Nursing Trend: Cloning
Elizabeth Bauer
Lakeview College of Nursing

	There is an ongoing debate about something that affects healthcare directly. That ongoing debate is human cloning. Whether you are in support of, or actively against human cloning, the fact remains that someday you will probably be touched by it in someway. In order to form an opinion of cloning, one must be educated in what it is. After the definition is established, the view points on opposing sides will be explained and considered. Once this has been established, the significance that cloning has on the nursing profession will be delved into. And lastly, the impact on the nursing care recipient will be considered.
	In 1997, the world was introduced to a “new” technology- cloning. The introduction was made by a sheep named Dolly. Her creator, Ian Wilmut is the head of the Department of Gene Expression and Development (Kennedy). It is there that Wilmut changed the world concerning bioethics. In bringing cloning to the public eye, many issues needed to be addressed concerning this. However, first one must know the definition of cloning and what it entails. In cloning, there are multiple factors that are brought together. The first being genomics, which is the study of all the genes in the human genome  that include their reactions to each other, the environment, psychosocial, and cultural factors (Simpson). The second being cloning itself, which is replicating the exact makeup of a cell from an existing donor cell. With this interest, comes the idea of integrating the two (cloning and genomics). Of course, with the issue of cloning human cells, many more issues have arisen. Most of which revolve around the ethical, moral, and legal standards of healthcare.
	According to our book, bioethics is concerned with determining what should be done in a specific situation by applying ethical principles (Chitty). There is an understanding that when cloning is involved, there are ethical issues to be addressed. This has to do with the fact that ethics can be used to describe what actions an individual should take (Chitty). It does not, however, give an exact right or wrong answer to the issue of cloning. It is in each of our intellectual abilities to either accept this practice as something to be considered standard in the future, or to deny it’s capabilities based on our own set of morals.
	According to David Stevens, the executive director of the Christian Medical Association, cloning human cells is completely wrong for any reason. He states that manufacturing a human being for the sole purpose of research, and then to just discard that human being after you are finished is motivated mostly by greed- not humanitarian efforts (Pulse). He also states that there are no benefits of human cloned embryos. There are, however, benefits of using adult stem cells to help cure diseases.
	However, on the opposite spectrum of this issue, is Roy Simpson. He concludes that genomics is a now integral part of nursing whether you agree or disagree with it. This includes genetically modified foods and pharmaceuticals, along with cloning. He also states that nurses must be prepared to accept genomics and accept it as an inevitable incursion into nursing (Simpson). 
	This has quite the significance for the nursing profession. As genomics makes it way into the everyday nursing processes, each individual nurse must learn how to accept and integrate it into the nursing care that they provide. Some things are easier to accept for some nurses than others. For example, genetically modified foods are not quite the same pill to swallow as human cloning. Both involve the human genome though, and are related by that involvement. The other slightly less ethical issue involving genomics is targeted pharmaceuticals (Simpson). By having the right information provided by genomics, companies are able to provide medications that are targeted for certain people. This helps with the  overall effectiveness of the drug and allows that drug to work much better than before.
	Although nurses must one day recognize and accept the reality of certain ways that human genomics will impact nursing as a profession, one thing they will not have to worry about is the decisions they would have to make regarding the care of a cloned human being. The reason for this is that the 59th General Assembly has adapted the United Nations declaration surrounding human cloning. On August 3,2005, the General Assembly voted into action the forbidding of all forms of human cloning. The reasoning behind this decision was to protect human life, prohibit genetic engineering that contradicts human dignity, to help prevent the exploitation of women, and to implement national legislation (Assembly). 
