Evidence Review

Genomics for Nursing Education and Practice: Measuring Competency Gwen Anderson, RN, PhD • Anna C. Alt-White, RN, PhD, FAAN • Kendra L. Schaa, ScM, CGC • Andrea M. Boyd, RN, PhD • Christine E. Kasper, RN, PhD, FAAN, FACSM

ABSTRACT Keywords literature review, integrative review, measurement, assessment, competency, instruments, nursing, genomic education, genetic nursing, genomic nursing

Background: Nurses lack genome literacy, skill, and self-confidence in applying genomics to health care. Standardized curricula and evaluation tools are needed for wide spread uptake and application of genome science in nursing education, practice, and research. Aim: To determine whether psychometrically robust survey instruments exist to assess knowledge, skills, attitudes, and self-confidence in applying genomic nursing competency among students and registered nurses. Design: Psychometric systematic review. Data Sources: Medline, CINAHL, Academic Search Elite, Web of Science, and ProQuest Dissertations were searched from 1995 to 2014, with an English language restriction. Procedures: Critical analysis of the study elements and psychometric attributes was conducted after data were abstracted into analysis and synthesis tables. The synthesis assessed the design, methods, and measurement properties with a focus on reliability and validity using 16 criteria on a 4-point grading scale. Findings: Twelve studies were included in a detailed review that focused on assessment of genomic nursing core competencies. Six studies met the inclusion criteria. In terms of psychometric quality of the instruments, one study scored high, two moderate, two low, and one very low. Linking Evidence to Action: Most instruments assess self-perceived rather than objectively assessed competency. The highest quality instrument lacks clinical application. Knowledge-focused test questions based on up-to-date genome science that are relevant to practice need to be developed.

INTRODUCTION Genetic and genomic medicine services are available to patients in a wide variety of clinical and community settings, with more than 3000 genetic tests (Gene Tests, 2014) available. Despite a large and ever growing field of genomics knowledge, the profession of nursing has not yet incorporated core competencies for genomics into annual registered nurse (RN) competency assessment and evaluation in a systematic way. Nursing faculty and practicing nurses (Garcia, Greco, & Loescher, 2011) need to be "genome literate" (Godino, Turchetti, & Skirton, 2013). For decades, a few nurse leaders have designed and delivered genetics nursing education to faculty, nursing students, and RNs in practice; however, these efforts are far from organized and remain “patchy” (Burke & Kirk 2006). It is not surprising that current systematic reviews of nursing research indicate that nurses lack genomic literacy and self-confidence (selfefficacy) in performing skills related to genomics health care (Skirton, O’Conno, & Humphreys, 2012). Previous researchers found general practice nurses to be lacking self-confidence in

pedigree construction, risk identification, and taking responsibility for making a referral to a genomic medicine service (Barr & McConkey, 2007; Irwin et al., 2004). Pestka, Meiers, Shah, Junglen, and Delgado (2013) reported that nurses who are genomically literate are receptive to adopting family historytaking as part of their professional role. Knowledge, practice experience, role delineation, policy and clinical guidelines are all essential. In 2000, an education policy guideline was set forth to draw attention to the need for developing a systematic process for translating genomics into nursing education and practice (Anderson, Read, & Monsen, 2000). Since that time, progress has been made toward accomplishing a few of the steps necessary for effecting nation-wide uptake. Three additional critical steps have yet to be achieved:

Worldviews on Evidence-Based Nursing, 2015; 12:3, 165–175.  C Published 2015. This article is a U.S. Government work and is in the public domain in the USA

r Core genomic nursing competencies must be mapped onto academic curricula and aligned with national policies.

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r Standardized tools must be developed to evaluate genomic nursing competence at basic and advanced levels in academia and in practice.

r Development of accreditation standards for genetic nursing education in graduate programs for specialty tracks in genomics.

