A Toolkit for Canadian Nurses
Preparing Canadian Nurses for the Genomic Era
The resources within this toolkit have been curated from sources informed by international subject matter experts. This project was funded through a
Canadian Institutes of Health Research (CIHR) Planning and Dissemination Grant.
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- About
Welcome to the genomics toolkit for Canadian nurses!
In 2020, a group of nurse leaders formed the Canadian Nursing and Genomics (CNG) Steering Group with a mission to accelerate the
integration of genomics-informed nursing through knowledge mobilization, collaborative partnerships, and strategic planning. Our research
team has engaged with leaders in genomics and nursing internationally and across Canada to develop strategic directions for advancing
genomics-informed nursing.
There is increasing public demand for genomic services and the benefits of genomics for decreasing disease burden and improving health
outcomes are well-recognized. There are over 400,000 regulated nurses working in Canada. To ensure Canadians have access to these new
technologies, the nursing workforce must be prepared to fully contribute to interprofessional genomics-informed healthcare. Preparation
must start with developing genomic literacy.
The resources curated for this toolkit represent a starting point to guide the integration of genomics into nursing. The inclusion of a resource
does not constitute our endorsement of its use. Genomics is a rapidly evolving field. We encourage users to use critical appraisal skills to
determine if a resource is the most accurate and appropriate for their unique context.
Resources to Develop Genomic Literacy
Ethical, Legal, Social, and Policy Issues
These resources can help develop foundational knowledge on the ethical, legal, social, and policy issues associated with genomics. Familiarizing yourself with these concepts can help you to situate scientific knowledge into nursing practice.
Genomic Nursing Competencies
This section contains genetic and genomic competencies for nurses, designed to complement existing competencies and standards of practice. Competencies can provide a framework for genomics curriculum development.
Genomics Organizations
Several organizations provide practice guidance and resources for healthcare professionals, contribute to advocacy efforts and are involved in policy development. Many of these also offer opportunities for professional development.
Recommended Readings
A curated list of Canadian nursing and genomics articles, including information on advocacy efforts to create a genomics-informed nursing workforce.
Advanced Resources
A list of free genetics and
genomics courses and
resources to extend
understanding of genomics in
different practice areas.
Foundational Scientific Knowledge
These resources can help develop foundational scientific knowledge in genomics. We suggest you start here to familiarize yourself with terminology and introductory concepts.
Foundational Genomic Knowledge
- Genetic Non-
Discrimination Act
(GNDA) Fact Sheet
- Canadian
Association of
Genetic Counselors
- Nice Genes Podcast Episode 4: Decoding Ancestry - Race is not Genetic
Genome BC
- ACCESS: An
Empirically-Based
Framework to Address
Genomic Disparities
- International
Nursing Cascade
Consortium
- Intersections Between Genomics, Social Determinants of Health, Race, and Racism
Canadian Nurses
and Genomics
- Policy Issues in Genetics and Genomics
National Institutes
of Health (NIH)
- A Must-Read Book for
Anyone Interested in
the History of Genetics
- The Gene: An Intimate History (Book for Purchase)
Ethical, Legal, Social, and Policy Issues
in Genomics
Click on the cell in meiosis for the link to resources
The American Nurses
Association (ANA)
Essentials of Genomic
Nursing: Competencies
and Outcome Indicators
Genomic Nursing Competencies
Genomic nursing competencies currently do not exist in the Canadian context; however, competencies
developed from other jurisdictions can provide guidance on roles, responsibilities and accountabilities for
knowledge and practice.
National Organizations
Global Organizations
This page provides links to select organizations involved in genomics. Click
to learn more about cutting-edge research, policy, and practice initiatives.
Advanced Resources
Genetics Education
Canada: Knowledge
Organization
(GECKO)
A compendium of
resources for nurses in
primary care.
National Institutes
of Health (NIH)
Genomics FAQ for
Advanced Practice
Nurses and Nurse
Educators
American College of
Medical Genetics
- Genetics 101 -
tailored for physicians
but relevant to
nurses. - 5h self-paced.
- Free!
