The Masters’ Essentials (2011) mandate the integration of genetic and genomic evidence into the graduate nursing curriculum for use in advanced nursing practice. Faculty strive to answer the question: How can we incorporate current and emerging genetic/genomic evidence into the Masters’ Curriculum to promulgate the provision of advanced nursing care to individuals, families and communities utilizing a meaningful, interactive, and motivating approach?
Since the first draft sequences of the human genome (International Human Genome Sequencing Consortium, 2001) the study of human genetics has developed exponentially. Patient’s genomic information is currently being used in their clinical care by multiple institutions. Therefore, how can faculty ensure that graduate nursing clinicians have the necessary genetic knowledge to apply genetics/ genomics in a clinical setting?
Methods:
An active teaching strategy that fosters critical thinking in students is simulation; yet the use of simulation in graduate nursing education is limited. The design and implementation of interprofessional simulations was used to increase confidence, critical thinking and clinical decision making in graduate nursing students. The simulations embodied the presentation, assessment, diagnostics, and intrprofessional outreach needed to arrive at and deliver the diagnosis to the family in an emotionally and educationally supportive manner. The scenario for this strategy focused on the diagnosis of Downs Syndrome.
In addition, concept mapping and reflective thinking were found to be effective strategies to guide students in expressing the meaning of the material and identifying strengths and weaknesses in their thought processes. Both of these strategies were utilized to measure the integration of genetic/genomic knowledge at the clinical and personal level. These complex concept maps encompassed all aspects of the diagnostic and care plan for the family experiencing a genetic disorder such as: the location of the gene on the chromosome, the physical presentation, the diagnostic work up, the treatment, referrals to specialists to assist in treatment of the disorder, and finally the community resources needed for quality of life of the patient and family.
Lastly, the use of a panel discussion was extremely beneficial to impact student learning regarding patients who had experience with cancer that may or may not have had a genetic etiology, and their degree of willingness to pursue genetic testing. This learning modality created a vividly realistic atmosphere as the panelists related their cancer journey. The students researched and composed the panel questions that were preapproved by faculty and were shared with the panelists prior to the panel discussion. By examining the lived experiences of cancer survivors (i.e. what parts of their clinical treatment and care were supportive and which parts caused them despair) the graduate nursing students learned about shared responsibility and empathy of clinicians.
Results: The student evaluations of the teaching techniques were extremely positive: ""Having interprofessional interactive sims was helpful in making connections and furthering my understanding", "The concept maps allowed us to feel the investment of the sim character's viewpoint", "The debriefing after the cancer panel was very powerful & emotional. The panelists gave us a valuable glimpse into their journeys; I learned a lot!" and "The simulations complemented the genetics info well".
Conclusion: The use of genetic-based interprofessional sims set the stage for students to engage in a variety of teaching strategies to facilitate learning, critical thinking, and foster clinical decision making in graduate nursing students.