Description

Nursing has contributed significant leadership to advance genomics and precision health patient care models. Examples include: development of academic frameworks to guide curriculums, nurse workforce education and training, and use of genomics in everyday clinical nursing practice across a range of patient care settings for pharmacogenetics, hereditary cancer screening, newborn screening and more. Nursing's holistic philosophy and evidence-based practice approach positions nurses as leaders to implement precision health into routine patient care, including: prescribing and administering pharmacogenetic-based treatments and medications, conducting family history assessments to detect the presence of high-risk hereditary and multifactorial diseases, making referrals to genetic colleagues, interpreting common chromosomal, genetic and genomic laboratory tests, developing health plans for and providing counseling and education to patients, families, and communities.

Nursing Education

Nursing faculty consistently report insufficient knowledge and competency to instruct nursing students about how to effectively care for SGM people (Cornelius et al., 2017; Lim et al., 2015; McCann & Brown, 2018; McNiel & Elertson, 2018; Mitchell et al., 2016; Stewart & O'Reilly, 2017). In the absence of knowledge and pedagogical and/or andragogical expertise regarding SGM health, nurses entering practice will continue to be inadequately prepared to care for SGM people. This is troubling given

COVID-19 has raised a concern about the quality and continuity of education. The uncertain situation has required universities to undertake several innovative measures to continue their educational programs without compromising the quality of education. The aim of this paper is to introduce the hybrid approach for undergraduate nursing students for teaching mental health nursing course, utilizing Gagne's instructional design theory, in a private nursing institution in Pakistan. The nine steps of instructions in Gagne's theoretical framework were utilized for teaching the mental health nursing course. The approach enhanced students’ therapeutic communication skills, boosted their confidence level, and assisted them in overcoming their fears in caring patients with psychiatric illnesses. Students appreciated the innovative strategies, such as problem-based learning, case studies, interactions with standardized patients, and learning through movies. The innovative and creative clinical teaching approaches can be used to develop nursing students’ competencies, core clinical skills, and to bridge the theory-practice gap.

Development and Validation Process

A mixed methods design was employed to develop and validate the TALHT. Data were collected between summer 2020 and Winter 2021.The study team consisted of a sexual and gender diverse group of students and faculty at JHSON and NHWSON. The Emory University Institutional Review Board (IRB) determined that although this study was human subjects' research, it was exempt from IRB review and approval. Each participant completed the informed consent process reviewed and approved by the IRB.

In the United States (US), conservative estimates note that over 10 million people (4.1% of the population) identify as lesbian, gay, bisexual, transgender, queer, or intersex (LGBTQI+) (Gates, 2017). The LGBTQI+ community is comprised of people of many different races, genders, sexual orientations, socio-economic statuses, and cultures, creating many unique and intersecting identities within the community. However, the LGBTQI+ community as a whole faces a variety of health disparities related to widespread stigma. Historical and present-day cisgenderism (i.e. multilevel and systemic prejudicial ideology that acts to delegitimize or refuse other people's self-determination of their own gender) and heterosexism (i.e. the system of oppression that values and centers heterosexual people, upholds heterosexuality as normative and natural, and marginalizes queer people and communities) are associated with adverse health among this population (Ansara and Hegarty, 2014; Michigan State University: The Gender and Center, n.d.). LGBTQI+ people experience higher rates of some cancers, mental health disorders, substance use, and sexually transmitted infections compared to cisgender (i.e., people whose gender aligns with that normatively expected of their assigned sex at birth) and heterosexual peers.

Following a comprehensive literature review, the Tool for Assessing Cultural Competence Training (TACCT) was identified as an ideal measure to adapt for the TALHT. The TACCT is comprised of 67 items to evaluate five domains of cultural competency content in medical education curricula: (1) Cultural Competence Rationale, Context, and Definition; (2) Key Aspects of Cultural Competence; (3) Impact of Stereotyping on Medical Decision-Making; (4) Health Disparities and Factors Influencing Health; and (5) Cross-Cultural Clinical Skills. The TACCT has high validity and reliability (Cronbach's α = 0.964) (Association of American Medical Colleges, 2005; Lie et al., 2006, Lie et al., 2008). Each item is designed to measure aspects of students' knowledge (K), skills (S), or attitudes (A) (KSA's) regarding cultural competence. The TACCT is used to systematically guide course/program evaluation, intervention development, and outcome testing for general cultural competency in health professions.

In addition to the TACCT, the development of the TALHT was guided by the widely used theoretical model, ‘The Process of Cultural Competence in the Delivery of Healthcare Services.’ This model describes cultural competency as a perpetual process that healthcare providers continue to learn throughout their practice. In this model, five domains of cultural competency guide education and evaluation: (1) cultural awareness, (2) cultural knowledge, (3) cultural skill, (4) cultural encounters, and (5) cultural desires. Although this model is focused on practicing healthcare providers, the domains helped guide item and domain construction for the TALHT.

Health care quality improvement and performance measurement tools are instrumental to implementing new clinical advances and processes into routine health care delivery operations. These tools provide a way to objectively evaluate whether a health care team, organization or system is making positive changes that lead to improved health care delivery processes and outcomes and are linked to value-based financial reimbursement. As genomic science moves beyond government-academic collaborations into routine health care operations, a health quality performance measurement and quality improvement infrastructure policy emphasis is imperative.

From January 2019 to July 2019, experts who served on the American Academy of Nursing's (AAN) Genomic Nursing and Health care Expert Panel (EP) conducted a scoping review and policy priorities analysis, aiming to: (a) provide an overview of current status on U.S. genomic nursing health care policy; (b) identify gaps for implementing precision health in clinical practice; (c) identify opportunities for greater impact in genomic nursing using health care quality measurements and benchmarking standards for genomic outcomes, and; (d) promote innovative solutions for driving wider implementation of precision health by issuing calls to action for nursing practice workforce, education, research, and health care policy arenas.