	Although the United States has adopted the declaration that states that human cloning is wrong, some researchers are working around it. In the U.S. specifically, it is illegal to use federal money to research human cloning. In order to work around this, some researchers use private money, or state funded money in order to continue the research, which is not illegal. This is one way that an overall idea can be adopted by a group of people (or system), and then worked around by some subgroups within that group of people.
	However, if a nurse thinks that he or she may never take care of a patient who has received cloned cells, they may want to think twice. Ian Wilmut, of the Department of Gene Expression and Development at the Roslin Insistute in Scotland, has been given the permission to clone human embryos for medical research (Kennedy). The plan of this experiment is to clone embryos for patients with amyotrophic lateral schlerosis, or ALS, in order to help their disease. ALS is a disease that includes neurons that affect voluntary muscle movement in the brain.  He will clone the embryos and use the stem cells from the cloned  human embryos. He then will discard (or destroy) of the embryos 14 days after their creation (Kennedy).
	 This experiment may directly affect nurses and the care that is provided to their patients. The impact on nursing care for the recipient would be quite significant. For example, if a patient had ALS for an extended amount of time and then was able to use cloned stem cells from a cloned human embryo, their disease would be quite less hopeless as before the stem cell transplant. It may help them significantly and impact the nursing care provided to them. Something like that would change their life, and if all went well- for the better.
	As a nurse, one must be open to the reality of this concept. A professional quality that is needed in this case is open-mindedness. It is  not the nurses position to judge a patient on where they were able to seek a cure from. It is solely the nurses responsibility to accept that patient as needing their care, and to provide care to that patient in the best way possible. 
	The Human Genome Project , which is an international effort that began in 1990, studied the human genome (Simpson). It has addressed issues that have arisen with the new knowledge that was gathered from its efforts. From this project, much has been learned about human genomes. Some of this knowledge has been applied to cloning. And some of this knowledge can be applied to nursing care for the recipient. Taking genomics into consideration, a nurse may be able to assess a patient’s condition based on their genetics, the nurse may be able to recognize a newborn baby’s risk of developing genetic metabolism errors, or identify a couple that are at risk for having a child with a genetic condition (Simpson).  These are just some ways that using knowledge about the human genome can benefit the nursing profession and have an impact on nursing care for the recipient. 
	While cloning may remain an unsolved issue, genomics has been brought to light because of the possibility of cloning. Genomics will influence nursing care tremendously through-out the years. The possible ways of influence are through genetically modified food and targeted pharmaceuticals, as well as the nurses ability to recognize signs of genetic problems in patients.
	In summary, cloning has much impact on the healthcare field. There are many opportunities that lie ahead with the possibility of cloning. However, there are many moral, legal, and ethical issues that arise out of the subject of cloning. You now know that genomics is the study of all the genes in the human genome and that cloning is replicating the exact make up of an existing donor cell. In regards to the significance for the nursing profession as a whole, the United States has adopted a rule of no human cloning. Although some researchers have found a way around this adoption. They have been funded privately and therefore can research by cloning human embryos. In Scotland, Ian Wilmut  is cloning human embryos for the stem cells in which he will use to help cure ALS in adult patients. This would directly affect the nursing care recipient in a good way. 	Overall, it is to be believed that there is a benefit to cloning, should there ever be a halfway meeting point between ethical and logical implications of cloning.
Reference Page

