Chapter 40/41/42

CHAPTER 40

           Nursing Informatics in Asia

  DEVELOPMENT OF NURSING INFORMATICS (NI) IN SELECTED ASIAN COUNTRIES

Ø  Since computers were first introduced into the health care sectors of Asian countries in the 1970s,there have been exciting developments in the health care Informatics associated with the rapid growth in information and communication technology.

Ø  The first applications of information technology in health care in Asian countries were in administration, billing, and insurance.

Ø  This chapter provides an over view of the current status of the field of NI in South Korea, japan, China , Taiwan, and Thailand.

     

            SHORT HISTORY

Ø  In most of these countries computers were first use in nursing during the early 1970s,

Ø  Health informatics and NI were not introduced until the 1980s following is the establishment of professional organization for the health informatics.

Ø  The adaptation of informatics in Asian countries usually began as vision by a group if individuals in the government or a professional organization, who promoted the use of information technologies to support nurses in all areas of nursing practice.

KOREA

                       South Korea comprises eight provinces with 7 metropolitan cities, and the   
                          total  population was about 47million in 2002.There are currently 190,720 
                         licensed midwives and nurses, of whom 81,478 are practicing and 23,331 of these 
                         are situated in the Seoul metropolitan area,Health informatics in South Korea has  
                         grown considerably in recent years with the professional outreach activities of the
                         KOREAN SOCIETY OF MEDICAL INFORMATICS (KOSMI).

HISTORY OF NURSING INFORMATICS IN KOREA 

•           The use of computers in South Korean healthcare began in the late 1970s in hospital finance and administration systems to expedite insurance reimbursements
•       To contrast, computer were not used in nursing education and research until 1994 in 1993, the nursing informatics special interest Group was organized as one of the five special interest groups in the KOSMI, since the nursing informatics groups has held its own session at the biannual conferences of the KOSMI. 
•      The IMIA MEDINFO98, held in Seoul, provided an excellent opportunity for Korean nurses to become acquainted with Nursing Informatics.

USE OF INFORMATION TECHNOLOGY

IN CLINICAL PRACTICE

•            According to report published by the Korea Health industry Development Institute in 2000, 100percent of teaching hospitals, 96percent of general hospitals, and 75percent of private clinic now have hospital information systems ( Korea Helth Industry Institute 2000) 
•           A recent study shows that all of the teaching hospitals and about 40percent of general hospitals in Korea are using order communication system
•       In, addition about 95percent of teaching hospitals are equipped with picture archiving and communication systems (PACSs)

HEALTH INFORMATION EDUCATION

•      As information technology has become indispensable in healthcare and its impact on the daily activities of health care professionals has become significant, schools are beginning to realize the importance of health informatics education for clinicians.
•        South Korean medical and nursing schools, about 25percent of medical schools and 21percent of nursing schools offer health informatics courses,.

 RESEARCH

•         Most papers presented at KOSMI conferences and published in the Journal of the KOSMI since 1991 have addressed the application of commercially available programs, with more recent papers discussing the use of computers as a tool for nursing education.

SUMMARY

Ø  The Korean healthcare environment is becoming inhospitable due to high health care costs, increasing competitions among health care organizations, decreased funding from the government, and customers with more sophisticated demands.

    Most of the Korean healthcare organizations were computerized following the introduction of the national health insurance system.

      All of these developments have improved, either directly or indirectly the productivity of healthcare professionals, the efficiency and effectiveness of the health care industry, and also the education of health care professionals.

JAPAN      

Ø  The population in Japan is about 127million, which is about twice that of the United Kingdom and half that of United States.

Ø  All citizens can choose healthcare institutions and doctors freely, and their financial contribution to health insurance is proportional to their income.

Ø  Insured individuals and families to pay 30 and 30percent, respectively, of all health expenditure. 

HEALTH INFORMATICS IN JAPAN

Ø  Japan began to pay attention to all use of computers in health care during the late 1970s following the increased of computers in other industries.

