Integrating Genomics Into Undergraduate Nursing Education

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1 GENETICS AND GENOMICS SERIES Integrating Genomics Into Undergraduate Nursing Education Sandra Daack-Hirsch, PhD, RN 1, Carla Dieter, EdD, FNP-BC 2, & Mary T. Quinn Griffin, PhD, RN 3 1 Gamma, Assistant Professor, The University of Iowa, College of Nursing, Iowa City, IA 2 Phi, Director & Associate Professor of Nursing, University of South Dakota, School of Health Sciences, Sioux Falls, SD 3 Alpha Mu, Associate Professor, Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH Key words Nursing curriculum, undergraduate, genomics Correspondence Dr. Sandra Daack-Hirsch, The University of Iowa, College of Nursing, 50 Newton Rd, 372 NB, Iowa City, IA sandra-daack-hirsch@uiowa.edu Accepted March 5, 2011 doi: /j x Abstract Purpose: To prepare the next generation of nurses, faculty are now faced with the challenge of incorporating genomics into curricula. Here we discuss how to meet this challenge. Organizing Construct: Steps to initiate curricular changes to include genomics are presented along with a discussion on creating a genomic curriculum thread versus a standalone course. Ideas for use of print material and technology on genomic topics are also presented. Information is based on review of the literature and curriculum change efforts by the authors. Conclusions: In recognition of advances in genomics, the nursing profession is increasing an emphasis on the integration of genomics into professional practice and educational standards. Incorporating genomics into nurses practices begins with changes in our undergraduate curricula. Information given in didactic courses should be reinforced in clinical practica, and Internet-based tools such as WebQuest, Second Life, and wikis offer attractive, up-to-date platforms to deliver this now crucial content. Clinical Relevance: To provide information that may assist faculty to prepare the next generation of nurses to practice using genomics. Globally, scientists are making discoveries that contribute to our understanding of how genomics influences human health and disease. Regardless of where health care is provided, advances in genomics will change and are indeed already changing the approach to many facets of medicine (Calzone et al., 2010; Feero, Guttmacher, & Collins, 2010; McInerney, 2008); to keep pace, the nursing profession must increasingly emphasize the integration of genomics into professional practice and education (Consensus Panel on Genetic/Genomic Nursing Competencies, 2009; Kirk, McDonald, Longley, & Anstey, 2003; Skirton, Lewis, Kent, & Coviello, 2010). Genomics is no longer regarded as a specialty but is applied at the point of care to assess risk and to diagnose, treat, and prevent illnesses. Despite increased exposure to relevant information from media and healthcare outlets, studies show that the public understands few of even the most basic genomic concepts (Bates, Lynch, Bevan, & Condit, 2005; Bowling et al., 2008; Christensen, Jayaratne, Roberts, Kardia, & Petty, 2009). Moreover, many health-care providers attain only low levels of genomic literacy (Calzone et al., 2010; McInerney, 2008). To provide the best health care, using genomic-based information, practicing nurses must understand not only the basic principles of human genomics, but also how this knowledge is applied. To prepare the next generation of nurses, we are now faced with the challenge of incorporating genomics into curricula. Here we discuss how to begin to meet this challenge. Background and Significance Most threats to an individual s health have a genomic component that is, to some extent, influenced by environmental factors. Over the next decade, genomics will increasingly use information, such as family history and genetic testing, to identify more accurately risks for Journal of Nursing Scholarship, 2011; 43:3, C 2011 Sigma Theta Tau International

2 Genomics and Undergraduate Nursing Education Daack-Hirsch et al. illness or adverse reaction to treatments, to personalize treatment options, and to motivate lifestyle changes to prevent illness (Calzone et al., 2010; Feero et al., 2010). Ultimately, nurses will use genomics to promote health, prevent illness, diagnose disease, treat and manage patients symptoms, and prescribe and monitor medication. Currently, technology can identify more genomic information than most healthcare professionals can interpret and relay to patients (Guttmacher, Porteous, & McInerney, 2007; McInerney, 2008). This problem should not be surprising since a relatively recent review confirmed nursing curricula in New Zealand, South Africa, the United Kingdom, and the United States do not provide adequate instruction in genomics (Prows, Glass, Nicol, Skirton, & Williams, 2005). While there have been considerable efforts to educate nursing faculty since 2005 (Williams et al., 2011), we found few studies that address current curriculum genomic content or genomic knowledge of nursing