Assembly, G. (2005, August 5). General assembly adopts united nations declaration on human cloning by vote of 84-34-37. Retrieved from http://www.un.org/News/Press/docs/2005/ga10333.doc.htm

Chitty, K.K., Black, B.B. (2007) Professional Nursing: Concepts and Challenges. St. Louis, MO: Saunders Elsevier

Kennedy, M. (2005). News: world health roundup. American Journal of Nursing, 105(5), Retrieved from http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=582795

Pulse beats. (2002). Journal of Christian Nursing, 19(4), Retrieved from http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=725084

Simpson, R. (2006). Genomics meets nursing practice. Nursing management, 37(12), Retrieved from http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=683043 

8/3/2005 
	Press Release
GA/10333 	

Fifty-Ninth General Assembly
Plenary
82nd Meeting (AM)
GENERAL ASSEMBLY ADOPTS UNITED NATIONS DECLARATION
ON HUMAN CLONING BY VOTE OF 84-34-37
The General Assembly this morning adopted the United Nations Declaration on Human Cloning, by which Member States were called on to adopt all measures necessary to prohibit all forms of human cloning inasmuch as they are incompatible with human dignity and the protection of human life. 
Acting on the recommendation of the Sixth Committee (Legal), contained in its report A/59/516/Add.1, the Assembly adopted the text by a vote of 84 in favour to 34 against, with 37 abstentions (See Annex). 
By further terms of the Declaration, Member States were also called on to protect adequately human life in the application of life sciences; to prohibit the application of genetic engineering techniques that may be contrary to human dignity; to prevent the exploitation of women in the application of life sciences; and to adopt and implement national legislation in that connection. 
The Declaration adopted today was the product of a Working Group established by the Assembly to finalize the text of a United Nations declaration on human cloning, which met in New York last month. Last November, the Sixth Committee averted a divisive vote on the question of an international convention against human reproductive cloning by deciding to take up the issue as a declaration.
Regretting the failure to achieve consensus, several delegations said they had voted against the text today because the reference to “human life” could be interpreted as a call for a total ban on all forms of human cloning. The Assembly had missed an opportunity to adopt a convention prohibiting reproductive cloning, said the United Kingdom representative, because of the intransigence of those who were not prepared to recognize that other sovereign States might decide to permit strictly controlled applications of therapeutic cloning. Echoing the views of a number of speakers, he said the Declaration was a non-binding political statement, which would not affect his country’s position on the issue.
Those in favour of the Declaration welcomed its adoption, saying it constituted an important step in the protection of human dignity and the promotion of human rights, as well as a stepping stone in the process towards a complete ban on human cloning. The text, noted Costa Rica’s representative, sought to advance science in a clear framework of ethical norms. The text, added Ethiopia’s representative, sent a clear message against unethical research which made human life the object of experimentation. 
Also this morning, the Assembly conveyed its deepest condolences to the families of the nine United Nations peacekeepers from Bangladesh who were killed in the Democratic Republic of the Congo on Friday, 25 February. 
In addition, the Assembly was informed that Afghanistan, Cape Verde, Côte d’Ivoire, the Dominican Republic, Palau and the Solomon Islands had made the necessary payments to reduce their arrears below the amount specified in Article 19 of the Charter.
The next meeting of the Assembly will be announced in the Journal.
Explanations after Vote
The representative of Mexico, speaking in explanation of position after the vote, said that those negotiating the Declaration had had to take into account uncertainty over new scientific advances, as well as its ethical, cultural and religious implications. There was a dichotomy between reproductive and therapeutic cloning and, during the entire process,Mexico had focused on seeking a consensus, first on the negotiation of a mandate and subsequently on the text itself.
Regretfully, it had not been possible to achieve a consensus that would facilitate a universal norm, he said. Despite the fact that some delegations had decided not to yield in their original positions, many of their concerns had, in fact, been included in the final text just adopted. The text had the fundamental concern of guaranteeing human dignity and it reflected a realistic form of compromise. Hopefully, the National Parliament would take the necessary action, as the letter and spirit of the Declaration were in step with Mexican legislation and jurisprudence.
The representative of China, also speaking in explanation after the vote, said that different countries varied in their understanding of the text’s inherent moral, ethical and religious aspects, and it was regrettable that the Declaration failed to give effect to the concerns of those countries. The prohibitions contained in the text could be misunderstood as covering all forms of cloning. Having voted against the Declaration, the Chinese Government would continue to adhere to its position against reproductive human cloning, while maintaining strict controls over therapeutic cloning.
The representative of India expressed deep regret that the Sixth Committee had been unable to recommend to the plenary a text that was acceptable to all Member States on a matter of such paramount importance as an international convention against the reproductive cloning of human beings. India had voted against the political Declaration, as some of the provisions of the Declaration could be interpreted as a call for a total ban on all forms of human cloning.
India remained totally opposed to reproductive cloning owing to the doubtful nature of its safety, success, utility and ethical acceptability, he said. However, the merits of therapeutic cloning were considered on a case-by-case basis within the bioethical guidelines laid down with the approval of the National Bioethical Committee. The Declaration voted upon today was non-binding and did not reflect agreement among the wider membership of the General Assembly. India’s approach to therapeutic cloning, thus, remained unchanged.