Problem Statement This review was completed to determine evidence-based recommendations for selecting a validated instrument to assess RNs’ genome competency after completing a genomic nursing education module. Although numerous nurse educators and clinical experts have created their own education programs and surveys to assess self-perceived levels of genetic knowledge, there are very few instruments that measure actual knowledge possessed by practicing nurses, students, or faculty. No validated instruments exist that measure all aspects of the genetic and genomic nursing core competencies (GNCs).

THE REVIEW Aims The aim of this integrative review was to: (a) evaluate survey instruments that assess knowledge, skills, and attitudes of genomic nursing in students and RNs; and (b) determine whether there are psychometrically robust tools to evaluate education programs and RNs’ genomic knowledge competency in practice. Two research questions are addressed: (a) which genomic nursing core competencies (i.e., knowledge, skills, and abilities) are assessed in these instruments, and (b) which instruments used to measure GNCs have adequate psychometric properties?

Design The design and conduct of this integrative review of the literature was completed according to the Cochrane Handbook for Systematic Reviews of Interventions (Higgins & Green, 2011).

Search Methods The first coauthor conducted an integrative review of the literature described by the Cochrane Reviews and a nursing textbook (Fink, 2010). All coauthors retraced the audit trail of the search strategy to confirm the results of the searches as described in the flow chart of the retrieval and selection of the studies. Databases were searched between 1990 and 2014 using Mesh search terms (Figure 1). The article titles and abstracts were retrieved from EbscoHost (including CINHAL PLUS with full text, Academic Search Premier, Medline with full text and ProQuest Dissertations & Theses full text). The search identified 44 publications that focused on assessment of nurses’ genetic and genomic nursing core competencies. To determine whether the articles met the inclusion criteria, each abstract was read and selected if relevant for the purpose of this review study. Dissertation abstracts

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were searched using ProQuest because very few publications included the survey instrument. Publications were selected for review if they met all of the following inclusion criteria: (a) original research papers, theses or dissertations, (b) target population that focuses on or includes RNs, student nurses, or nursing faculty, (c) actual knowledge assessed using test items, (d) questions that assessed the subject’s self-perception of their level of knowledge and application to practice, and (e) descriptive statistics were used to analyze and report the findings from the survey items. Publications were excluded from this review if the survey questions used to measure genetic nursing knowledge or competency were not included in the publication, or the study assessed genomics knowledge in a nursing specialty area which is not the focus of this systematic review.

Search Outcome The search and retrieval strategy (Figure 1) resulted in a total of 44 articles for review of the titles and abstracts. There were 18 dissertations, 2 theses, 20 original research studies, and 4 systematic review articles. Of the 20 original research studies, 6 were from outside the United States including Canada (Bottorff et al., 2005), Spain (Iglesias, Vallejo, Cena, & Fuentez, 2011; Mudd, 2011), China (Hsiao, Van Riper, Lee, Chen, & Lin, 2011), Turkey (Vural, Tomatir, Kurban, & Taspinar, 2009), and Korea (Choi, Jun, Ahn, & Anderson, 2008). Studies that focused on a specific nursing specialty area were not included. Twelve studies were reviewed in detail; two studies did not meet inclusion criteria. Four publications were systematic evidence-based reviews which provided high-quality evidence. Six studies were identified for the detailed data extraction analysis. There were three original descriptive research studies (Bankhead et al., 2001; Bottorff et al., 2005; Calzone et al., 2012), one nonnursing thesis (Bowling et al., 2008), and two nursing dissertations (Jaekel, 2012; Ward, 2011). Four studies were designed specifically to develop a new instrument or refine an existing one.

Data Abstraction The six studies included in this detailed systematic review were read, abstracted, and analyzed using seven data extraction elements outlined by instrument development experts (Allen & Yen, 2002; Soeken, 2005; Cabrera-Nguyen, 2010):

r Describe the instrument development process. r Identify the concepts and subdomains described in the survey questions.

r Identify the study purpose, population, research design, methods, and statistical analyses.

r Describe the reported validity and reliability of each instrument.

r Determine the core elements of the genetic and genomic nursing competencies addressed in each instrument. Worldviews on Evidence-Based Nursing, 2015; 12:3, 165–175.