students in the past 10 years. Although few studies document nursing students actual expertise in genomics, one study of 46 advance practice U.S. nursing students found significant gaps in their perceived knowledge of genetic concepts, disorders, and diagnostic procedures. Not surprisingly, these nurses felt uncomfortable integrating clinical genomics into their practice (Maradiegue, Edwards, Seibert, Macri, & Sitzer, 2005). In another survey (Dodson & Lewallen, 2010) of 275 U.S. undergraduate nursing students, students reported that although over the course of their program their knowledge and comfort with genomic terms increased, their perceived knowledge remained low. A variety of causes for poor training have been cited: overcrowded curriculum, lack of knowledgeable faculty, failure to integrate genomics across the curriculum, and lack of emphasis on genomics in certification examinations (Guttmacher et al., 2007; McInerney, 2008). Moreover, several barriers inhibit genomics from being put into practice: Few providers specialize in genomics or even have a basic knowledge about genomics, and for managing and referrals, there are no standard guidelines in genomics (Guttmacher et al., 2007; Kirk, Lea, & Skirton, 2008; McInerney, 2008). In addition, there are too few genomic professionals (physician geneticists, PhDs, genetic counselors, and genetics nurses) to keep pace with the public s genomic information needs (American Board of Medical Genetics, 2009). Since 2003, when the international Human Genome Project investigators finished sequencing the human genome, we have seen an increase in the number of genomic competency guidelines for healthcare providers. Nursing recommendations favor integrating genomics into virtually every undergraduate nursing course, instead of teaching it as a stand-alone course (Consensus Panel on Genetic/Genomic Nursing Competencies, 2009; Kirk, Tonkin, & Burke, 2008; Prows et al., 2005). Among the first nursing guidelines for genomic knowledge are two seminal U.S. documents. One, the Essentials of Baccalaureate Nursing Education for Professional Nursing Practice (American Association of Colleges of Nursing, 2008), identifies nine basic essentials that form the curricular foundation for the 21st century baccalaureate and addresses the ever-changing and complex healthcare environment. Four of the nine essentials specifically address genomics. A second guide, Essentials of Genetic and Genomic Nursing: Competencies, Curricula Guidelines, and Outcome Indicators (2nd edition), was developed by an independent panel of nurse leaders from clinical, research, and academic settings... to establish the minimum basis by which to prepare the nursing workforce to deliver competent genetic- and genomic-focused nursing care (Consensus Panel on Genetic/Genomic Nursing Competencies, 2009, p. 1). Other equally useful competency guidelines exist in the United States (National Coalition for Health Professional Education in Genetics, 2007), the United Kingdom (National Health Services National Genetics Education and Development Centre, 2004), and Europe (Skirton et al., 2010). These documents reinforce that health care for all people will increasingly include genetic and genomic information and that nurses worldwide play an integral role in the provision of this care. Such a mandate requires that academic settings consider how to prepare competent nurses through review and improvement of current curriculum content. Models to Integrate Genomics Into Undergraduate Nursing Curricula Integration: Faculty-Initiated Change A cornerstone of change is a faculty workgroup consisting of members who are experts or, if no expert is on site, faculty interested in the topic. Depending on the size of the faculty, the workgroup could include either the curriculum chair or vital curriculum committee members, or both, as well as lead faculty from each program area. In departments with smaller faculty, most members may initially need to participate. Depending on the college or school, direct participation of department chairs might add credibility to the project; however, in some instances, department chairs might hinder a workgroup if faculty will not express opinions different from the department chair. To develop a plan, initially the workgroup should glean input and support from a broad spectrum of faculty involved in all aspects of the curriculum. To counteract initial barriers, opening discussions can focus on the group s 224