Belgium’s representative regretted that it was not possible to find agreement on a Declaration that could have found consensus in the Assembly. Today’s vote reflected the wide divergence in the international community on the text. Rather than bringing States together, it had divided them. It was essential that reproductive human cloning be prohibited. However, it was reasonable to preserve, at the national level, the possibility of carrying out therapeutic cloning. 
The representative of the United Kingdom said he voted against the Declaration, because the reference to “human life” could be interpreted as a call for a total ban on all forms of human cloning. He could not accept such an ambiguous Declaration, which might sow confusion about the acceptability of that important field of research. The Assembly had missed an opportunity to adopt a convention prohibiting reproductive cloning because of the intransigence of those who were not prepared to recognize that other sovereign States might decide to permit strictly controlled applications of therapeutic cloning. The Declaration voted on today was a weak, non-binding political statement that did not reflect anything approaching consensus within the Assembly, and would not affect the United Kingdom’s strong support of stem cell research. 
Hungary’s representative said he voted in favour of the Declaration because it attached the utmost importance to sending a strong message that the birth of cloned human beings was not acceptable. Furthermore, during the conduct of life sciences, there was a need for a delicate balance between the freedom of research and the adequate protection of human life and dignity. Also, the Declaration was in line with the existing obligations of Hungary under international law. He hoped the Declaration was only one step in the consideration of human cloning, and not the final stage. Hungary was open for further discussions in the international community at the appropriate time.
The representative of the Republic of Korea said his country had voted against the political Declaration, which had not achieved a political consensus. It was not binding and would not affect the Republic of Korea’s future position on therapeutic cloning, which would reaffirm human dignity by relieving pain and suffering.
The representative Thailand expressed regret that the General Assembly and the Sixth Committee had been unable to adopt a consensus Declaration. The Declaration just adopted was not binding and the text was ambiguous. In light of that, Thailand had voted against the Declaration and felt that it should be left to Member States to use their own interpretation as to whether or not to prohibit therapeutic cloning.
The representative of Spain said that the term “human life” contained in the text was confusing and should be replaced by the term “human being” as used in scientific texts. The Declaration did not cover the well known fundamental differences between the two types of cloning. The fact that there had been no consensus on the issue after four years of discussion showed just how precarious the text was as adopted. Spain was opposed to reproductive cloning, but favoured therapeutic cloning, which was looked upon positively by the scientific community. The issue would now be passed on to the National Parliament.
Japan’s representative said he had voted against the resolution. The Declaration was difficult to interpret and did not respect the various views of Member States. The adopted text would not affect Japan’s domestic legislation on the issue. 
The representative of Brazil regretted the lack of consensus on the text adopted, which highlighted the deep division in the international community on the issue. He also regretted that the Sixth Committee had deviated from its original mandate to elaborate an international convention on human cloning. He had voted against the text, which did not contain language consistent with his country’s position on the issue. 
Singapore’s representative said he had voted against the resolution because it did not capture the diversity of views on the issue. Four years ago, the Assembly endorsed an initiative to begin work on an international convention on human cloning. There was still unanimity that reproductive cloning should be banned. It was unfortunate that that initiative was hijacked, and culminated today in the adoption of a text which sought to impose a single set of regulations on States regarding all forms of human cloning. 
The representative of the United States, welcoming the adoption of the Declaration, recalled that his delegation had explained its position in the Sixth Committee and would not give a further explanation today. The full text of that explanation was on the web site of the Permanent Mission of the United States.
The representative of Poland said his delegation had voted in favour of the Declaration and unequivocally opposed the cloning of human embryos. Any use of human stem cells should be permitted only when the stem cells or stem cell lines were obtained from supernumerary cells, or when donors had expressed their willingness to permit it.
The representative of South Africa said his delegation had abstained from the vote and found that the language of the text was deliberately ambiguous so as not to infringe on the rights of those who wished to continue with research in their own jurisdictions. South Africa was against reproductive human cloning and would continue with the strict regulation of therapeutic cloning. South Africa considered therapeutic cloning to be aimed at protecting human life and, as such, it was not inconsistent with the Declaration just adopted.
The representative of Canada, emphasizing that his country’s position was clear, said reproductive cloning was illegal in Canada in whatever form. The ambiguity of the Declaration might give rise to certain political and other concerns.
Norway’s representative said that his Government opposed both reproductive human cloning and therapeutic cloning, as reflected in its domestic legislation. It had sought to contribute to the elaboration of an international convention on the issue. At the same time, it had been willing to go along with a declaration, as long as it enjoyed consensus. He had voted against the Declaration, since it did not reflect the views of all States and did not enjoy consensus.
