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Journal of Genetic Counseling, Vol. 9, No. 3, 2000

Book Review

Genetics in Clinical Practice: New Directions for Nursing and Health Care.By D. H. Lea, J. F. Jenkins, and C. A. Francomano. Jones & Bartlett, Sudbury,MA, 1998, 300 pp.

Janet K. Williams, PhD, RN, CPNP, CGC1,2

The integration of genetic information into every aspect of health care ispredicted by genetics leaders and has received an enthusiastic response by nursesin many nursing specialties. It is a daunting challenge to write a text on genetichealth care for nurses that is not limited to age of client or nature of health caresystem in which the client receives services. This text is directed toward the gen-eralist nursing professional, and the authors of this text are to be commendedfor producing a text for such a wide audience. This book is timely and containsinsights from authors who are experienced in clinical genetics and who clearlyunderstand the profession of nursing. Two authors are genetics advanced practicenurses, and the third author is a physician. The entire text reflects a respect forclient autonomy and an understanding of the roles of nurses with regard to assess-ing client understanding of genetic aspects of health and disease, identifying needfor referral, and nursing responsibilities in genetic testing for clinical and researchpurposes.

A strength of this text lies in its reader-friendly format. The chapters applygenetic concepts in clinical case situations and include questions and activities toencourage the reader to seek further information on the Web, in the literature, orthrough other knowledgeable resources. The book can be useful as a handbook forpracticing nurses who wish to look up specific topics, and as an introductory textfor nurses or student nurses with minimal clinical genetics background. However,this text does not provide a comprehensive overview of application of geneticconcepts to clinical practice, and readers will need to supplement the text withadditional readings on specific topics.

The target audience for this text is the professional nurse or nursing studentwho has little background or experience in genetic health care. Prior to the first

1College of Nursing, The University of Iowa, Iowa City, IA.2Correspondence should be directed to Janet Williams, 356 Nursing Building, College of Nursing,University of Iowa, Iowa City, IA 52242.

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1059-7700/00/0600-0271$18.00/1C© 2000 National Society of Genetic Counselors, Inc.

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chapter, a self-awareness activity is included which can help the reader identifyways in which his or her life experiences may influence integration of genetic infor-mation into professional nursing practice. Each chapter provides Web page links,objectives, rationale, application activities which are written as behavioral out-comes, and summary points. Many chapters contain questions for critical thinking.

The first two chapters are on the Human Genome Project and on genetics andhealth care. Both are brief and serve as an introduction to material that appearslater in the text. Chapter 3, “The Scientific Basic of Genetics,” provides a veryunderstandable introduction to clinical genetics for the reader who is not familiarwith these concepts. The inclusion of case studies at the end of this and otherchapters facilitates the learner’s movement from comprehension of selected basicgenetic concepts to application of introductory genetic content in clinical nursingpractice. Some case studies include a discussion covering the major applicationissues, while other cases in the appendix require analysis by the reader. These latercase studies would be appropriate for class discussion, and the development of aninstructor’s guide would be a useful addition to this text.

Several chapters focus on aspects of genetic health care that can be part ofany nursing situation. Application of genetic concepts is illustrated in chapter4, “Integrating Genetics into Nursing Practice.” Nursing interventions are brieflymentioned, but the majority of the chapter focuses on assessment. Here the reader isintroduced to elements of a family history, a screening questionnaire, and physicalassessment. Addition of basic concepts of identification of dysmorphology andgrowth alterations that are found in common genetic conditions would strengthenthis content. The chapter concludes with a discussion of informed consent forgenetic research, a situation in which many nurses will participate. This chapteris followed by one on what to expect from genetic counseling, which discussesthe interdisciplinary team and components of the genetic counseling process. Thediscussion of this process for clients at various points in the life span makes iteasy for readers to find information that would apply to a specific group of clients.Chapter 6 focuses on genetic testing, with application of content in examplesfor diagnosis, carrier testing, and presymptomatic testing. While the book coversmany relevant topics, it lacks a section on the discussion of laboratory issuessuch as the time between sample receipt and results, how the report will be issued,availability of genetic professionals who can provide an interpretation of the report,and credentials of the laboratory. This content would be particularly useful fornurses in clinical practice.

The book continues with more in-depth information in the next two chapterson the genetic basis of cancer and cancer risk assessment and counseling. Geneticand other factors in etiology of cancer are introduced, and cancer risk counseling,susceptibility testing, and psychosocial issues are reviewed. In these chapters,elements of genetic testing and informed consent are expanded upon. There is achapter on ethics, genetics, and nursing practice, with the focus primarily on genetic

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testing. The book concludes with a brief chapter on genetic health care issues in thefuture. National and regional resources are listed, and the self-awareness survey isrepeated.

Genetic counselors may find this text useful as a resource for presentations toundergraduate nursing students or in continuing nursing education programs foraudiences that have had minimal exposure to clinical genetics. The case studiescan be especially helpful in assisting learners to make the transition from basicscientific concepts to clinical situations and to foster clinical decision making. Foradvanced practice nurses, the text provides useful definitions and an introductionto basic genetic concepts, but this audience would benefit from a more in-depthpresentation of content and references directed to their particular areas of nursingpractice.

This book presents an overview of current clinical genetic topics in a formatthat will appeal to busy practitioners. There is a paucity of accessible, understand-able, and clinically useful introductory resources on genetics for practicing nurses,and this text begins to fill that void. With the increasing emphasis on genetics innursing education, this reviewer hopes the authors will increase the depth andscope of content of this text in a future edition.