Ø   The focus the shifted to research and development of systems at the organizational level, such as hospital and regional information systems, and research into basic information technology for healthcare such as data base design, network security, and data-switching technology.

History of Nursing Informatics in Japan

Ø  The Third International Congress ion Medical Informatics, MEDINFO80, organized by the IMIA, was held in Tokyo, Japan in 1980. This did not result in immediate progress in Japanese NI education, due to schools being vocationally oriented.

Ø  There are now more than 100 universities offering baccalaureate programs and 40 universities offering graduate program during the 1990s, with more nurses learning about utilizing computer in nursing practice through the activities of medical information department setting in national university hospital.

Ø  The annual meeting for nursing information system that was established as a task force  of the JAMI also support clinical practice , and most of its members are clinical nurses. The Japanese nurses association prepared a course on nursing information management as first step of a continuing education curriculum for ward manager.

 Nursing Informatics Education

Ø  As on April 2004, there were 486 professional schools, 31 juniors colleges , 129 universities , and 45 graduate school in Japan ,compared to 461 professional schools 74 juniors colleges and 30 universities in 1994. The increasing development of hospital information system in Japan has lead to discussion on the utilization of information technology in clinical nursing practice.

Ø  Universities provided elementary computer literacy education during the first half of the 1990s, but this became unnecessary thereafter due to the introduction of computer education into elementary and the junior high school.

   Ø  Overall , the teaching of computer literacy on document retrieval , utilization of statistical  processing and web utilization has increased, but barrier to the development  of the NI remain in Japan: (1)there are few researcher and educators in NI,(2)there is little development of educational tools, and (3) the cost of improving the network and computer environment is high.

 Nursing information  research

Ø  The amount of NI research is increasing in Japan , the two main purpose of which are improving the quality and standardization of nursing practice.

Ø  There were many report on research into the use of information technology as an education tool during 1990s.

   Nursing informatics practice 

Ø  Becoming a specialist in NI is useful when hospital information system and electronic health record are introduced.

Ø  Instead , the training of informatics nurses mainly occurs in hospital setting .  In each hospital, nurses working in medical information are active in committees and working groups.

  Their lack of formal technical education often cause difficulties , and hence it is predicted that the importance of nurses with NI education will increased.

   Hospital are looking for new healthcare staff with knowledge of both health care and information technology who can control information flow.

                             Japanese government initiatives and standard development in Japan.

Ø  An “e-Japan” strategy encompassing all Japanese ministries and related agencies in progressing now in Japan.

Ø  The terminology used in nursing practice has been collected , analyzed and redesigned. About 260 fundamental nursing practices have been identified and named in Japan.

Ø  The two hospital where electronic health record using this nursing terminology were developed have utilized the terminology describing nursing care plan and nursing orders and in the implementation of care and differences in the nursing order.

China

Ø  According to the fifth National Census reported by the national bureau of statistic ,the population of china was almost 1.3 billion in 2000. The population is aging fast with 65 years old and older representing 6.9%of the population in 2000, compared to 5.57 % in the 1990 census. The SARS epidemic in China lead to reconsiderations of the current healthcare system in rural areas. Some Chinese consider that the system is not moving forward and that more effort should be devoted to epidemic prevention, and that a new system of cooperative medical care and new salvation system of the poor should set up to ensure health and rural areas and enhance the stability of society  and economic development of country.

Ø  The China Medical Informatics Association (CMIA) was founded in 1981. There are two other professional societies related to medical informatics in China: The Chinese Society of Medical Information (under the China Medical Association) and the Chinese Hospital  Information Management Association (under the Chinese Hospital Association).It was founded in 1996,and its activities include holding national and international academic collaborations and exchanges, establishing rules and standards of national hospital management, and training hospital information management staff.

Nursing Information System in China

Ø  The nursing information management system began in China in late 1970’s and they were first use in 1987.Many hospitals  in China  now use nursing information systems, although there are no official statistics available. Some examples include nursing information system for the management of nursing staff, nursing operation works, continuing education, scientific research, and finance and economics.