The representative of Costa Rica said the adoption of the Declaration today constituted a historic step to promote human rights and guarantee human dignity in all circumstances. The text urged the scientific community to advance, bearing in mind the value of human dignity and human life. It was impossible to reach a consensus because a small group of States had rejected all reference to human life in the text. The Declaration sought to advance science in a clear framework of ethical norms. It was of concern that some delegations had undermined the value of the Declaration, which had received majority support. 
France’s representative said she regretted the failure to find consensus. She was convinced that there was a clear consensus regarding the prohibition of reproductive human cloning. Also, given the threat of dangerous experimentation, it was essential to prohibit reproductive human cloning. However, she could not agree on prohibiting all forms of cloning. France had voted against the Declaration, and regretted the inability of the Assembly to send a universal message on such a vital issue.
The representative of Nigeria regretted that he was not in the room when the voting took place. He was fully in favour of the Declaration. His country supported the Declaration because there was no alternative to it, for the time being. Human life was sacrosanct, and there was no reason for its violation. It was an inconceivable paradox that proponents of therapeutic cloning would sacrifice the life of one in order to serve another. He stressed that human cloning was unethical and a direct assault on human dignity. Today’s Declaration was only a stepping stone in the process towards a convention on a complete ban on human cloning. 
The representative of Mali said, had his delegation been present, it would have abstained from the vote, in accordance with the common position of the Organization of the Islamic Conference.
The representative of the Russian Federation said that the question involved complex scientific and ethical issues and that his country had always been in favour of consensus. Regrettably, there had been no consensus. But, the Russian Federation had voted in favour of the Declaration, in order to send a message to the international community about the impermissibility of reproductive human cloning.
The representative of Uganda said that her country had voted in favour of the Declaration because it opposed the destruction of human embryos and believed in the protection of human dignity. The Declaration was consistent with humanity’s responsibility to protect the sanctity of human life.
The representatives of the Netherlands said his country had opposed the Declaration because it could be interpreted as a total ban on all forms of cloning. There was a need for strict oversight, but not a total ban. The Declaration just adopted was not binding.
The representative of Ethiopia said he had voted in favour of the Declaration, which sent a clear message against unethical research, that made human life the object of experimentation. He hoped the funding for research into human cloning could be redirected towards research and development to find cures for those affected by HIV/AIDS, tuberculosis and malaria.
The representative of Antigua and Barbuda said that, had she been in the room during the vote, she would have voted in favour of the text.
Kyrgyzstan’s representative also said that, had he been in the room, he would have voted in favour. 
Libya’s representative congratulated the international community for adopting the Declaration, which was a step forward in the process towards a future convention to ban all forms of human cloning. The Declaration was a starting point in the protection of human dignity. He had voted in favour of the Declaration.
ANNEX
Vote on Declaration on Human Cloning
The United Nations Declaration on Human Cloning (document A/59/516/Add.1) was adopted by a recorded vote of 84 in favour to 34 against, with 37 abstentions, as follows:
In favour: Afghanistan, Albania, Andorra, Australia, Austria, Bahrain, Bangladesh, Belize, Benin, Bolivia, Bosnia and Herzegovina, Brunei Darussalam, Burundi, Chile, Comoros, Costa Rica, Côte d’Ivoire, Croatia, Democratic Republic of the Congo, Djibouti, Dominican Republic, Ecuador, El Salvador, Equatorial Guinea, Eritrea, Ethiopia, Georgia, Germany, Grenada, Guatemala, Guyana, Haiti, Honduras, Hungary, Iraq, Ireland, Italy, Kazakhstan, Kenya, Kuwait, Lesotho, Liberia, Liechtenstein, Madagascar, Malta, Marshall Islands, Mauritius, Mexico, Federated States of Micronesia, Monaco, Morocco, Nicaragua, Palau, Panama, Paraguay, Philippines, Poland, Portugal, Qatar, Rwanda, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Samoa, San Marino, Sao Tome and Principe, Saudi Arabia, Sierra Leone, Slovakia, Slovenia, Solomon Islands, Sudan, Suriname, Switzerland, Tajikistan, The former Yugoslav Republic of Macedonia, Timor-Leste, Trinidad and Tobago, Uganda, United Arab Emirates, United Republic of Tanzania, United States, Uzbekistan, Zambia.
Against: Belarus, Belgium, Brazil, Bulgaria, Cambodia, Canada, China, Cuba, Cyprus, Czech Republic, Democratic People’s Republic of Korea, Denmark, Estonia, Finland, France, Gabon, Iceland, India, Jamaica, Japan, Lao People’s Democratic Republic, Latvia, Lithuania, Luxembourg, Netherlands, New Zealand, Norway, Republic of Korea, Singapore, Spain, Sweden, Thailand, Tonga, United Kingdom.
Abstain: Algeria, Angola, Argentina, Azerbaijan, Bahamas, Barbados, Burkina Faso, Cameroon, Cape Verde, Colombia, Egypt, Indonesia, Iran, Israel, Jordan, Lebanon, Malaysia, Maldives, Mongolia, Myanmar, Namibia, Nepal, Oman, Pakistan, Republic of Moldova, Romania, Serbia and Montenegro, Somalia, South Africa, Sri Lanka, Syria, Tunisia, Turkey, Ukraine, Uruguay, Yemen, Zimbabwe.
Absent: Antigua and Barbuda, Armenia, Bhutan, Botswana, Central African Republic, Chad, Congo, Dominica, Fiji, Gambia, Ghana, Greece, Guinea, Guinea-Bissau, Kiribati, Kyrgyzstan, Libya, Malawi, Mali, Mauritania, Mozambique, Nauru, Niger, Nigeria, Papua New Guinea, Peru, Russian Federation, Senegal, Seychelles, Swaziland, Togo, Turkmenistan, Tuvalu, Vanuatu, Venezuela, Vietnam.