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Evidence Review

PotenƟally relevant studies idenƟfied and screened for retrieval (n = 44)

Studies excluded aŌer Ɵtle & abstract analysis (n = 2)

Studies retrieved for evaluaƟon (n = 42)

Studies excluded aŌer abstract analysis (n = 34)

Studies retrieved for more detailed evaluaƟon (n = 12)

Studies excluded aŌer full text analysis (n = 2)

SystemaƟc review studies reviewed for background (n = 4)

Studies reviewed in detail (n = 10)

Studies included in the data abstracƟon table (n = 6)

Search Terms "nurses' knowledge of genetics" (8/401 selected) "genetic nursing knowledge" (7/347 selected) "genetic nursing education" (9/135 selected) "genetic nursing knowledge" (10/46 selected) "genetic nursing and assessment of knowledge" (10/14)

Figure 1. Flowchart of the retrieval and selection process of the research studies.

r Summarize the strengths and weaknesses of each study.

r Assess and score the quality of the science using 16 criteria focused on validity and reliability (CabreraNguyen, 2010) for quality as assessed by the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) system (Jones, 2010). A data abstraction table was created for analysis of the studies. The first coauthor read each publication and extracted the detailed information about each study into each category of the table. All authors conducted an audit review of the selected papers, the data abstraction tables, and the data synthesis table.

for study components that promote rigorous measurement instrument methodology (Allen & Yen, 2002; Soeken, 2005). The data synthesis table was created to examine 16 criteria for evaluating findings published and reported in instrument development papers as described by Cabrera-Nguyen (2010). All coauthors used these criteria to score the quality of the studies using a 4-point GRADE system, that ranges from very low (1) to high (4) as described by Jones (2010). One study scored high, two moderate, two low, and one very low. The synthesis focused on the two study aims: (a) degree of incorporating the published core competencies for genomic nursing, and (b) the psychometric properties.

Quality Appraisal and Synthesis

RESULTS Description of the Studies

Six studies met the inclusion criteria and were evaluated to assess the quality of instruments. All six studies were analyzed

The articles tended to focus on genetic knowledge, selfreported perception of relevance and usefulness in practice, or

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confidence in applying knowledge and skills. Four studies used test items to assess actual genetic knowledge (Bottorff et al., 2005; Bowling et al., 2008; Jaekel, 2012; Ward, 2011). Two studies focused on self-reported perception of genetic knowledge and its relevance or usefulness in clinical practice (Bankhead et al., 2001; Calzone et al., 2012). Four studies assessed application of genetic knowledge to clinical practice (Bankhead et al., 2001; Bottorff et al., 2005; Calzone, et al., 2012; Ward, 2011). The study subjects were primarily university students, which included student nurses who took an academic course (Bowling et al., 2008; Jaekel, 2012; Ward, 2011), or practicing nurses (Bankhead et al., 2001; Bottorff et al., 2005; Calzone et al., 2012).

Development Process for Each Instrument Knowledge, attitudes, and information needs of practice nurses. A mailed survey was designed in collaboration with practicing nurses in England and Scotland. “The survey aimed to measure . . . the prevalence of family history recording by primary care nurses, confidence in collecting and acting upon family history, and practice nurses’ knowledge about familial disorders and genetics, using case studies” (Bankhead et al., 2001, p. 475). Likert scale assessment questions and narrative descriptive responses provided data about confidence in applying the knowledge to practice. Part 1 included 13 questions about using and applying family history assessments in “general practice” clinical care management. Knowledge questions emphasized perceived genetic risk in diseases such as cancer, heart disease, asthma, and diabetes. Part 2 asked four questions pertaining to genomic knowledge needs in relation to familial cancer and its usefulness in practice. Part 3 assessed nurses’ experience, confidence with, and potential usefulness of a computer software program to collect family history in daily practice.