 History of Nursing Informatics in China

Ø  Nursing Informatics Special Interest Group with 20 hospital nurses was founded as a branch of the CMIA in 1991. A later an expert group for nursing information technology was founded by the Nursing Department  of the Chinese Ministry of Health, its mission being to establish criteria for nursing management and the training of nurse administrator for nursing information management (Nursing Center, Ministry of Health,China,1995).The first article referring to the term ”nursing information science” appeared in China in 1999, and this led to the application of information technology in the field of nursing science for education and research. 

Nursing Informatics Education

Ø  Higher nursing education was introduced in 1983, and by 2001 there were 120 schools with 3-years diploma programs, 62 schools offering a baccalaureate, and 11 schools with master’s programs. At least one computer course is required at the baccalaureate level, and nursing students can select other computer courses as elective courses. According to a literature review, computer assisted instruction began at nursing institutes in China during the mid-1990s, since then it has been use to baccalaureate and continuing education courses in the clinical nursing field. The first distance learning program in China is a collaboration between China and Canada run by the school of Nursing, Tianjin Medical University in 1999.

Nursing Informatics Research

Ø  NI research is at its infancy in China, with only 30 research articles published in domestic nursing journals from 1994 to 2004(with key words related to the use of computers in nursing and nursing information with the research areas of nursing practice, nursing management, and nursing education).

Nursing Informatics Practice

Ø  The use of NI in clinical practice in China includes nursing quality

management, staff management, nursing information management,

And training clinical skills for staff nurses  (Zhang, Cheng, and QI, 2003).   Several expert system for nursing diagnosis, nursing care plan, and nursing assessment have been reported.

Thailand

•      Thailand is located in south east Asia with Burma, Cambodia, Laos, and Malaysia as    neighboring countries.
•      The country has a population of about 65million living in 76 provincies. 
•      The life expectancy of males and females is 71.6 and 74.7 years expectively 
•      Nursing informatics introduced as small special interest groups and later expanded to the national level through the support of the Nurses ‘Association of Thailand, the World health organization, and Ministry Of Public Health.

THE DEVELOPMENT OF HEALTH INFORMATION SYSTEM

• IN 1997 the Thai MOPH began to implement a national health information system, which included the development of nursing component.

DEVELOPMENT OF AN NMDS

• The first step in developing a nursing information system is to identify an essential NMDS, and here the process of developing an NMDS specific to Thailand is discussed.

Survey study identified 23 items of nursing data

•      patient name
•       hospital number
•      ID number admission number
•      patients address phone number address 
•      phone number significant person gender
•      birth date
•      religion
•      education
•      health insurance
•      patient and family
•      medical history/allergy
•      Admission date
•      Medical diagnosis
•      Laboratory test
•      Nursing problem
•      Nursing intervention
•      Nursing outcome
•      Discharge/expired date
•      Discharge plan,
•      Condition before discharge
•      Referral
•      Home visit

NURSING INFORMATION SYSTEM

Ø   A further attempt to implement the ICNP in the Thai nursing environment was the developed, a collaborative software called “Healthware 2000” by the MOPH Nursing Division for the collection and retrieval of nursing care data.

     PROFESSIONAL OUTREACH

Ø   The first Medical Consortium meeting in 1991 lead to the establishment of the Thai Medical Informatics Society (TMI), who introduce the concept of medical informatics into Thailand.

OBJECTIVES of the TNI

•      To be the center for coordinating and distributing medical information. 
•      To develop means for the management of medical information in administration and academic areas. 
•      To exchange information and experience in medical informatics. 
•      To support those who practice medical informatics. 
•      To provide suggestions and recommendations for medical information sectors both within and outside the MOPH. 
•      To not be involved in any commercial or political activities.

MAIN ACTIVITIES of TNI

•       Holding an annual conference. 
•       Supporting the meeting, training, and information sharing for the development of medical informatics in Thailand. 
•       Publishing and distributing four issues of documents per year as approved by the board. 
•       Being the center for the coordination of the medical information exchanges. 
•       Being the center for information and ideas focused on the development of medical informations.