NEWS: World Health Roundup 
Maureen Shawn Kennedy MA, RN 

	AJN, American Journal of Nursing
May 2005 
Volume 105 Number 5 
Pages 22 - 22 	

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A strike by physicians, nurses, and other medical personnel in government hospitals in the Democratic Republic of Congo has led to the deaths of more than 1,350 people in the capital, Kinshasa, according to the United Nations Integrated Regional Information Networks (IRIN). Physicians began the strike in December, demanding that their salaries match those of other public servants-$30 to $70 a month. The government responded by promising better pay and offering a one-time payment of $170 to $361. Nurses and paramedics followed suit and are currently in negotiation with the government. IRIN also reports that nurses in Burundi struck, beginning on March 7, forcing many hospitals to limit care primarily to emergency treatment. The nurses were demanding better working conditions and pay. The nurses resumed work on March 31, after the union and the government signed an agreement.
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The creator of Dolly the sheep has been given the green light to clone human embryos for medical research. Ian Wilmut, head of the Department of Gene Expression and Development at the Roslin Institute near Edinburgh, Scotland, will clone embryos of patients with amyotrophic lateral sclerosis in order to derive stem cells, and will go on to destroy the cloned embryos within 14 days of their creation. Wilmut is the second scientist (after Alison Murdoch of the University of Newcastle) to receive the British government's authorization to clone an embryo.
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In South Korea and China, researchers have already derived stem cells from cloned embryos. In the United States, using federal money for human cloning is illegal, although some researchers are planning to use private or state funding to do so.

Genomics meets nursing practice 
Roy L. Simpson RN, C, CCMA, FNAP, FAAN 

	Nursing Management
December 2006 
Volume 37 Number 12 
Pages 31 - 33 	

						

						

						