Health professionals’ knowledge and attitudes toward genetics. Bottorff et al. (2005) investigated the knowledge, professional involvement, and confidence in providing genetic services for adult onset hereditary diseases. Their survey was developed by an eight-member panel of experts from a variety of disciplines. The instrument was pilot tested for comprehensibility in a focus group of RNs and physicians. The tool was designed to explore current practices and expected roles of each profession in providing genetic services, including degree of confidence in providing genetic services, perceived usefulness of participating in continuing education related to genetics, and testing five genetic knowledge questions.

Genetics Literacy Assessment Instrument. A nonnurse graduate student pursued an instrument development study for a master’s thesis (Bowling et al., 2008). The 43 concepts the instrument tested originated from a committee of genetic professionals from the American Society of Human Genetics (Hott et al., 2002). Bowling et al. (2008) reviewed these concepts for alignment with a published definition of

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genetics literacy. The 43 concepts were reduced to 17 and used to develop the Genetics Literacy Assessment Instrument (GLAI). A number of biology textbooks were reviewed for additional test items. All suitable items were added to the initial test bank. “A number of questions were created de novo, and almost all were modified more than once” (Bowling et al., p. 17). The instrument was developed by 25 educators, researchers, genetic counselors, physicians, biologists and criminal justice educators. The process was systematic and included content validation by a “subset of the original 25 experts” (Bowling et al., p. 19). Experts were asked three content validity questions. Reviewers’ feedback was used to refine and select the final set of items. No content validity scores were reported. Test–retest reliability was assessed in a group of 112 psychology students not enrolled in a genetics course. Construct validity was used to assess differences and similarities in the genetics literacy of undergraduate and graduate students, including nurses. Discriminant validity was assessed using 395 students in eight introductory nonmajor biology and genetics courses, 113 psychology students, and 23 graduate students from specialized fields in genetics. The GLAI distinguished high from low scoring groups as expected.

Genetic Nursing Concept Inventory. Ward (2011) developed the Genomic Nursing Concept Inventory which was designed in a series of detailed stages. Sixty-five key concepts were selected from the original Essentials of Genetic and Genomic Nursing Competencies, Curricula Guidelines and Outcome Indicators (American Nurses Association [ANA], 2008). The authors conducted an online survey to establish content validity by asking a panel of 104 experts to identify 65 essential concepts as critical to know, important to know, nice to know, or not important. Twenty-one essential concepts emerged from this first step. “The understanding of those concepts among baccalaureate nursing students was investigated using student-supplied response surveys (N = 96–134). Inventory items were then written as multiple choice questions, utilizing common misconceptions as distractors. Thirdly, cognitive interviews with 15 first year nursing students guided item revision. Fourth, the survey was pilot tested with 238 nursing students to measure psychometric characteristics. The instrument was then reduced to the most parsimonious scale possible, retaining the most psychometrically robust items while preserving coverage of the intended content domain. The product of these steps is a 31-item empirically derived inventory designed to assess understanding of concepts most fundamental to genomic nursing.” (Ward, 2011, p. 56)

Nursing students’ knowledge of genetics and genomics. The purpose of this intervention study was to assess genetic nursing knowledge among undergraduate nursing students in

Worldviews on Evidence-Based Nursing, 2015; 12:3, 165–175.  C Published 2015. This article is a U.S. Government work and is in the public domain in the USA

Evidence Review two sections of one course at one school of nursing (Jaekel, 2012). The intervention group (n = 108) completed a genetics online education module and a control group (n = 114) completed a curricular specific module. The items on the assessment survey were created from a nursing textbook on genetic nursing. Content validity was assessed by two faculty members who compared the test questions against the textbook. A group of nine students in a clinical rotation reviewed the survey for readability and question clarity. Students were randomly assigned to one of the two groups. All students completed a 20-item pretest before undertaking either type of educational method. After completing the online education, the same students were asked to complete Form A or Form B of the genetics survey. Each form consisted of 10 randomly selected questions from the original 20item test bank. Item and total scale reliability statistics were unreported.

