Genetics and genomic competency of Turkish nurses: A descriptive cross-sectional study

Abstract

Background:

Nurses have essential roles in genetic related healthcare, including risk assessment, referring individuals to genetics services, advocating for and educating individual, families, and communities who might benefit from genetic services.

Objective:

To determine the genetics and genomic competency of Turkish nurses.

Design:

A descriptive cross sectional research design was used to collect data.

Setting:

Totally 385 nurses working in clinical or academic settings in Turkey were recruited between 20 January and 20 April 2020.

Methods:

Data were collected using socio-demographic characteristics form and Genetics and Genomics in Nursing Practice Survey on 20 January-20 April 2020. Descriptive statistics, Kruskal Wallis, and Mann-Whitney U tests were used for data analyses.

Results:

A total of 385 nurses participated in this study. Most, 44.9% had a BSN degree, 42.1% were clinical nurses. Of the nurses, 34.5% reported that they had genetics included in their nursing curriculum, and 74.0% intended to learn more about genetics. The mean knowledge score was 9.36/12. Gender, primary role of nurses, and whether to see patients actively in practice were the factors effecting knowledge score of nurses in genetic and genomics.

Conclusions:

Turkish nurses’ genomics skills need additional development and integration of genomics to the nursing curriculum can be effective to decrease their knowledge gaps. Clinical nurses’ genomic competency should improve to increase the nursing care quality.

1. Background

Since the completion of the Human Genome Project, scientific and technological advances in genomics have improved our understanding of the genomic basis of diseases, diagnosis, screening and treatment methods. While these advances have brought new opportunities for clinical application of genomics, nurses must realize these benefits to contribute to integrating genomics in clinical practice (Campion et al., 2019; Regan et al., 2019). Nurses with diverse professional roles comprise the largest component of the healthcare workforce (Tonkin et al., 2020) and are often the first contact point for those utilizing healthcare services. From novice to advanced practice levels, nurses have essential roles in genetic related healthcare, including risk assessment, referring individuals to genetics services, advocating for and educating individuals, families, and communities who might benefit from genetic services (Calzone et al., 2018a; Kok and Aydin, 2019).

2. Introduction

As genomics is shaping the future of healthcare services, regardless of area of practice and specialty, every nurse needs to be equipped with the necessary knowledge and skills in genomics (Rogers et al., 2017; Seven et al., 2015; Tonkin et al., 2020). Although the need for accessible educational resources remains a priority, the need for genomics experts, support networks, infrastructure, and leadership in nursing is also essential for equipping the next generation of nurses with genomics (Tonkin et al., 2020; Calzone et al., 2018b). In some countries, such as the United States of America (USA) and United Kingdom (UK), essential competencies for nurses in genomics were defined (International Society of Nurses in Genetics; American Nurses Association (AMA), 2006; Kirk et al., 2014). In addition to country-level efforts, there have been international efforts such as ISONG (International Society of Nurses in Genetics), G2NA (The Global Genomics Nursing Alliance), and Global Genomic Medicine Collaborative (G2MC) that support the global nursing community to develop genomic competency among nurses and nurse educators (Tonkin et al., 2020).

Although there are some improvements in the integration of genomics into nursing education and practice, current evidence shows that nurses are not adequately prepared to implement recent advances in genomics in practice (Calzone et al., 2018b; Kok and Aydin, 2019; Seven et al., 2015). Studies conducted in different countries reported that nurses are willing, but they need educational sources and support from their senior staff and their institution to integrate genomics into daily nursing care (Chair et al., 2019; Hickey et al., 2018; Kronk et al., 2018). According to the Nursing Regulation, in Turkey, counseling families at risk for genomic conditions is the only genomic related responsibility mentioned as a responsibility of women’s health nurses (“Turkish Nursing Regulation,” n.d.). Moreover, few studies assessing nursing students’ and nurses’ knowledge, confidence, and educational needs (Seven et al., 2015; Terzioğlu and Dinç, 2004; Tomatir et al., 2006) reported a lack of knowledge and skills in genomics among nurses in Turkey. It shows the critical need to improve nurses’ competency and nursing roles in assuring genomic health care in Turkey. To integrate genomics into nursing practice, it is necessary to evaluate nurses’ knowledge, skills, and competency to design tailored education and provide necessary sources. Current studies conducted in Turkey used author-developed surveys to measure perceived knowledge, roles, and awareness of genetics with a limited emphasis on competency in practice. To the best of our knowledge, there is limited number of studies focusing on nurses’ competency in genomic practice measured by the Genetics and Genomics in Nursing Practice Survey (GGNPS). Assessing nurses’ competency in practice with a reliable survey is important for comparison and global collaboration in the integration of genomics in nursing education and practice.

2.1. Aim

The aim of this study was to assess the genetic and genomic competency of Turkish nurses in practice.