In 1954, the first color television sets went on sale for $995 (the equivalent of $6,186 today). A year earlier, the first commercial computer, UNIVAC 1103, used random access memory (RAM)-1024 words of 36-bit cathode-ray storage tubes, magnetic drums, and cores. Also in 1953, two little-known British researchers-James Watson and Francis Crick-published a paper on their discovery of the double helix structure of DNA. Today, a little more than 50 years later, you can still pay a thousand-plus dollars for a color TV, but you'll be getting a 50-inch plasma display.
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Computers still use RAM, but what UNIVAC 1103 had would fit inside the period at the end of this sentence. And the work of Watson and Crick is challenging and changing everything we know and believe about life and what sustains it. Healthcare has seen the future and it's genomics.
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Actually, genomics is already here. From Dolly, the cloned sheep, to genetically modified foods and targeted pharmaceuticals, genomics is becoming part of our everyday lives. Individuals can agree or disagree about the social and/or moral implications of cloning and genetically altered foods and drugs. Nurses, however, must accept genomics as a reality of practice, understand both the promises and pitfalls it holds for patients and practice, and learn how to adapt to its inevitable incursion into healthcare. Technology can and must help.
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But what exactly is genomics and what are its true implications for nursing? By cracking the code on DNA, Watson and Crick ushered in the science of genetics, which is the study of individual genes and their impact on biologic inheritance. Now, however, technology has made it possible to look at all of the genes in a living creature at once. This new, scaled-up genetics is called genomics, the study of all the genes in the human genome, including their interactions with each other, the environment, and the influence of other psychosocial and cultural factors.1 Finally, a science that truly mirrors the holistic practice of nursing.
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The most comprehensive genomics effort to date is the Human Genome Project, an international 13-year effort that began in October 1990. Thanks to rapid technological advances, the project was completed 2 years ahead of schedule in 2003. The goals of the Human Genome Project were as follows:
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[white diamond suit] identify all the approximately 20,000 to 25,000 genes in human DNA
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[white diamond suit] determine the sequences of the 3 billion chemical base pairs that make up human DNA
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[white diamond suit] store this information in databases
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[white diamond suit] improve tools for data analysis
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[white diamond suit] transfer related technologies to the private sector
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[white diamond suit] address the ethical, legal, and social issues that may arise from the project.2
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The U.S. Department of Energy's Human Genome Program and the National Institutes of Health's National Human Genome Research Institute together sponsored the Human Genome Project, which is already having a major influence on healthcare.
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Now that we've sequenced the human genome, future developments will be an integral part of disease prevention, diagnosis, treatment, and management. As genomics and genomic technologies become a driving force in patient management, nurses must understand what these technologies are, why and when to use them, and the implications of their use.
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Nursing must apply this genetic information to nursing practice. It's about moving from the old genetics to the new genomics by recognizing that such common diseases as cancer and heart disease are the result of complex interactions between genetic factors and a variety of environmental exposures that cause and/or exacerbate the disease process.
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On a day-to-day basis, caring for patients, families, and communities will require nurses to incorporate genetic and genomic information into their practice. For example, genomics may make it possible and expected for nurses to:
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[white diamond suit] assess a patient's condition based on genetic and/or genomic factors
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[white diamond suit] recognize a newborn at risk because of genetic metabolism errors
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[white diamond suit] look for symptoms of colon cancer in an asymptomatic adolescent who's high risk for hereditary colon cancer
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[white diamond suit] identify a couple at risk for having a child with a genetic condition
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[white diamond suit] guide interventions for the prevention of cardiovascular disease in young adults
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[white diamond suit] support informed consent that includes the risks, benefits, and limitations of participation in genetic research.1
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To do these things, there'll be an increased need and growing challenge to integrate new genetics knowledge into nursing practice so that nurses can provide quality genetic health services to patients and families affected with genetic-related health conditions.3 Increasingly, consumers will expect nurses to use genetic and genomic information and technology when providing care. But how, exactly, is genomics going to penetrate practice? There are two primary avenues: education and technology.
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Applying a genomic approach throughout the continuum of care depends not only on technologic advances, but also on nursing expertise. In its report on genetics and nursing, an expert Health Resources and Services Administration panel emphasized the importance of integrating genetics content into nursing curriculum to ensure an adequately prepared nursing workforce now and for the future.4 Nurse educators must be able to teach and support nurses in the new era of genetic healthcare. However, continuing debates over minimum competencies and entry-to-practice obstruct efforts to educate nurses for genomics-based healthcare.
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The only solution is a collaborative effort-national and international-to establish minimal competencies in knowledge, skills, and attitudes for all nurses, no matter what their educational level.5
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The most promising way to get genomics into practice, however, is through technology. While much has been written about emerging technologies for genomics, the literature focuses on scientific tools, including:
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[white diamond suit] nanotechnology for manufacturing systems and devices that work at a molecular level
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[white diamond suit] fluorescence resonance energy transfer, used to measure molecular interactions
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[white diamond suit] laser microdissection, used to remove and collect specific cells from a tissue sample.6-8
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With these tools, genomics is already becoming part of nursing science. Many nurses use such genomic technologies to conduct genomic-focused nursing research. The biobehavioral nature of much of this research reinforces the importance of nursing's contribution to genomics.9
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To move genomics beyond science into actual practice, most nurses will look to new forms and functions of the clinical information systems they already use. And even though such systems are in the infant stage, already there are familiar technological hurdles slowing their development. Providing genomics knowledge to inform practice is no harder than providing clinical data to facilitate evidence-based nursing. But that's hard enough. Information technology (IT) is the only solution. Making IT a workable solution calls for:
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[white diamond suit] automating manual tasks. The routine operations needed for large-scale, data-driven genomics research projects are as challenging to deal with as those involved in amassing practice data for evidence-based nursing.
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[white diamond suit] accumulating data at the point of research. Data must be entered where it's gathered to ensure accuracy. Like point-of-care data collection, point-of-research data entry will require mobile tools such as electronic notebooks and PDAs.
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[white diamond suit] analyzing data from various types and sources of research. Interrelated or not, systems must work together and share data.10
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Historically, nursing has held one of two views about technology and practice:
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1. technological optimism, which views technology as an agent for enhancing nursing science
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2. technological romanticism that says technology minimizes the human factor in nursing, both philosophically and practically.11
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The former view promotes nursing knowledge of the biosciences and technological change; the latter impedes the development of nursing knowledge.9 Clearly, technological romanticism has no place in a genomic world. Rather, it's time for nursing to look at the changing world of healthcare as one in which to assume its rightful place. And as that world becomes an increasingly genomic one, a profession that professes a holistic approach will be right where it should be-leading the race toward quality care.						

PULSE BEATS 
	Journal of Christian Nursing
Fall 2002 
Volume 19 Number 4 
Pages 48 - 48 	

Earns the Big One!!

