Genomics in nursing practice in Australia: a critical realist case study

Wright, Helen Worsley (2018) Genomics in nursing practice in Australia: a critical realist case study. PhD thesis, James Cook University.

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Genomic research continues to 'change the landscape' of healthcare worldwide (Camak, 2016, p.86). Genomics is beginning to reshape healthcare delivery by changing the way we prevent, diagnose, treat and monitor illness, providing the opportunity to offer more precise and tailored treatments. As genomic developments change healthcare, so too are they changing the nursing profession. This revolution has led to a new responsibility for all nurses to be knowledgeable of genomics and incorporate genomics into nursing practice. Research addressing the integration of genomics into nursing practice in Australia is limited. The aim of this study was to determine how nurses engage with genomics in nursing practice in this country.

Case study research was used to achieve the research aim. A case study is 'an empirical inquiry that investigates a contemporary phenomenon (the 'case') in depth and within the real-world context' (Yin, 2014, p. 16). A single holistic case study design drawing on the works of Robert Yin (2014) was conducted. This case study was underpinned by a critical realist philosophy. Critical realism is concerned with the nature and knowability of the social world and social phenomena (Schiller, 2016), making it a suitable framework to guide an exploration of Australian nurses' engagement with genomics.

Data were collected via a cross-sectional survey of Australian registered nurses and midwives in 2016, and via semi-structured interviews with registered nurses working in oncology departments within a regional Australian hospital in 2018. Key case findings were generated using thematic analysis, and grouped into three categories: Point of learning (education), Point of reference (professional expectations) and Point of care (clinical practice). These three categories were used as a framework to describe the case, and presented in relation to the key tenets of critical realism - (i) the primacy of ontology, (ii) the stratified character of the realworld (reality) and the search for generative mechanisms, and (iii) the interplay between social structures and human agency (Bhaskar, 1975/2008, 1979/1998, 2011).

The case indicated that Australian nurses have limited engagement with genomics at the point of learning, point of reference and point of care. Nurses' inadequacy at each of these points is sequential, meaning that if nurses are not knowledgeable about genomics and are unclear about professional expectations, they cannot be expected to adequately integrate genomics into their practice. The critical realist philosophy underpinning the case led to consideration of the way point of learning, point of reference and point of care form the context for nursing practice. How nurses respond to this context determines the extent to which they are able to transform education, policy and practice.

Australian nurses' limited engagement with genomics has consequences for the nurse, the patient and the wider nursing profession. This limited engagement must be addressed. It is recommended that (i) genomics be embedded throughout the nursing curricula with healthcare applications made clear to the learner (point of education), (ii) nursing policy articulates the alignment between the NMBA's Standards for Practice and genomic competencies (point of reference), and (iii) nurses incorporate genomics knowledge and skills into practice (point of care). The 'genomic revolution' (Jenkins et al., 2005, p.98) will require further development of Australia's capacity, capability and infrastructure if these are to support the integration of genomic information and technology into the national health system (Australian Health Ministers' Advisory Council, 2017b). As the largest component of the Australian health workforce, nursing cannot ignore the opportunity before us.

Item ID: 63432
Item Type: Thesis (PhD)
Keywords: competency, family history, genetics, genomics, nursing, pedigree, Australian, genomics knowledge, midwife, registered nurse, oncology
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Copyright Information: Copyright © 2018 Helen Worsley Wright.
Additional Information:

This is a thesis by publication. Published articles included in chapters 2 and 5 have been redacted from the thesis due to copyright restrictions.

Three publications arising from this thesis are stored in ResearchOnline@JCU, at the time of processing. Please see the Related URLs field. The publications are:

Chapter 2: Wright, Helen, Zhao, Lin, Birks, Melanie, and Mills, Jane (2018) Nurses' competence in genetics: an integrative review. Nursing and Health Sciences, 20 (2). pp. 142-153.

Chapter 5: Wright, Helen, Zhao, Lin, Birks, Melanie, and Mills, Jane (2019) Genomic literacy of registered nurses and midwives in Australia: a cross-sectional survey. Journal of Nursing Scholarship, 51 (1). pp. 40-49.

Chapter 6: Wright, Helen, Birks, Melanie, Zhao, Lin, and Mills, Jane (2020) Genomics in oncology nursing practice in Australia. Collegian. (In Press)

Date Deposited: 10 Jun 2020 02:01
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1110 Nursing > 111099 Nursing not elsewhere classified @ 50%
06 BIOLOGICAL SCIENCES > 0604 Genetics > 060408 Genomics @ 50%
SEO Codes: 92 HEALTH > 9202 Health and Support Services > 920210 Nursing @ 100%
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