From Nightingale and Mendel to Genomics in Health Care for Children
Article Outline
More than 150 years ago, Florence Nightingale identified principles of epidemiology and management of the environment in the practice of nursing (Nightingale, 1859). Six years later, Gregor Mendel published findings from garden pea plant experiments that explained inheritance of traits from parent to offspring (Jorde, Carey, Bamshad, & White, 2006). Each of these pioneers established the foundation for new areas of science. These foundational principles of genetics and of nursing have continued to evolve and are applied by nurses today to promote health, prevent disease, and manage symptoms of illness in children and their families. This special issue of Journal of Pediatric Nursing features cutting-edge activities by nurse researchers, educators, and clinicians in their application of genomic discoveries in nursing practice for children for whom genetic or genomic factors will influence their health and well-being.
Two of the articles in this issue review current cultural and societal factors affecting children's health. The article by Dr. Martha Driessnack addresses the importance of understanding a child's view of genomic concepts that form the basis of a child's genetic literacy and emphasizes the role of contemporary children's literature and entertainment on the formation of these perceptions. This understanding can be useful to pediatric nurses when planning explanations to children about the role of inheritance in individual variability, factors that affect how likely it is that any person will become ill with a specific condition, and how one's individual inherited traits can affect what treatment would work best for a child who is ill.
The next article discusses research contributing to day-to-day issues faced by children and families in which members have an inherited condition. Drs. Agatha Gallo, Kathleen Knafl, and Denise Angst describe how parents evaluate and communicate information about their child's genetic condition both within and outside the family. These authors provide important insights into the ways in which parents prefer to share or maintain privacy of genetic aspects of their child's disorder, according to what they believe would promote or protect the health of their child.
The last two articles describe the application of genomic information in selection of individualized medical treatment for children with cancer and children with a psychiatric disorder. These articles describe the use of a child's and/or the disease agent's genomic data to tailor treatment options. Belinda Mandrell's article describes the use of genetic information in treatment selection for children with acute lymphoblastic leukemia. Cynthia Prows and Dr. Shannon Saldana examine issues in using a teen's genetic data in decisions regarding individualizing psychotropic drug and dose to treat depression. These articles explain technical information as well as the application of this information in nursing practice for selection, administration, and monitoring of individualized treatment based on genetic data. The Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group recently reviewed CYP450 genetic testing for adults with nonpsychotic depression who were being considered for SSRI treatment. EGAPP concluded the existing research evidence was insufficient to support a recommendation for or against use of CYP450 testing in these situations. Similar research involving children was not reviewed. Mastery of genetic competencies will enable pediatric nurses to understand ongoing developments regarding genomic applications in practice (Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group. 2007).
Clinical procedures based on the concepts of personalized medicine (i.e., drugs and doses are chosen according to an individual's genetic makeup; Lesko, 2007) and targeted therapy (i.e., use of tumor profiles to match treatment modality to specific genes expressed in the tumor or to selectively inhibit tumor growth factors; Calzone, Lea, & Masny, 2006) are part of pediatric health care. These concepts are critical for pediatric nurses to understand in developing appropriate nursing management of children in which genomic information is an integral part of the child's treatment plan.
This special issue provides pediatric nurses with examples of the application of genetic and genomic information in the lives of healthy and ill children and youth, as well as their families. Each of the topics selected for this special issue reflects scientific discoveries in nursing, genetics, and genomics that influence management of the child's personal, family, health care, and/or societal environment to promote and maintain the child's health. Nightingale and Mendel were pioneers who introduced the concepts of management of the environment to promote healing and patterns of genetic inheritance into science and society. The topics addressed by the authors in this special issue are examples of new pioneering efforts by nurse clinicians and researchers to lead nurses in integrating genomic discoveries into today's nursing scholarship, research, and practice.
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PII: S0882-5963(07)00335-1
doi:10.1016/j.pedn.2007.08.018
© 2009 Elsevier Inc. All rights reserved.