Axley (2008) explored these for the concept of competency: (a) antecedents—self-assessment, assessment of readiness, willingness to use innovative educational approaches; (b) various elements—knowledge—intellectual problem solving and performance, skills—psychomotor, and abilities-attitudes and values; (c) empirical referents—measures that are comprehensive, reliable, valid and free of bias; and (d) consequences of competence—clinical judgment, accountability, a socially relevant purpose, self-confidence, and enhancement of patient outcomes. Consequently, the concept of competency must be considered in the broader context of practice standards, systems, models of service delivery and policy because these impact implementation of genomic nursing competency in the workplace. Competence in genomics requires integration of all these complex factors in the context of local and national organizations.

Genetic and Genomic Knowledge Genetics and Genomics in Nursing Practice Survey. Calzone et al. (2012) collaborated with colleagues to refine an existing instrument to assess adoption of a genetically informed optimal family history by 912 family physicians. The family physician assessment tool was developed using an iterative process by an interprofessional team, including family physicians, a behavioral scientist, online survey designers, and genomic experts. Measurement items were created for each domain of Roger’s Diffusion of Innovation Theory (DOI). Content experts not part of the group and a convenience sample of family physicians reviewed the items for clarity. The online survey was piloted with a small convenience sample of family physicians (Jenkins, Woolgord, Stevens, Khan, & McBride, 2010). In a 2012 refined version of the instrument, the Genetics and Genomics in Nursing Practice Survey questionnaire items were mapped to the conceptual and operational definitions in the DOI and the published GNC clinical indicators (ANA, 2008). The original physician survey and the refined instrument for practicing nurses reported structural equation modeling statistics to assess alignment of the Genetics and Genomics in Nursing Practice Survey to the DOI assessment framework.

DISCUSSION This discussion focuses on the two research questions: (a) degree of incorporating the published core competencies for genomic nursing, and (b) the psychometric properties of the instruments. In evaluating the studies and the instruments intended to measure competency, it is important to consider the meaning and the components of competency. The term competency in nursing is often defined as “cognitive ability and clinical proficiency” (Axley, 2008, p. 215). Bloom, Engelhart, Furst, Hill, and Krathwohl’s (1956) original taxonomy conceptualized competency as knowledge, attitude or self-confidence and skills. Walker and Avant (2005) stated that concepts have different components.

Knowledge is an essential aspect of genome competency in nursing practice (Greco, Tinley, & Seibert, 2012) and is best described in the clinical performance indicator that requires the nurse to “incorporate genetics and genomics health assessment data into routinely collected biopsychosocial and environmental assessments of health and illness peters in [the] client, using culturally sensitive approaches” (ANA, 2008, p. 19). Each of the research studies conceptualized GNCs differently: Skills and attitudes (Bankhead et al., 2001), genetics or genome knowledge (Bowling et al., 2008), and situational knowledge (Bottorff et al., 2005). None of the study instruments assessed all the GNCs, thus educators in academic and clinical settings would be required to fit the genome curriculum to the survey that best fits the competency of interest. For RN competency evaluation to be most useful in academic programs and in practice, questions that assess actual knowledge rather than self-perceived level of knowledge must be incorporated into a psychometrically sound instrument. The instrument by Bowling et al. (2008) emphasizes genome science but has limited utility in nursing practice despite the high quality of the instrument development process. The instrument created by Calzone et al. (2012) emphasizes self-perceived knowledge has limited utility in an academic testing situation. Clinical application of knowledge is necessary in any assessment or action situation; however, knowledge is not sufficient to demonstrate competence.