3 Daack-Hirsch et al. Genomics and Undergraduate Nursing Education agreement on the significance of genomic education and how to apply it in clinical practice (Horner, Abel, Taylor, & Sands, 2004; Kirk, Tonkin, & Burke, 2008). Two strategies to promote a positive attitude toward genomics include the use of real case examples that resonate with the audience, and increasing knowledge with conferences, workshops, and nursing journals (Kirk, Tonkin, & Burke, 2008). If a faculty lacks an on-site expert, curriculum leaders can find a faculty member willing to become the expert. Here, support at the institutional level is critical (Horner et al., 2004; Tonkin & Kirk, 2007), and institutions can help through providing release time and financial support for faculty in training. A compilation of resources to guide faculty in strengthening genomic expertise can be found in this issue (Williams et al., 2011). Alternatively, an outside expert can consult with the workgroup and ultimately the entire faculty to recommend appropriate resources, lead a faculty workshop, and organize faculty workgroups. The first step we recommend is a faculty selfassessment. The Genetic Literacy Assessment Instrument (GLAI) is a readily available tool for determining faculty s basic genomic literacy level (Bowling et al., 2008). The GLAI was designed to evaluate the entry-level biology literacy of high school graduates, but it is also useful for our purposes. Test results can be kept private or be shared with the faculty; both approaches have unique advantages. If faculty self-assess only, they may feel more comfortable participating; however, the program will not benefit from collecting and analyzing the groups data. We have experience using the GLAI with our faculty before beginning curricular changes. At one institution it was used as a self-assessment tool only; at the other, aggregate results were shared with the faculty. Anecdotally, faculty from both institutions felt positive about the GLAI and gained reassurance that they did know something about genomics. Create a Curriculum Thread Focused on Genomics Perhaps, to best teach genomics to undergraduates, genomic content should be integrated into all facets of the curriculum. Hetteberg and Prows (2004) developed an excellent checklist to assist in this process, and we found it to still be useful. First, identify the genomic content already existing in the program and identify gaps. Next, develop a matrix, listing each course, with course descriptions and objectives. Instructors can identify courses in which they incorporate the identified objectives and give specific examples of activities that meet those objectives. This information can be collapsed into one document for review by the task force and ultimately the entire faculty. The document should be formally discussed by faculty as a fundamental part of gaining critical input. This exercise helps faculty to acknowledge strengths and pinpoint gaps in the curriculum. The matrix exercise assesses curriculum and identifies opportunities to include content, but it does not identify the standards for evaluating curriculum. The workgroup must set the evaluation standards, ensuring they specifically address gaps revealed in the matrix. The evaluation is completed by matching specified competencies such as the Consensus Panel s Genetic-Genomic Nursing Competencies (or other competencies listed above) with current coursework. Expanding the original matrix to compare the expected competencies with current content will highlight areas of strength as well as gaps when content is matched to competencies from the document from which you choose to compare your curriculum (Table 1). While threading genomics across the curriculum is desired, it comes with a caveat: Students get information in context, but are never taught genetics and genomics in depth. To minimize this problem, collaborating faculty must carefully integrate the curriculum. In addition, an integrated approach might require faculty training in genomics a challenge when faculty or curricula are in flux. Stand-Alone Courses A stand-alone required or elective course is another option. Ideally, a standalone genomics course should be given early in the program, so content can be built upon in subsequent courses. Course content should include basic science concepts, such as the nature of genetic material, transmission, gene expression, gene regulation, evolution, genetic testing and treatment, and genomics and society (Bowling et al., 2008; Lewis, 2010). This course can be taught by the nursing faculty, colleagues from other disciplines such as biology, or as an interdisciplinary collaboration. This type of course is typically open to all undergraduates (since it is of general interest, focusing on genetic concepts and broad areas of genomics). This type of course can also fulfill a general education requirement in a liberal arts program and be used as a prerequisite to entry into the nursing program. The goal of this type of course is to increase students knowledge of basic genomics so they can later apply this knowledge to more fully understand genomically based diagnostic tools and therapies. Alternatively, a required or elective genomics course could be developed specifically for the nursing curriculum to teach basic human genetics concepts (e.g., taking and drawing a family health history; genetic 225