Vanderbilt University -
TIGER
- Must hold a DNP, PhD,
DNSc, DNS, or EdD
degree and teach
doctoral students - See website for
additional requirements.
These resources can help extend your understanding of genomics in specific practice areas. Nurses in specialty roles will benefit from this
detailed information. The target audience is indicated for each resource, though some roles overlap.
Resources to Support Teaching and Curriculum Development
If you are an educator, this section of
the toolkit contains resources and
readings that you can readily adopt
and integrate into your lesson plans at
both the undergraduate and graduate
levels. These may also assist you in
linking your learners to
supplementary resources.
Resources to Support Teaching and
Curriculum Development
General Online Educational Resources
- Includes learning
outcomes, a selection
of journal articles,
and online resources.
- Topics include
eugenics, genetic
screening in children,
addressing health
disparities, genetic
discrimination, and
scientific racism.
- Maternity, pediatrics, oncology, mental health, neurology, cardiology, obesity, public/population health, climate change.
- Resources for
conducting a 3-
generation pedigree,
individual and family
risk assessment, and
select articles.
- Genetics and TCPS2, equity and diversity in research, nursing research in genomics, and building trust around genomic research.
- Includes pharmaco-
genomic resources,
pharmacodynamic
and pharmacokinetic
implications of
genetic variants, and
gene therapies.
Genomics by Curriculum Concept
Click on the underlined title to advance to the associated resources
These sections will provide resources that can be implemented in existing curriculum. Each section is organized into content areas that correspond with typical nursing program concepts.
Foundational Knowledge
As genetic and genomic technologies progress, a patient’s genomic profile will be used to personalize nursing
interventions by guiding assessment, treatment, and ongoing evaluation. The following are suggested foundational
genetic concepts that all nursing students and practicing nurses should be competent with.
For a comprehensive curriculum, please see existing competency documents to guide content inclusion.
Health Assessment and Family History
A family history is the most sensitive and least expensive genetic test a nurse can conduct, and it is an informative part of a
comprehensive health assessment. Nurses should be familiar with conducting a three-generation pedigree.
Ethical, Legal, Social, and Policy Issues (ELSI)
Nurses must be aware of the multiple ethical, legal, social, and policy issues they will encounter related to genetics and genomics to effectively protect their patients’ interests and advocate for their rights. The Canadian Nurses Association (CNA) Code of Ethics guides registered nurses’ ethical practice. Equity, diversity and inclusion are also important considerations for providing safe and accessible genomic services. Culturally safe, anti-racist practices in genomics are critical to rebuild consumer trust in genomics healthcare and research and to prevent the perpetuation of eugenics.
There is also a film starring Oprah Winfrey titled The Immortal Life of Henrietta Lacks (1h33m) available on most streaming services.
Click on the underlined title to advance to the associated resources
Pharmacology
Genomics has significant applications in pharmacology due to advancements in pharmacogenetics - the study of how gene variants affect metabolism and therapeutic responses to medication. Increasing application of pharmacogenetic/pharmacogenomics can contribute to improved therapeutic response to treatments, improved cost-effectiveness, and reduced symptom burden and adverse medication effects.
Suggested Content for Pharmacology Courses
- The impact of genetic variants and polymorphisms on pharmacokinetics and pharmacodynamics.
- Improved treatment of pain, cancer therapy, mental health issues, and neurodevelopmental disorders.
- Targeted drug treatment and development.
- Gene therapy (e.g., Casgevy and Lyfgenia are the first gene therapies approved to treat Sickle Cell Disease).
Research / Inquiry
There is a strong need in Canada to develop nurse scholars who are equipped to advance genomics nursing research. There are unique
considerations for genomics research, and the following resources can help interested nurse scholars explore potential areas of inquiry.
Best, S., Stark, Z., Brown, H., Long, J. C., Hewage, K., Gaff, C., Braithwaite, J., & Taylor, N. (2020). The leadership behaviors needed to implement clinical genomics at scale: a qualitative study. Genetics in Medicine, 22(8), 1384-1390.