After years of winning the Evangelical Press Association award of merit (second place) in the Christian Ministry category, JCN was pleased to receive first place, the Award of Excellence, this year, for the 2001 issues. Some of the judges' comments: "Excellent writing with important focus on accessibility and comprehension [horizontal ellipsis] a wide array of topics and ideas [horizontal ellipsis] effective use of contemporary and traditional content [horizontal ellipsis] elegant graphics and content-driven visual storytelling." "JCN staff takes its mission and makes an excellent magazine." JCN also won fourth place in poetry in the Higher Goals portion of the contest for Mary-Kate Heffern's poem "The More Than Ten Commandments" in the summer issue.
Resources for Sexual Trauma Victims

In 1994, in response to allegations of sexual misconduct against some members of the monastic community, the Interfaith Sexual Trauma Institute (ISTI) was formed. Its vision is to facilitate the building of safe, healthy and trustworthy communities of faith. They seek to prevent sexual abuse, exploitation and harassment through research, education and publications. Board members include survivors and offenders, psychiatrists, psychologists, social workers, lawyers, theologians, educators, researchers and writers. Men and women are represented, as well as representatives of the Jewish community and eighteen Christian denominations. E-mail them at isti@csbsju.edu or check their websitewww.csbsju.edu/isti .
CMA Objects to Cloning Ads

David Stevens, MD, executive director of the 16,000-member Christian Medical Association, states that an ad campaign launched by the Coalition for the Advancement of Medical Research promoting human cloning research is "a big, expensive lie that is tantamount to deceptive advertising. It's motivated by greed, not humanitarian motives. [horizontal ellipsis] By redefining the term human cloning, the biotech lobbyists think they can get around public revulsion to cloning. But whether you call it somatic cell nuclear transfer, therapeutic cloning, or anything else, the fact remains that you are intentionally manufacturing a human being for the sole purpose of research in which he or she will be destroyed. [horizontal ellipsis] While hundreds of studies show adult stem cells are providing real cures for real people, not one study shows clinical benefit with cloned human embryos." Stevens asks the question, "Are we going to allow financially motivated biotech lobbyists to determine the path for our future, or are we going to step in and say, "No, there are some lines that science must not cross"?-Contact Margie Shealy of CMA, (423) 844-1000, MAShealy@cmdahome.org.
Nursing Stats

-Minority Nursing Statistics, MinorityNurse.com website. As quoted inNursing Spectrum, February 11, 2002
Shared Hope International

As a congresswoman in 1998, Linda Smith visited one of the worst brothels in the world in Bombay, India. The hopeless faces of the desperate women and children who had been forced into prostitution compelled her to found Shared Hope International, a non-profit organization with a mission of rescuing and restoring victims of sex trafficking. Shared Hope is committed to prevention, intervention and support of their existing safe houses, but they find that the escalating problem of human trafficking worldwide dictates that they aggressively develop strategies and alliances to more effectively wage war against this dehumanizing action. For more information about how you can help through prayer, finances or active involvement, contact Shared Hope by e-mail at savelives@sharedhope.org.
The MS Detective

More than 300,000 Americans have multiple sclerosis (MS), a disabling central nervous system disease. Doctors have long been baffled as to why some MS patients respond well to certain drug treatments, while others decline rapidly. Claudia Lucchinetti, MD, a neurologist at the Mayo Clinic in Rochester, Minnesota, may have found the answer. She identified four types of lesions-the places where protective coating has been stripped from nerve fibers-and found that each patient has only one type of lesion, but they vary from patient to patient. She soon hopes to be able to differentiate lesion types using MRI technology and tailor individual therapies.

-Gina Shaw, Ladies Home Journal, May 2002
You Can Aid Victims of Abuse

Whether they know it or not, most health care providers treat victims of domestic violence on a regular basis. The National Health Resource Center on Domestic Violence has resources, guidelines and materials to help doctors, nurses and other providers identify and help patients facing abuse. By calling (800) RX-ABUSE, a nurse can request information, talk to an expert on domestic violence and be connected to a national network of experts who can provide training or consultation on domestic abuse. "Too often, health care providers miss the chance to help battered women because they do not know how to ask the right questions," said Family Violence Prevention Fund (FVPF) associate director Debbie Lee. The FVPF works to end domestic violence and help women and children whose lives are devastated by abuse, because every person has a right to live in a home free of violence. Check out FVPF's multi-faceted health program at www.fvpf.org/health .