4 Genomics and Undergraduate Nursing Education Daack-Hirsch et al. Table 1. An Example of a Matrix to Assess the Course Offerings and Educational Objectives Course Course learning Learning Recommendations Competency number objective activities Assessment and resources Outline essential nursing skills (i.e., conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems). Describe learning objective in relation to competency. List the class activities that promote the course objective. Theory Clinic How do you evaluate meeting the course objective? Activities, quizzes, etc. Be specific! Recommendations for filling gaps. Resources available to assist faculty. C South Dakota State University, College of Nursing. testing; pharmacogenomics; ethical, legal and social issues). This type of course could illustrate the course content with case studies and include required readings and small group discussions. Students might write papers (or present orally) on a genomic issue of personal interest, assess their own family s health history, or work in groups on case studies. Genomic concepts can be reinforced in a health assessment class and focus area didactic courses (e.g., maternal child, mental health, medical-surgical, and adult-gerontology). Thus, topics covered in a standalone genomics class are revisited and applied in didactic and clinical courses throughout the program. Organizing and integrating material, so it is clearly presented as a cohesive thread, takes careful collaboration among the faculty. Some nursing schools have transitioned an elective genetics course into a required undergraduate course, or parceled components of a standalone course to other courses (Horner et al., 2004). Beginning with a standalone course (whether it is an elective or required) may be the best first step because it allows genomics to be infused into curricula quickly while the faculty plans for more compressive changes. Creating a new class may acutely increase one faculty member s workload, but this can give other faculty members time to acquire knowledge, materials, and skills needed to incrementally incorporate genomics into their courses. A major disadvantage to a stand-alone required genomics course is that nursing students heavy course load allows no time for another requirement. One solution is to develop the matrix we described to help faculty identity concepts needed in a prerequisite course, whether a standalone course is needed, and, if so, which concepts need to be reinforced or added to this course. Offering genomics as an elective suffers the drawback that few or even no students may elect to take the course, which may lead to class cancellation or frustration for the faculty who developed the course. These occurrences would be negatively viewed by the faculty and might lead to reluctance to support integrating genomics into the nursing curriculum. An elective course may send a message to students and faculty that genomic content is not important. It is also unrealistic to expect faculty in other courses to build upon a course that not all students take. Clinical Practicum and Simulation Clinical faculty is key for integrating genomics in the curriculum because these faculty directly apply many genomic concepts, giving students opportunities to demonstrate competency in genomics. During pre- and postclinical conferences, students could identify family health histories and other genomic risk factors that may influence patient care, including the selection of prevention and treatment options. A module on communication with patients on genetic topics can be developed as part of simulation labs and may include discussing privacy and confidentiality of genomic information. Students can also role play communication activities by taking a family health history as a context to practice communication skills. These communication skills may include ways to deal with difficult family issues (e.g., nonpaternity and right to know about family health history), active listening, summarizing, and empathy. Simulation or role playing can use a genomic case study as a problem-based teaching method where the student alone or in a group analyzes the genomic data presented in the case and applies relevant concepts to solve the given problem (Newcomb & Riddlesperger, 2007). We have used simulation by asking students to create a case study and then act it out with a volunteer, where one of the students is the provider and the other is a patient. The activity is videotaped and later critiqued by the students and instructor. The students provide genetic 226