     The TNI supports the development of NI, especially nursing databases using the ICNP. The society has collaborated with the Nurse’s Association of Thailand and the MOPH Nursing Division in validating and developing the ICNP. The Nurse’s Association of Thailand currently aims to develop a standard nursing care plan for clinical applications using the ICNP (Volrathongchai, Abbott, and Phuphaibul, 1999)

ACTIVITIES of TNI

•      Holding a joint annual meeting with the Nurses’ Association of Thailand and the Medical Informatics Society.
•      Publishing and distributing its new letter every 4 months. 
•      Supporting other academic and research activities in NI. 
•      Responding to the NI training needs of Thai.

TAIWAN 

          There were 610 hospitals and 175,000 healthcare professionals in Taiwan in 2002, serving a population of 22.5 million (Health and National Health Insurance Annual Statistics Information Service in Taiwan, 2004). The healthcare professionals included 34.4% registered nurses and 17.7% licensed practicing nurses.

NURSING INFORMATION SYSTEM in TAIWAN

          Based on the unpolished result of a 2002 National survey, only 27% of hospitals had implemented Nursing Information System, 9% were developing them , and 24% are making plans to develop them, whereas 40% were not planning to make any investment in Nursing In formation System in the near future.

                       

 

 Chapter 41

• Nursing  informatics in 13 south American countries has been based more on activities of individuals  than on a policy established  by government or national effort. 
• The growth of information technology   in Latin America   and Caribbean has been consistently the world’s highest for  20 years ;however ,significant  differences  exist among countries and regions in each country. 
• The use of technology by nurses follows the evolution of  technology  use in the region . Most  developed parts of the country have better access and  ability to implement  services  in application in nursing. 
• Computer are considered  an important  tool to help nurses take care of patient and to organize nursing service and nursing education . Consequently ,health  institute and universities are exploring ways to introduces new source in order to facilitate the process of patient care and promote quality and safety. 

     Background 

 

•  Nursing has been identified around the world as an emerging profession  for over 100 years. The  professional  evolution has  been a continuous  process influenced  by science and technology , which has been the driving force to further nursing development . Several  example of use of development of computer application in healthcare impact nursing profession. For many years nurses  were considered as the primary uses of technology of healthcare.
• Historically ,nurses are use to facing challenge adapting new tools into the practice to improve their performance , and creating new models to enhance patient care.
• Today’s technology cause significant modification of human activities and consequently, of the way  we learn  and work.
• Recognizing computer and all information technology resources  available  as powerful instrument. Gradually , each country became more aware of the possibilities to apply  information technology to enhance  activities in taking care of clients /patients. There is a clear trend in the direction of the computerization  of health. In addition , more people are able to connect to the  internet  that is a telecommunication with no parallel to fast exchange data and information .

     Considering trends and tendency in healthcare informatics and to facilitate the process in the south America  countries , the Pan America health organization (PAHO) has published guideline and protocol to orient the development of information and communication technology  in Latin America  and the Caribean.\

Nursing informatics initiatives

     In South American countries, as any other country in the world , the initial motivation to develop systems in the healthcare in the health care area was driven by financial and administrative concern.

Although clinical information system are being used in the some ways  to support clinical care and  management , a few hospital or healthcare institutes  developed application for nursing documentation where nursing data can be processed.

     Hospital have been working to design  their own system  in order to attend  ton specific needs and policies . More  recently  national and international software industry became more represented in the South America  health care market.

   Many additional initiatives are spread throughout  the Latin America. Clinical system based on the nursing  process are not common in these countries . Most of the computer system implemented are intended to control administrative data . The most  frequently implemented and used application still are nursing orders.

   In addition, as an open evolving market , international developers  are making investment to sell and implement computer system in South America represent one of the most promising market in the world of technology.

   Congress, conferences, workshop, education and training  programs are being organized in the countries to share experiences and information in nursing informatics searching for solution that could enhance the delivery of patient care.

Distance Learning and the educational perspective

In nursing informatics.