Skills, Attitudes, Abilities, and Self-Confidence The instruments developed by Bankhead et al. (2001) and Calzone et al. (2012) were designed to measure and describe nurses’ self-confidence in performing family medical history assessment skills, actual experience using family history information, and perceived support by nurse leaders for applying genomics in practice. The relationship between self-confidence and competency warrants further exploration.

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Self-competence and self-confidence are founded on the concept of self-efficacy which generally refers to “the overall assurance or faith that individuals have the ability to achieve their goals . . . . Self-competence refers to the overall positive or negative conception or attitude of oneself as a source of power and efficacy” (Dumitrescu, Zetu & Teslaru, 2012, p. 23). Self-competence and self-confidence are defined as “the valuative experience of oneself as a causal agent, an intentional being that can bring about desired outcomes” (Dumitrescu, et al., p. 23). Self-confidence is considered one of the most important motivators and regulators of behavior (Dumitrescu, et al.). Based on Godino and Skirton’s (2012) evidence-based practice review, nurses lack self-confidence in using genome knowledge and skills in practice. The authors claim this is the case because RNs lack knowledge. The second study aim assesses the psychometric properties of the published instruments. Four instruments did not report adequate psychometric properties (Table 1). Bankhead et al. (2001) did not report any measures of reliability or validity. A limitation in the study by Bottorff et al. (2005) is the unreported reliability coefficient, despite a large sample size and no reporting of a content validity index (CVI) score by the panel of experts. Ward’s (2011) study did not report a CVI, even though 109 experts assessed content validity. According to Polit and Beck (2006) and Polit, Beck, and Owen (2007), an unreported CVI illustrates weakness in the study design. Jaekel (2012) reported no measures of reliability and the validity assessment was inadequate. Calzone et al. (2012) reported structural equation modeling to assess item alignment with the DOI theory using a comparative fit strategy to demonstrate the relationship between DOI and nurse competence. The limitation is that neither reliability nor validity were reported for their instrument. Bowling et al. (2008) used classical test theory (Allen & Yen, 2002) to incrementally develop the GLAI that included concepts, definitions, and principles of genetics but no genomics or epigenetics. The questions focused on genetic science rather than application to clinical care. Furthermore, a nurse was not part of the research team. Out of the six studies reviewed, Bowling et al. (2008) conducted and reported the most detailed psychometric analysis of the six instruments (Table 1). In addition, the GLAI is the only instrument that has been used to assess degree of genetic literacy among faculty and students (Daack-Hirsch, Driessnack, Perkhounkova, Furukawa, & Ramirez, 2012).

Strengths and Limitations This analysis includes a description of six instruments used by nursing scholars to measure various dimensions of GNC (antecedents, core elements, clinical performance indicators, and self-confidence). It is important to note the standing of existing instruments used in nursing to assess GNC and their psychometric properties. In particular, the gap in reliable and valid instruments is noted. This review is limited to survey

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instruments that were used to assess the competencies of nurse generalists with the exclusion of studies designed to evaluate the GNC of nurses in specialty services.

IMPLICATIONS FOR EDUCATION, PRACTICE, AND POLICY Education Valid and reliable instruments will assure nurse educators that they can measure the efficacy of genomic nursing curriculum and different teaching modalities across diverse student and RN populations which would be useful on a global scale (Burke & Kirk, 2006; Godino & Skirton, 2012; Godina, Tuschetti & Skirton, 2013). Standardization of the education and competency evaluation is necessary for RNs already in practice (generalists and specialists; American Nurses Credentialing Center, 2015) and in university programs educating the generalist, nurses who seek advanced specialization in genomics, and nurse researchers. Accreditation of genomic nursing education programs will accelerate advancement of nurse leaders with expertise in genomics, policy, ethics, system design, informatics, teaching, and research.

Practice Practice leaders should promote development of models and guidelines that foster RN role development and competency in genomics. Nurses, like other health professionals, must learn and apply genomic knowledge, skills, and attitudes to achieve competence in all practice roles. RNs need genome knowledge that is accessible, relevant, and practical. Opportunities to gain experience are also needed. In practice settings, nurse executives and medical center directors must advocate for practice policies, procedures and guidelines as well as system resources that enable nurses to actualize genomic competency in their practice roles.