5 Daack-Hirsch et al. Genomics and Undergraduate Nursing Education counseling for this scenario to the volunteer patient, using patient education materials and whatever resources he or she chooses. The purpose of the activity is for students to demonstrate their ability to apply their knowledge of genomics and convey genomic information as patient education. Undergraduate students might work on faculty research activities (e.g., reviewing literature related to selected genomic concepts), help recruit, or collect data, and thus gain experience gathering genomic information for research studies. In nursing schools with an honors program, getting high-achieving students involved with genomics is one way to spread information about genomic innovations throughout nursing. Alternatively, schools can offer opportunities for independent study in the form of research activities, evidence-based practice, or clinical experience in genomics. Use of Printed Materials and Technology in the Classroom Print and Online Materials Textbooks must be carefully reviewed for genomic content. We suggest students purchase a clinical genomics textbook at the beginning of the program and use this text throughout the curriculum as appropriate. Clinical faculty can find particularly excellent textbooks, with genomic case studies (Monson, 2009; Read & Dionnai, 2010; Skirton & Patch, 2009) that can facilitate discussion in pre- and postconference. Journal articles are another great source for genomic content; some even have online case studies. Case studies can be used in class and in the clinic to facilitate discussions that emphasize thinking genomically. Some websites give genomic case studies (University of Buffalo, 2010); nevertheless, websites must first be evaluated for authenticity and applicability with critical evaluation tools such as Kathy Schrock s Guide for Educators (Schrock, 2010). A weekly review of genomicrelated stories in the media can also facilitate discussion and heighten awareness of genomics in the news. Faculty should also be encouraged to use current and appropriate online resources as much as possible, as these are continually updated. Table 2 contains a list of websites we have used to develop course content. Bulletin Board A bulletin board, clearly displayed in the school of nursing and dedicated to genomic information, will heighten awareness about the importance of genomics today. Faculty and students must be responsible for updating the board. Perhaps students involved in independent studies can assist faculty with this task. The bulletin board might include interesting journal articles (perhaps highlighting a different genomic topic each month), guidelines and competencies, games, websites, and a news section, highlighting media coverage of genomic topics in the past month. Clickers Clickers are hand-held, wireless devices that enable individuals to anonymously respond to questions in real time. They can engage students in class, for example, through quizzes or student polls. As the instructor introduces new content, a question could be displayed on the screen, and the instructor could ask the students to respond using the clicker. The students responses can give instant feedback related to the students understanding of material just presented; thus, faculty can immediately address confusion. Multiple choice, true or false, yes or no, and rank-ordered question formats can be used with the clicker technology. Checking student understanding, with polls and quizzes, is extremely useful when dealing with complex genomic concepts. Students might be asked whether they agree or disagree with a particular issue, or related ethics, before the concept is introduced and discussed. Later, students could be re-polled to see if their views change. A 24-pack of clickers, with the response software and support, costs approximately $2,000 (Engaging Technologies, 2010); many college teaching-technology centers have this software available. Another avenue for student classroom polling is facilitated through a web conferencing site such as Elluminate ( If your college or school has the use of Elluminate, polling can be accomplished through the Elluminate site, but only if all students have a laptop to use during the presentation. Clickers are not needed for this option. WebQuests In a WebQuest, students solve problems through discovery and teamwork, with most information coming from the web (Dodge, 2007). WebQuests are discoverylearning tools and are ideally suited as an exercise either before a topic is discussed or as a follow-up assignment. WebQuests have specific components: an introduction, a task, a process, an evaluation (usually involving building an evaluation rubric), and a conclusion. In addition, an instructor resource page is included. WebQuests are ideal for group activities, in which all information comes from the Internet. Students are given a task (e.g., create a presentation on the genetic determinants of race); then, using WebQuest tools, they integrate 227

