"

10.5 Nursing Implications

Implications for Nursing Practice

Each province and territory in Canada has a nursing regulatory body that sets out the professional and practice standards and entry-level competencies. These are based on the Canadian Nursing Associations (CNA) Framework for the Practice of Registered Nurses in Canada (2015). Nurses practicing in genomics apply these standards to ethical issues as they arise. These standards and competencies promote the provision of safe, ethical, compassionate, competent, and evidence-informed nursing care. Nurses must consider issues around consent, privacy, and confidentiality when working with clients and families receiving genomic services. Trauma-informed practices are a vital component of genomic nursing care, particularly given historical harms related to genetics and genomics. Establishing a therapeutic nurse-client relationship can help build trust and promote informed decision-making.

The CNA Code of Ethics (the Code) provides a framework to guide nurses in navigating ethical dilemmas and decision-making that align with professional values and principles. In addition, the Code promotes equity and addresses social determinants of health by encouraging nurses to challenge systems of oppression, discrimination, and inequity in healthcare. The Code Recognizes the importance of culturally safe care, particularly in addressing the health needs of Indigenous peoples and other communities that experience disproportionate burdens. Thus, the Code can serve as a resource for nurses to address ethical issues arising from genomics-informed nursing. The previous version of the Code (CNA, 2008) included mention of genetic endowment as a health determinant (Puddester et al., 2023). Additionally, the document noted that advances in genetics and genomics impact healthcare system transformation in Canada (Puddester et al., 2023). The absence of any mention of genetics or genomics in the current (CNA, 2017) version of the Code is concerning, given the mainstreaming of genetics and genomics in medicine.

The following article explores how the American Nurses Association (ANA) Code of Ethics can be applied to genomics nursing, emphasizing the ethical responsibilities of nurses working in this rapidly evolving area. The article explains how the core principles of the ANA code – including respect for persons, beneficence, justice, and the nurse’s duty to advocate for patients – are applicable to genetic/genomic nursing. Additionally, it highlights the importance of informed consent, ensuring patients understand complex genetic information, and the need to protect patient privacy and confidentiality.

Although the ANA Code of Ethics only applies to American nurses, there are many similarities to the CNA Code of ethics. While both the CNA and ANA Codes of Ethics align in their commitment to patient care, advocacy, and professional integrity, the CNA Code reflects Canada’s focus on global health, cultural safety, and reconciliation with Indigenous communities. In contrast, the ANA Code addresses issues relevant to the U.S., such as privatized healthcare and disaster response. These distinctions highlight how each code adapts ethical nursing principles to meet the specific needs of their populations and healthcare systems.

The article below focuses on the nurse’s role in patient education, advocacy, and addressing health disparities related to access to genetic services. While the specific context is American, the ethical considerations and the role of the nurse outlined in this article can be readily related to the CNA code of ethics and to the practice of nursing in Canada.

Read

Tluczek, A., Twal, M. E., Beamer, L. C., Burton, C. W., Darmofal, L., Kracun, M., Zanni, K. L., & Turner, M. (2019). How American nurses association code of ethics informs genetic/genomic nursing. Nursing ethics, 26(5), 1505-1517. https://doi.org/10.1177/0969733018767248

Access Tluczek et al (2019) via the Georgian college library - login required     Access Tluczek et al. (2019). through your library- login required

Questions for Reflection

While reading the above article, consider the following questions:

  1. How can nurses ensure truly informed consent when patients may have limited health literacy? Consider the challenges nurses face in conveying complicated genetic concepts, such as DNA, variants, and inheritance patterns.
  2. How can nurses balance the patient’s right to know with the right not-to-know, particularly in cases where genetic findings may have no clear treatment?
  3. In what ways can nurses advocate for equitable access to genetic/genomic services and address potential health disparities? Given that genetic technologies and information are not always equally available or accessible to all populations, what steps can nurses take to ensure that all patients receive appropriate genetic services?
  4. What strategies can nurses use to protect patient privacy and confidentiality in the age of electronic health records and increased genetic testing?
  5. How does having knowledge and awareness of the eugenic past contribute to trauma-informed care and ensuring a safe practice environment?

Position Statements

A position statement is a strategic tool used to define and communicate an organization’s perspective on a topic, provide guidance, and advocate for change. It is essential for influencing practice, shaping policy, and fostering awareness and alignment on critical issues.

The International Society of Nurses in Genetics (ISONG) have issued policy statements that align with nurses responsibilities related to ethical issues arising from genomics. Note that these are also founded on nursing guidance from the United States, therefore, should be read with a critical view to their relevance in the Canadian context.

Briefly review the following documents:

Attribution & References

Except where otherwise noted, this section is written by Andrea Gretchev, CC BY-NC 4.0

References

Canadian Nurses Association. (2008). Code of ethics for registered nurses. https://hl-prod-ca-oc-download.s3-ca-central-1.amazonaws.com/CNA/2f975e7e-4a40-45ca-863c-5ebf0a138d5e/UploadedImages/documents/Code_of_Ethics_2008_e.pdf

Canadian Nurses Association. (2015). Framework for the practice of registered nurses in Canada. https://hl-prod-ca-oc-download.s3-ca-central-1.amazonaws.com/CNA/2f975e7e-4a40-45ca-863c-5ebf0a138d5e/UploadedImages/Framework_for_the_Pracice_of_Registered_Nurses_in_Canada__1_.pdf

Canadian Nurses Association. (2017). Code of ethics for Registered Nurses. https://hl-prod-ca-oc-download.s3-ca-central-1.amazonaws.com/CNA/2f975e7e-4a40-45ca-863c-5ebf0a138d5e/UploadedImages/documents/Code_of_Ethics_2017_Edition_Secure_Interactive.pdf

Puddester, R., Limoges, J., Dewell, S., Maddigan, J., Carlsson, L., & Pike, A. (2023). The Canadian landscape of genetics and genomics in nursing: A policy document analysis. Canadian Journal of Nursing Research, 55(4), 494-509. https://doi.org/10.1177/08445621231159164

License

Icon for the Creative Commons Attribution-NonCommercial 4.0 International License

Precision Healthcare: Genomics-Informed Nursing Copyright © 2025 by Andrea Gretchev, RN, MN, CCNE is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

Share This Book