Policy There are many national policies that promote genomics into health care. However, it is important to understand that nurses’ self-confidence is influenced by multiple factors including designated role descriptions, models of care, professional collaborators, clinical guidelines, and clinical practice policies. Bankhead et al. (2001) and Calzone et al. (2012) employed selfconfidence as a proxy measure to assess the healthcare context that impacts GNC. Self-confidence is dependent on genomic nursing education (Giarelli & Reiff, 2012), but also professional practice policy, clinical practice guidelines, and system-based supports such as electronic healthcare records (EHR). Annual evaluation of RNs’ practice responsibilities should include genome competencies such as: family history-taking, pedigree documentation and interpretation, and communicating the results of genomic risk assessments to the healthcare team. Policy and system changes along with knowledge-uptake, skills, and a positive attitude about changing practices are needed to boost self-confidence among nurses in practice. WVN

Worldviews on Evidence-Based Nursing, 2015; 12:3, 165–175.  C Published 2015. This article is a U.S. Government work and is in the public domain in the USA

Worldviews on Evidence-Based Nursing, 2015; 12:3, 165–175.  C Published 2015. This article is a U.S. Government work and is in the public domain in the USA

2. Botorff et al. (2005)

1. Bankhead et al. (2001)

Author,Year

Theoretical framework, hypotheses

Design is appropriate and sample size adequate; Directions for future research

3

Current practice habits in terms of taking family histories; Confidence in providing services; Perceived usefulness of genetic information; Genetic knowledge; Role expectations related to genetics

4

3

2

3

The instrument was Descriptive survey to based on the compare groups HuGem genetic convenience education project sample of RNs & test survey Drs (N = 900); Response rate (Lapham, Kozma, range 50%–79% Weiss, Bendendorf, & Wilson, 2000)

1

Attitude, skill, and confidence Justifies need for new 600 RNs; 66% in performing family measure response rate; No history assessments; date of data Interpretation of risk collection assessment and referral to advanced provider

Content domains precisely define the construct(s)

Table 1. Evaluation of Psychometric Propertiesa of the GNC Instruments

1

Does not state the statistical software used to analyze the data; None reported for test items or the overall instrument

Reliability Cronbach’s α test–retest parallel forms item correlation

2

0

Face validity using a pilot test None reported for test items focus group; Panel of or the overall instrument experts participated in item construction; No content validity scoring by experts; Does not address missing data

1

Face validity among practice nurses in pilot testing; No panel of experts to score the content validity; Does not address missing data

Validity face, content, discriminant, concurrent, CVI, factor analysis, model of fit

(Continued)

10 (Low)

10 (Low)

Quality Scoringb 1 = very low 2 = low 3 = moderate 4 = high Total = 20

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4. Ward (2011)

3. Bowling et al. (2008)

Table 1. Continued

4

3

3

4

Justifies need for new Instrument Panel of 25 interdisciplinary Test retest conducted in 112 measure development study; experts created, revised students not enrolled in a convenience items; Review by genetic genetic course then retest sample of 395 professionals, instructors 7 weeks later. Cronbach’s introductory and graduate students; α calculated for the prebiology course Focus group interviews, and posttests; Item students (not pilot study data collection, correlations exclusively nurses) and evaluation; No content validity scoring by experts; No factor analysis

4

2

2

3

2

Genetic bioscience Inventory capable of Instrument 14 experts created the items; Scale difficulty average .53; knowledge, discriminating development study; Multistep process to ranging from .26 –.83; pharmacogenomics, and between students convenience create, revise and refine Total Item correlation r = patterns of hereditary who do and do not sample of 238 the instrument analysis; .33. Cronbach’s α for the transmission of single gene understand basic student nurses in Content validity in focus 52-item scale was .791 and diseases and cancer and important one university groups of students; No .84 for the 31-item concepts of genetic completed the content validity scoring by inventory; Internal literacy survey experts; No discriminant consistency using average validity; No factor analysis interitem correlation

3

Genetics bioscience knowledge No healthcare application questions

(Continued)

13 (Moderate)

17 (High)

Nurses’ Genome Competency

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Worldviews on Evidence-Based Nursing, 2015; 12:3, 165–175.