6 Genomics and Undergraduate Nursing Education Daack-Hirsch et al. Table 2. Online Sources for Genetic/Genomic Content Development Online sources G2C2, The Genetics/Genomics Competency Center Eurogene Project a Genetics Education Supporting Education in Genetics and Genomics for Health National Coalition for Health Professional Education in Genetics National Human Genome Research Institute Genetics Home Reference: Your Guide to Understanding Genetic Conditions The PharmGenEd TM program Website/URL a Multimedia learning resources available in nine languages. images, text, and sound to create a finished product. WebQuest software is available free at ( webquest.org), but using it may involve making the WebQuests public. QuestGarden.com (2010) shows examples of WebQuests focusing on genomics by students up to grade 12. Wikis Wikis are collaborative websites that students and faculty can edit live, providing an easy way to share project information. Faculty may find that a wiki encourages productivity and creativity in students. You can start a wiki on the wiki.com website at but first decide whether the pages will be public or locked from public view. Many colleges or schools make wiki capabilities available via secure learning technology (e.g., Blackboard learn 9.1.; Blackboard, 2011). When setting up a wiki within these secure sites, faculty will decide whether students will be allowed to edit the wiki, view and add comments, permanently delete the wiki, or export the wiki to another application. Faculty will be able to choose dates when students can view the wiki and when they can add comments. Content storage is another consideration, but if you use a secure site, content can be stored with your class materials. Faculty must also consider strategies for wiki grading, judging the quality of the content posted, and student participation. Blogs A blog is a type of website or a part of a website that is set up and maintained by an individual. They are chronological and are a written regular journal. Entries on a blog may be descriptions of an experience or may include video and images of the experience. Students can maintain a blog of their experiences (e.g., their experience at a genetic counseling clinic or an interview with people with genomic conditions) and invite visitors comments and entries, allowing classmates and faculty to interact. By reading the blog, faculty can assess whether practicum objectives are met. Blogs differ from wikis in that they are author based (whereas a wiki is more collaborative) and can easily be set up to restrict access to class members. Second Life Second Life is a virtual, three-dimensional world available on the Internet, where students can interact in cyberspace via avatars (graphical representations of a real people). With Second Life, students explore and participate in group and individual assignments. Faculty can stream lectures with feedback sessions, conduct interactive sessions, and develop innovative curriculum strategies (e.g., assign a family history from a virtual world). Virtual case studies can involve images, videos, and patient stories. In Second Life, students can do things virtually that they may not be able to do in reality (e.g., communicate with patients about their genomic conditions). Max Chatnoir (his Second Life name) created an island for genomic education, complete with genetic images, videos, tests, and quizzes. We recommend that faculty develop assignments using available materials (Meskó, 2007). Second Life can be downloaded for free from but to get started you may need help from the technology support staff at your institution. Conclusions The deciphering of the human genome promises to change how health care is delivered, and nurses worldwide competent in genomics will be empowered to improve health for all. Indeed, we have reached a pivotal crossroads and must work to prepare our next generation of nurse clinicians. Incorporating genomics into nursing practice begins with changes in our undergraduate curricula. We believe change is most effective when the faculty participates in all stages of the process. We propose that curricular changes that incorporate 228

7 Daack-Hirsch et al. Genomics and Undergraduate Nursing Education genetics-genomics begin with a self-assessment of faculty knowledge, followed by an action plan for closing knowledge gaps. An individual who champions the change is essential to coordinate the process, and administrators may consider hiring a consultant with expertise in genetics-genomics. Delivering basic genomic content can be done in collaboration with faculty who teach basic science prerequisite courses. Competency documents can guide faculty in incorporating genomics throughout the curriculum. Information given in didactic courses should be reinforced in clinical practica, and Internet-based tools such as WebQuest, Second Life, and wikis offer attractive, up-to-date platforms to deliver this now crucial content. Acknowledgment We gratefully acknowledge the support of Linda Curran and Diana Colgan for their excellent assistance in the preparation of this manuscript. Clinical Resources See Table 2 References American Association of Colleges of Nursing. (2008). Essentials of baccalaureate nursing education for professional nursing practice. Washington, DC: Author. American Board of Medical Genetics. (2009). Number of certified specialists in genetics. Retrieved from certspecial.shtml Bates, B. R., Lynch, J. A., Bevan, J. L., & Condit, C. M. (2005). Warranted concerns, warranted outlooks: