This study enrolled Family Nurse Practitioner (FNP) students in two Programs, Entry Level Masters N=122 consisting of 61 control and 61 intervention, and Post-Professional Hybrid N=56 consisting of 16 control and 40 intervention students for a total of 178 evaluable students. The study assessed the efficacy of two different strategies for integrating pharmacogenomics (PGx) into the FNP curriculum. Campus 1 received the intervention consisting of standard PGx content, supplemental classroom education and a PGx online case study. Campus 2 served as controls, receiving standard PGx curricular content. All students received an evaluation at the conclusion of their FNP curriculum consisting of an encounter with a virtual patient through an immersive virtual clinical environment (VCE) in which students decide whether to order a clinically indicated PGx test (yes/no). Participants were randomized to a VCE Black or White patient to assess implicit bias. 1-Data analysis of PGx knowledge and capacity is complete. There was no statistically significant difference in knowledge between intervention and controls. Statistically significant attitude improvements about genetics were noted in the intervention group. Only 5/178 (1 control/4 intervention) students ordered the PGx test. In conclusion, curricular enhancement and case study review were insufficient interventions to increase genomic knowledge or result in students ordering evidence-based PGx tests in a VCE. There was a trend in positive attitudes about genomics despite concerns about cost and potential discrimination. Further work to determine what educational strategies will result in appropriate clinical application of PGx is essential for nurse practitioners who will have prescriptive privileges. The manuscript describing these findings is in preparation. 2-Implicit bias data will be analyzed by collaborators at NHGRI and data transfer is in progress. 3-Qualitative post VCE interviews have been transcribed and qualitative data analysis is ready to begin once transcriptions have been verified. Project 2) Omics Nursing Science and Education Network (ONSEN): The website is designed to facilitate achieving the Genomic Nursing Science Blueprint research priorities by facilitating collaborations, mentoring, and access to training opportunities to advance Omics nursing research and education. ONSEN has 3 sections: Education and Training provides information on mentoring, pre/postdoctoral opportunities, and a knowledge matrix to advance education and skills in genomic nursing science; Research Collaborations provides access to investigators conducting Omics nursing research who are interested in collaborations, sharing of samples and/or data; and Common Data Elements (CDE) provides information on the CDE benefits and links to resources. ONSEN content was developed by experts in genomics, Omics, education, practice, and nursing research. The publication describing the website development is published. The website PIA was just approved by DHHS on 7/23/2020. An expanded ONSEN publicity campaign led by NINR is just starting. We will also conduct an ONSEN session at ISONG 11/2020 (virtually). 3) Global Genomics Nursing Alliance (G2NA): G2NA, established in 2017 led by the US, UK, and 23 global nursing leaders has grown to 83 nursing leaders. The G2NA website https://g2na.org/ has funding and support from the University of South Wales (USW); sustains quarterly education webinars; grown the countries represented; established a strategic plan; communicates through a listserv; completed or are conducting research projects described below; and secured funding from ACSC and NCI for a global meeting on genomic implementation in nursing education and practice 4/27-29/2020. The meeting was postponed due the pandemic and is rescheduled for 7/7-9/2021. The research projects completed or are being conducted by G2NA: 1-A Genomic Global Nursing Landscape assessed nursing leaders and organizations scope of genomic integration in practice and education, challenges and barriers, and priorities for action. Data collection and analysis is complete and findings used to inform the Maturity Matrix (MM) and Roadmap projects. 2-A resource assessment of existing global genomic resources, source, type and accessibility and resource gaps was completed PMID:30007148. 3-Establish and pilot test the MM, a tool to evaluate genomic capacity. Indicator measures are grouped into stages of maturity, creating a matrix of cells against an ordinal scale from new to established. Development used an iterative process with the G2NA constituency, refined, pilot tested, and published. 4-Establish a Genomic Integration Roadmap for nursing. Roadmaps are used in healthcare planning to provide a framework for achieving a desired outcome, in this case nursing genomic literacy and capacity. This builds on the MM to guide users with pathways that can be measured using the MM. 5-Establish a Global Genomic Nursing Science Blueprint. This project starts with a systematic evidence review. A doctoral student from USW is working with me and the proposal and search strategy has been established. We are waiting on the first set of papers for review from the librarian. This review will be complete by the July 2021 meeting where a panel will be convened to establish the Blueprint following the meeting. Next steps are to establish Global Genetic and Genomic Competencies for nurses and midwives. Methods have been established and the project will launch in fall 2020. The competencies will be presented for review at the July 2021 meeting. 4) Genetic and Genomic Nursing Competency Update: The Genetic/Genomic Nursing Competency Initiative developed and published The Essentials of Genetic and Genomic Nursing: Competencies in 2005. These competencies establish the minimum basis by which to prepare the nursing workforce to deliver competent genetic-and genomic-focused nursing care. A Second Edition in 2009 included Outcome Indicators consisting of competency specific knowledge and clinical performance indicators. Advances in genomic technology and evidence based clinical applications continue to impact nursing practice yet competency integration into practice and education remains uneven. Given expanding genomic applications, updated competencies are essential. An Advisory Board was compiled to guide this update. A Delphi study was conducted in 4 phases. 1-establish a review panel of individuals from academics, clinical education and practice, ethics, policy, informatics, nursing leadership, organizational leadership, and regulation. This is complete. 2-A Delphi completed by the review panel. Round one was completed August 2019, competencies were revised followed by round two which revealed consensus. Phase 3 consisted of the panels review of 3 clinical cases to identify missing competencies. None were identified. Phase 4 was added by the Advisory Board which involves soliciting public comment. The American Nurses Association agreed to disseminate the competencies for public comment in March 2020. This was postponed given the pandemic. Public comment remains outstanding but we are investigating launching this in Fall 2020. Once completed, the updated competencies will be published and posted on the American Nurses Association and NHGRI websites replacing existing competencies.