The iceberg of genomics: New perspectives in the use of genomics and epigenetics in oncology nursing clinical reasoning. A discursive paper

Abstract

BackgroundAlthough, there is a wealth of information in the medical literature on the usefulness of genomic testing in assessing risk and its application in medical oncology decision making, there are no theoretical reflections in the nursing field.AimTo understand the implications of molecular biology in nursing practice and highlight the role of Nursing Theory in guiding nurses’ reasoning.Materials and MethodsSearching literature published between 2000 and 2022 in Medline and Google Scholar. Scientific evidence was analysed by the authors expert in different fields.ResultsBased on the findings of the literature, concerns have been raised about the proper care of cancer patients who have a genomic risk profile determination. In particular, the absence of theoretical thinking and conceptual models that consider developments in molecular biology and their impact on nursing, in addition to the prevalence of heuristic thinking and the application of clinical patterns in nursing practice, could induce patient misjudgement with inadequate planning of preventive, curative, rehabilitative and educational nursing interventions. Nurses working in the field of oncology should be aware that the risk profile determined by genomics tests is merely the visible and stated portion of the cancer patient: the tip of iceberg.DiscussionThis study demonstrates how genomic testing takes into account a fraction of genes discovered in tumour tissue to establish a risk profile. This subset differs, for example, from the social genome, which can determine the risk of dementia, cancer and cardiovascular disease, but in response to social adversity. Nursing theory, which views the environment as a metaparadigm, must consider a conceptual model that can integrate the findings of genomic testing with recommendations from studies on the social genome of humans to make it easier to build nursing treatments that can better reduce these risks.ConclusionA nursing theoretical discourse on genomics is a paramount requirement for developing effective nursing care.

The relevance of the contribution of psychoneuroendocrinoimmunology and psychology of reasoning and decision making to nursing science: A discursive paper

“…After reading the abstract and/or the full text, three articles were excluded due to the absence of one or two of the disciplines. Only 2 remaining articles propose the integration between the PNEI and nursing disciplines (Milani et al, 2023;Walling, 2006), with one of these also integrating the PRDM (Milani et al, 2023).…”

“…The amount of data provided by the CCA is extensive, and nurses must be able to integrate these data, to discover their interconnection, and to identify what is relevant to the patient's healing process, and then to decide the nursing care priority (Milani et al, 2023). For example, pain, dyspnea and sleep disturbance could be interrelated clinical problems if the patient presents a rib fracture: the fracture may create pain during chest expansion and forces the patient into an antalgic posture that prevents good sleep.…”

“…clinical reasoning, decision making, nursing, nursing priority, nursing theoretics, psychology, psychoneuroimmunology, theoretical nursing the sum of discrete diseases, but rather as 'an emergent state arising from the interactions between a multitude of factors in a person's socioecological environment and inherited biology (Sturmberg et al, 2021). According to this perspective, to identify the priority, a nurse should consider the relationships among all factors affecting the patient's health condition (including the patient's living context), the possible actions to be taken and the effects of such actions on the different morbid conditions simultaneously present in the multimorbid patient (Milani et al, 2023).…”