A focus group study of public understandings of genetic research. Social Science Medicine, 60(2), doi: /j.socscimed Blackboard. (2011). Blackboard learn 9.1. Retrieved from Bowling, B. V., Acra, E. E., Wang, L., Myers, M. F., Dean, G. E., Markle, G. C.,...Huether, C. A. (2008). Developing and evaluation of a genetics literacy assessment instrument for undergraduates. Genetics, 178(1), doi: /genetics Calzone, K. A., Cashion, A., Feetham, S., Jenkins, J., Prows, C. A., Williams, J. K., & Wung, S-F. (2010). Nurses transforming health care using genetics and genomics. Nursing Outlook, 58(1), doi: j.outlook Christensen, K. D., Tayaratne, T. E., Roberts, J. S., Kardia, S. L. R., & Petty, E. M. (2009). Understanding of basic genetics in the United States: Results from a national survey of black and white men and women. Public Health Genomics, 13(7 8), doi: / Consensus Panel on Genetic/Genomic Nursing Competencies. (2009). Essentials of genetic and genomic nursing: Competencies, curricula guidelines, and outcome indicators (2nd ed.). Silver Spring, MD: American Nurses Association. Dodge, B. (2007). WebQuest.org. Retrieved from Dodson, C. H., & Lewallen, L. P. (2010). Nursing students perceived knowledge and attitude towards genetics. Nurse Education Today. doi: /j.nedt Engaging Technologies. (2010). CPS pulse TM. Retrieved from Feero, W. G., Guttmacher, A. E., & Collins, F. S. (2010). Genomic medicine: An updated primer. New England Journal of Medicine, 362(21), Guttmacher, A. E., Porteous, M. E., & McInerney, J. D. (2007). Educating health-care professionals about genetics and genomics. Nature Reviews. Genetics, 8(2), doi: /nrg2007 Hetteberg, C., & Prows, C. A. (2004). A checklist to assist in the integration of genetics into nursing curricula. Nursing Outlook, 52(2), doi: /j.outlook Horner, S. D., Abel, E., Taylor, K., & Sands, D. (2004). Using theory to guide the diffusion of genetics content into nursing curricula. Nursing Outlook, 52(2), doi: /j.outlook Kirk, M., Lea, D., & Skirton, H. (2008). Geneomic health care: Is the future now? Nursing and Health Science, 10(2), doi: /j x Kirk, M., McDonald, K., Longley, M., & Anstey, S. (2003). Fit for practice in the genetics era: Defining what nurse, midwives and health visitors should know and be able to do in relationship to genetics. Glamorgan, UK: University of Glamorgan. Kirk, M., Tonkin, E., & Burke, S. (2008). Engaging nurses in genetics: The strategic approach of the NHS National Genetics Education and Development Centre. Journal of Genetics Counseling, 17, doi: /s y Lewis, R. (2010). Human genetics: Concepts and applications (9th ed.). New York: McGraw-Hill. Maradiegue, A., Edwards, Q. T., Seibert, D., Macri, C., & Sitzer, L. (2005). Knowledge, perception, and attitudes of advance practice nursing students regarding medical genetics. Journal of the American Academy of Nurse Practitioners, 17(11), doi: /j x McInerney, J. D. (2008). Genetics education for health professionals: A context. Journal of Genetic Counseling, 17(2), doi: /s z Meskó, B. (2007). Interview about the-genetic-revolution-of second-life. Retrieved from 22/ 229

8 Genomics and Undergraduate Nursing Education Daack-Hirsch et al. Monson, R. B. (2009). Genetics and ethics in health care. Silver Spring, MD: American Nurses Association. National Coalition for Health Professional Education in Genetics. (2007). Core competencies in genetics for health professionals (3rd ed.). Retrieved from org National Health Services National Genetics Education and Development Centre. (2004). Competence framework. Retrieved from Newcomb, P., & Riddlesperger, K. (2007). Using improvisational theater to teach genetics concepts. Nurse Educator, 32(5), doi: /01.nne fd Prows, C. A., Glass, M., Nicol, M. J., Skirton, H., & Williams, J. (2005). Genomics in nursing education. Journal of Nursing Scholarship, 37(3), doi: /j x QuestGarden.com. (2010). Quest garden: Where great WebQuests grow. Retrieved from examplestop.php Read, A., & Dionnai, D. (2010). New clinical genetics (2nd ed.). Bloxham, Oxfordshire, UK: Scion Publishing Ltd. Schrock, K. (2010). Kathy Schrock s guide for educators: Critical evaluation information. Retrieved from eval.html Skirton, H., Lewis, C., Kent, A., & Coviello, D. A. (2010). Genetic education and challenges of genomic medicine: Development of core competence to support preparation of health professionals in Europe. European Journal of Human Genetics, 18(9), Skirton, H., & Patch, C. (2009). Genetics for the health services: A handbook for clinical healthcare. Bloxham, Oxfordshire, UK: Scion Publishing Ltd. Tonkin, E., & Kirk, M. (2007). Genetics: Your nursing role. Primary Health Care, 17(8), University of Buffalo. (2010). National center for case study teaching in science. Retrieved from lib.buffalo.edu/cs/ Williams, J. K., Prows, C. A., Conley, Y. P., Eggert, J., Kirk, M., & Nichols, F. (2011). Strategies to Prepare Faculty to Integrate Genomics Into Nursing Education Programs. Journal of Nursing Scholarship, 43(3). doi: /j x 230