Technology   is transforming not only nursing practice but also nursing training and education models. With the introduction of computers in the health care area, nurse became primary user, responsible for data input.

     Computer  application in nursing education are also changing , nursing education from passive teaching to an active learning process.

      Formal education program in nursing informatics such as specific nursing informatics specialization and master or doctoral course is also being provided.NIEn/UNIFESP also provide, since 1989, the nursing informatics discipline in its graduate and undergraduate nursing program. The research "line" in nursing informatics is attended by professional from different region of the country and has been responsible for the preparation of several master and doctoral students in nursing informatics.The students after graduation return to their own institutes to implement education and research program and to participate in the development of patient care system.Latin America countries are investing significant effort to prepare professional in health informatics. An example of  this was recently implemented in Brazil.  A four year grant from Fogarty International Center of the National Institutes of  Health.. 

                                    Nursing Terminologies and Documentation

Sharing and communicating information is essential to make decision and deliver care. Exchange of information requires the communicating parties to agree on a communicating channel ,an exchange protocol, and a common language. The language includes an alphabet ,word ,phrases , and symbols that express and assign ,meaning , understood by all user. Clark(1995) pointed out that "communicating" among our selves has always been important but comunicating with other people about nursing has acquired a new urgency since we are forced to recognized that the value of nursing is no longer apparent to those who have the power to impluence our practice,In 1990 , the International Council Of Nurses(ICN) initiated a long term project to develop an International Classification for Nursing Practice(ICNP) with the objective to establish acommon languege about nursing care for people in a variety of setting. In Brazil , the dissemaination of the ICNP started around 1996, when NIEn/UNIEfESP became a sponsoring partner in the telenurse Consortuim ,a project led by Randy Mortersen , director of the Danish Institute for Health and nursing Researh. Several obstacles have yet to be passed before nursing communities embrace a standardized vocabolary that proves useful in a variety of task and setting ; regional , national and international . Historically, nurses have several problem in obtaining nursing documentation.Currently , with the expansion of health knowledge and information , the quantity of nursing documentation has certainly increased  :how ever the same cannot necessarily of the information documented. Health data rarely become health information. The main goal  was to charactererize how nursing informatics and the use of standard can improve nursing practice and management ,taking advanatges of resource .                        
                                                                                                
     

  Chapter 42

Future Directions

Kathleen A. McCormick

This fourth edition contains much that points the reader to the foundations of the future. The excitement of the electronic health record (EHR), open source, international standards, biodefense, Internet, handheld, and PDAs are a few of the peeks into the future. The authors are experts in these areas and have dedicated an entire chapter to describe their application to the nursing profession. This chapter aims to synthesize a vision of what healthcare might have for information system needs in the future years.

The New Twenty-First

 Century Scenario

• The nurse of this decade has much more evidence to point to in the patient’s genes, genomes, and proteomes. 
•   The new science will also allow the nurse to point to the particular patient’s reason for myocardial infarction, whether the person can regulate calcium, sodium, potassium compared to normal persons, or whether the ultimate of their food digestion leads to more cholesterol production or more glycogen storage. 
• The nurse needs new resources to monitor evidence for conducting genetic screening on children born with autism. 
• Nurses may be need environmental, agricultural, and health data combined. 
• The scenario begins and ends with the genetic information. Whether the concerns of the nurse are prevention, diagnosis, cure, or rehabilitation, the evidence will come from the genetic profiles.

A President and a Secretary of Health Decree Acceleration

There is reason for optimism for a shortened future toward achieving the informatics goals described in this book. The primary reason is a President who in his State of the Union Address said:

             “By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care”.

April 27, 2004 > the announcement of President Bush’s groundbreaking Health Information Technology (HIT) Plan was made during his speech at the American Association of Community Colleges Annual Convention in Minneapolis.