Worldviews on Evidence-Based Nursing, 2015; 12:3, 165–175.  C Published 2015. This article is a U.S. Government work and is in the public domain in the USA

3

1

2

4

3

Instrument Reported from the previous Item analysis conducted but development study instrument (Jenkins et al., no statistics reported; “to to evaluate the DOI 2010); Content validity assess survey theory to explain established by a panel of performance . . . ” the competency among 25 experts who were family researchers compared RNs in practice; A physicians; Structural responders and convenience equation modeling was nonresponders for each sample of 293 used to “evaluate whether test question practicing RNs 28% the instrument items Response rate aligned with the DOI No factor analysis; Addressed and described missing data in detail

0

Attitudes and receptivity (Diffusion of confidence in practice; Innovation theory) Integration of family domains, and history; Assessed establishing the knowledge competency; directionality of Assess supportiveness of the associations to supervisory social system; the DOI domains” Decision and adoption (p. 430)

1

2

4

0

Instrument Content validity was none development study established with for comments from two quasi-experimental faculty and nine nursing education students; providing evaluation 114 textbook rationale for each students in item in the survey was intervention and cited as providing content control group validity

Cause of common adult onset Aim to assess health conditions; Roles of knowledge after nurses in caring for exposure to persons with genetic learning disorders; Composition of DNA and RNA; Process of mitosis vs. meiosis; Most common polymorphisms Characteristics of polymorphisms; Persons affected in autosomal recessive conditions; Inheritance of Huntington’s disease; First step in establishing genetic history assessment

Note. a Cabrera-Nguyen (2010). b Jones (2010).

6. Calzone et al. (2012)

5. Jaekel (2012)

Table 1. Continued

13 (Moderate)

7 (Very low)

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LINKING EVIDENCE TO ACTION

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Author information Gwen Anderson, Department of Veterans Affairs, Office of Nursing Services, Washington, DC, USA, and Professor, Graduate Programs School of Nursing, Azusa Pacific University, Azusa, CA, USA; Anna C. Alt-White, Retired Director Research & Evidence Based Practice, Department of Veterans Affairs, Office of Nursing Services, Washington, DC, USA; Kendra L. Schaa, Health Science Specialist, Department of Veterans Affairs, Office of Research & Development, Washington, DC, USA; Andrea M. Boyd, Research Health Scientist, WJB Dorn Veterans Affairs Medical Center, Columbia, SC, USA, and Assistant Professor, Georgia Regents University, Augusta, GA, USA; Christine E. Kasper, Department of Veterans Affairs, Office of Nursing Services, Washington, DC, USA, and Professor, Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. This work was supported by a grant from the United States Department of Veterans Affairs Office of Nursing Services. The contents of the article do not represent the views of the U.S. Department of Veterans Affairs or the United States Government. Address correspondence to Gwen Anderson, Department of Veterans Affairs, Office of Nursing Services, Washington, DC 20422; [email protected] Accepted 14 December 2014 C 2015, Sigma Theta Tau International Copyright 

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doi 10.1111/wvn.12096 WVN 2015;12:165–175

SUPPORTING INFORMATION Additional supporting information may be found in the online version of this article at the publisher’s web site: Table S1. Data Abstraction and Analysis of Each Instrument

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Genomics for Nursing Education and Practice: Measuring Competency.

Nurses lack genome literacy, skill, and self-confidence in applying genomics to health care. Standardized curricula and evaluation tools are needed fo...
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