Thomas, J., Keels, J., Calzone, K. A., Badzek, L., Dewell, S., Patch, C., Tonkin, E. T., & Dwyer, A. A. (2023). Current state of genomics in nursing: A scoping review of healthcare provider oriented (clinical and educational) outcomes (2012-2022). Genes, 14(11), 2013.
Leadership
Leadership from nurses in all domains of practice is crucial to the safe and equitable integration of genomics and to support nurses as full participants
in interprofessional genomics-informed practices. Learning outcomes in leadership courses at the undergraduate and graduate levels can support the
development of leadership competencies that recognize genomics as a complex science and enable health system transformation for the genomic era.
The following readings can support this learning.
Resources for Select Specialty Nursing Areas
Suggested Content for Oncology Courses
- Hereditary cancer predisposition syndromes
(CPS) - Comprehensive genetic cancer risk assessment
- Targeted therapies
- Somatic and biomarker testing
Oncology
The field of oncology has served as a clinical paragon for genomic advances. Clinical practice guidelines exist to reduce cancer risk for
individuals found to have a genetic predisposition to cancer. Diagnostics have become more precise because of genetic testing.
Furthermore, an increasing number of anti-cancer therapies rely on genetic/genomic data for their clinical indication, resulting in more
individualized treatments.
Suggested Content for Maternity Courses
- Genetics of reproductive health and
conception - Developmental programming
- Pre-natal genetic testing
- Newborn screening
Maternity
Genomic services in the prenatal and postnatal periods are not new. However, the technologies used are advancing rapidly.
There are now many options available to screen for genetic conditions in a fetus. These tests allow potential parents and the
healthcare team to predict and prepare for outcomes of pregnancy to provide safer care for neonates and mothers. The
decisions made based on genetic test results can be difficult for parents to make. Nurses who obtain newborn screens must be
proficient in answering parent questions about the nature of the tests and the implications of a positive result. More tests are
being added to screening panels over time and some of these, such as screening for cystic fibrosis, have had significant impacts
on morbidity and mortality rates. There are social and ethical considerations that nurses should be aware of.
Sickle Cell Disease Canada
Pediatrics
Pediatric genomics is a rapidly developing field that is fraught with ethical tensions. Many genetic conditions have a childhood
onset. Emerging treatments, such as gene therapies for sickle cell disease, can alleviate sometimes debilitating symptoms that
children previously had to endure. There is a great deal of focus on epigenetics which recognizes the influence of environmental
and social factors on genetic expression and has altered the nature versus nurture debate and the belief in genetic determinism.
Suggested Content for Pediatric Courses
- Developmental origins of health and disease
- Epigenetics
- Developmental programming from conception to adolescence
- Genetic conditions with childhood-onset (e.g. Down Syndrome, Sickle Cell Disease, Cystic
Fibrosis, etc.) - Screening and testing in children
Mental Health
Incredible advances have been made in psychiatric genomics. There is emerging evidence for the genetic basis of many
psychiatric and neurodevelopmental conditions and their potential overlap. There is the potential that genomic sciences can
change the way we diagnose and treat these conditions. The genomics of disordered eating is an exciting subfield with new
insights into the pathologies of these disorders, new diagnostic potential, and promising therapies for those who have been
resistant to conventional treatment. Many parents of children with mental health diagnoses, autism spectrum disorder, or
attention deficit hyperactivity disorder are seeking direct-to-consumer pharmacogenomic testing to avoid trial-and-error
finding suitable medications for their child.
Suggested Content for Mental Health Courses
- Epigenetics
- Psychiatric pharmacogenomics
- Genetics and substance use disorder
- Genetics of disordered eating
- Genetics and neurodevelopmental disorders (genetic overlap with other
psychiatric disorders) - Genetics and psychiatric disorders
Population and Public Health
There are a variety of ways in which the genome and environment interact. Additionally, genomic sciences do not only pertain
to humans. Genomics is applicable to all organisms. The following are some cutting-edge advances in science where genomics
is used for broader public or population health initiatives and epidemiology. Climate change is also having a significant effect
on population health and has been shown to impact the genome.
Neurology Resources
Cardiology Resources