 The President set a 10-year goal for majority of Americans to have EHRs when and where they are needed. To accomplish this goal and to coordinate federal HIT efforts, the creation of anew, sub-Cabinet level post at the Department of Health and Human Services (HHS) is another major tenet of the President’s HIT Plan. But to achieve that goal, Dr. Charles Safran, the former President of the American Medical Informatics Association (AMIA), has said that we will need 6,000 more physicians and 6,000 more nurses prepared in information sciences to in this direction.

A Nation’s Health Information Technology Plan

President Bush’s HIT Plan also called for:

•      The federal government to accelerate the identification and adoption of voluntary standards necessary for the safe and secure sharing of health information among health providers. 
•      Increase money for demonstration projects involving modern electronic records systems that test IT and establish best practices for wider adoption, including a doubling of demonstration project funding to $100 million in the President Bush’s budgets. 
•      Creating federal incentives and opportunities that encourages healthcare providers to use electronic medical records.

National Standards Endorsement on July 1, 2003

Ø Prior to these announcements, July 1, 2003, former secretary of HHS, the Honorable Tommy Thompson, announced two new steps in building a national electronic healthcare system that allowed patients and their doctors to access complete medication records anytime and anywhere they are need, leading to reduced medical errors, improved patient care, and reduced healthcare costs.

Ø  College of American Pathologists(CAP) to license the College’s standardized medical vocabulary system(SNOMED) and make it available without charge throughout the United State

Ø  Instituted of Medicine (IOM) to design a standardized model of an EHR.

                        

     IT in Relationship to People,

    Organizational, and Policies

During  this conference there was a general consensus among the presenters and participants, that in the past 25 years of implementing systems, people, organization, and policies are dominant forces 90% of the time and the IT is only 10% of the implementation.

Several Drivers of More Information Technology Today

·        A recent American Hospital Association and Cap Gemini study forecasts top issues.

·        Among their issues are rising costs and limited access to capital

·        The consumer and patient have shifted focus away from the hospital toward a focus on the consumer and patient themselves.

HImss Leadership Healthcare CIO Surveys

Healthcare Information Management Systems Society (HIMSS) annual survey of healthcare Chief Information Officers (CIOs).  Upgrading security on IT systems to meet Health Insurance Portability and Accountability Act (HIPAA) requirements followed that issue.

The top Technologies that the CIOs predict for the future were:

    High speed networks

    The Internet

    Client server systems

    Wireless information systems

Additional needs included patient scheduling, additions to their Websites, and IT outsourcing of functions. Table 42.1 lists some of the technologists that may be important drivers in the future.

Table 42.1 Future Trends in IT

Bar coding     Bioinformatics/Biomedical Informatics/ Computational     Biology     Claims Processing     Client server systems     Data Warehousing    Decision Support     Disease Management/Outcome     Electronic Health Record – Clinical Information Systems- Computer- Based           Patient Records- Hospital/Healthcare     Information Systems     High speed networks     HIPAA compliance     Identify management- Smart Cards     Laboratory Information Management Systems     Medication error prevention/Patient Safety     Mobile computing/technology/wireless     Outsourcing services     Personal Digital Assistants (PDAs)     Point- of- care Computing     Practice Management     Prescription Management     Scheduling     Security upgrades     Speech Recognition     Standards     Supply ordering/management     Telecommunications/Telehealth/Telemedicine     Vocabulary integration/interface     Web portals/Internet access to/from staff/ professionals/consumers

Trends Toward 2030

Major trends in healthcare that will influence the IT developments are those in Table 42.2. Each of these will be described briefly in the remainder of this chapter:

Table 42.2 Trends in Health Affecting IT in the Future

Demographics- the graying of America     Growth in chronic disease     Emerging infectious disease threats     Changes in health- seeking behavior toward the Internet     Focus on quality = focus on IT     Security and biodefense     Genetic revolution

Growth in Chronic Diseases

Among the chronic diseases expected in the future are Ischemic Heart Disease, Unipolar Major Depression, Road Traffic Accidents, Cerebrovascular Disease, Chronic Obstructive Pulmonary Disease, Lower Respiratory Infections, Tuberculosis, War, Diarrheal  diseases, and HIV.

    The following are reasons children will continue to die in the next decade:

v  Mixed causes: 33%

v  Unintentional injuries: 22%

v  Congenital anomalies: 12%

v  Homicide and suicide: 8%

v  Short gestation: 8%

v  SIDs: 5%

v  Cancer: 4%

v  Respiratory Distress: 2%

v  Heart Disease: 2%

v  Placental cord membranes: 2%

v  Complications of pregnancy: 2%

Emerging Infectious Disease Threats

§  Flu

§  Respiratory infections

§  HIV/AIDS

§  Diarrheal diseases

§  Tuberculosis

§  Malaria

§  Measles

§  Pertussis

§  Tetanus

§  Meningitis

§  Syphilis

§  Antibiotic resistant disease

These are naturally occurring threats from infectious diseases without a bioterrorism event. These infectious diseases and new strains of the flu can cause worldwide devastation due to our global lives and our mobile society.

Security and Biodefense

•       Surveillance systems
•       Preparedness planning and readiness management programs
•       Control and disease prevention guidance embedded in decision supports
•       Vaccine and drug delivery registries, adverse drug reporting systems, and stockpile warehouses 
•       National education and health alert networks
•       Emergency response operational plans and systems
•       Quarantine databases and logistics planning
•       Mobilization and workforce systems  Field reporting via wireless and PDAs
•       Remote education and training Web- based and distance education facilities 
•       Real-time decision support systems
•       Database integration and interoperability
•       Assurance of services
•       Sustainment and improvement in delivery systems
•       Adverse drug reporting and hazard monitoring
•       User registration and workforce deployment registration systems
•       Data standards with specific terminology for biosafety and security
•       Information security assurance
•       Automatic access to policies, reporting requirements, and practices of multiple government

 Genetic Revolution

•  Genes are the segment of the chromosomes that regulate the fundamental physical and functional units of heredity. Genes regulate the synthesis of proteins 
• Genomics is the identification and functional characterization of multiple genes. Microarray technologies help to decipher the functional implication of gene expression and unravel some of the information related to the gene function 
• Proteomics is the analysis of a set of proteins in a cell that in turn is determined by gene expression at the protein level

Nanotechnology

•  refers to the interaction of cellular and molecular components of engineered materials-typically clusters of atoms, molecules, and molecular fragments-at the most elemental level of biology. 
• involves shrinking to the atomic scale, the diagnostics and treatments of our future, and studying the simplest parts of biology like flow of water, calcium, sodium, and potassium into and out of cells.

The most promising science to allow:

        1. Scientific investigation into the molecular nature of disease

        2. Simultaneous measurement of gene and protein expression

        3. Recognition of specific protein structures and

             structural domains

        4. The following of protein transport among different

             cellular compartments (NCI, 2004)

    Nanotechnology is said to be the biggest natural bridge between life sciences and physical sciences and requires interdisciplinary research and applications.

    Table 42.4 Genetic Academic Programs  and Other 

     Resources 

• University of Iowa College of Nursing MSN Genetics Nursing Programs 
• Cincinnati Children's Hospital Medical Center Genetics Programs for Nursing 
• Genetic Health Nursing, College of Nursing, Rush University, Chicago 
• University of Washington/Seattle Advanced Practice Genetics Nurse Program 
• University of California/San Francisco, Genomics Specialty Options, Department of Physiological Nursing 
• The National Coalition of Health Professional Education in Genetics 
• The International Society of Nurses in Genetics

Nursing and the Core Competencies for the Future

    Nurses have been involved as genetic counselors and have defined the core curriculum for this specific domain. The entry in genetic nursing in the future will require nurses to complete graduate degree programs and clinical practice requirements in genetics medicine, human genetics, and/or genetic counseling according to the International Society of Nurses in Genetics (ISONG).

          Ethical, Social, and Legal Issues

•   Assure patient informed consent
•  Assure confidentiality and security of information 
•  Assure that patients are not discriminated against 
• Assure access to genetic technologies from vulnerable and minority populations  
• Assure culturally sensitive genetic counseling