3. Methods

3.1. Design, participants, and data collection

A descriptive, cross-sectional survey research design was used. Nurses working in a clinical or academic setting in Turkey were recruited between 20 January and 20 April 2020. An online survey was used to collect data by using RedCAP software (https://projectredcap.org/software/).

This is a secondary analysis of a study conducted to test the reliability of the GGNPS (Yesilcinar et al., 2021). The methods, including sample and recruitment, were explained elsewhere in detail (Yesilcinar et al., 2021). Briefly, the study population included all nurses working in any hospital settings in Turkey. A minimum sample size of 85 was aimed to detect significant effects with power equal to 0.95 in the original reliability study of GGNPS in Turkish (Yesilcinar et al., 2021). The snowball sampling method was used by using two recruitment strategies. The first strategy was the collaboration with the head nurses working at different clinics in hospitals (majority from Ankara, Istanbul, Izmir, and Giresun), who were asked to distribute the study link with nurses in their contacts. The second strategy was to utilize group email listserv of nursing societies, such as the Turkish Oncology Nurses Society and Women’s Health Society. A total of 397 nurses started to fill the online survey; however, due to incomplete surveys, we included 385 nurses in the analysis.

3.2. Instrument

The Genetics and Genomics in Nursing Practice Survey (GGNPS) [Turkish version] was used to collect data. GGNPS was developed by Calzone et al. (2012) and the content and face validity of the GGNPS was established by Plavskin (2019). The test and re-test reliability for the Turkish version of GGNPS was conducted by Yesilcinar et al. (2021), reporting Cohen’s kappa (κ) and weighted kappa values for response agreements of each item.

The GGNPS consists of multiple responses, such as selecting pick lists, multiple-choice, yes/no, true/false, and Likert scales. The GGNPS consists of eight parts, measuring the 1) broad attitudes on genomics, 2) confidence and family history specific attitudes, 3) adoption of family history who is actively seeing patients, 4) general genomic knowledge, 5) detailed genomic knowledge, 6) individual genomic competency evaluation, 7) social system, and 8) demographic data.

Items consisting of attitudes, receptivity, confidence, social system, and adoption domains are analyzed personally and are not integrated to form a total score. The responses to 12 items measuring genomic knowledge are combined to form a knowledge score. Responses to each of the 12 items are scored as correct/incorrect. A total knowledge score is calculated as the total number of correct responses out of 12 items. The minimum possible score of this part is 0 and a maximum possible score of 12. The total knowledge score only can be calculated for the individuals who responded to all 12 items.

3.3. Ethical approval

This study was approved by Batman University Ethical Board (numbered 2020/1).

3.4. Analyses

The data were analyzed using the IBM SPSS Statistics 26 program. Number (n), frequency (%) for discrete data and mean ± standard deviation (X ± SD) for continuous data were used. Kolmogorov Smirnov Test, skewness and kurtosis values were used to evaluate the distribution of the data. As the data was not normally distributed, Kruskal Wallis Test and Mann-Whitney-U Test were used. The p value <0.05 was considered statistically significant.

4. Findings

Socio-demographic characteristics of nurses are given in Table 1. The mean age of 385 nurses was 34.55 ± 7.69 (min:21-max:60). Of the nurses, 95.8% were female, 44.9% had a BSN degree, and 42.1% were clinical staff nurses. Of nurses, 47.1% actively saw patients, and 33.2% of these nurses were seeing patients 0–20% of their working hours (Table 1).

Table 1.

Socio-demographic characteristics of nurses.

N = 385	$\overline{\mathrm{X}}\pm \mathrm{S}\mathrm{D}$
Age (years)	34.55 ± 7.69
Number of years working in nursing (min-max:0–33)	12.68 ± 8.20
Gender	n	%
Female	369	95.8
Male	14	3.6
No response	2	0.5
Highest nursing degree
Associate degree	15	3.9
BSN	173	44.9
MSN	128	33.2
PhD	59	15.3
Missing	10	2.6
Primary role
Clinical staff nurse	162	42.1
Education nurse in clinical setting	2	0.5
Head nurse/supervisor	39	10.1
Faculty/instructor	75	19.5
Graduate students	27	7.0
Other	60	15.6
Missing	20	5.2
Actively seeing patients
Yes	181	47.1
No	161	41.8
Missing	43	11.2
Percent time seeing patients
0%–20%	128	33.2
21%–40%	50	13.0
41%–60%	56	14.5
61%–80%	58	15.1
81%–100%	58	15.1
Missing	35	9.1

Of the nurses, 55.3% reported that their nursing curriculum didn’t include genomics and 94.0% indicated that they didn’t attend a course that included genomics as a significant component. Most nurses, 74.0%, reported that they intend to learn more about genomic, 52.5% would be able to attend a course during work hours, and 72.5% would attend a course on their own time (Table 2).

Table 2.

Nurses’ genomic educational background and intent to learn more.

N = 385	n	%
Genomics included in the nursing curriculum
Yes	133	34.5
No	213	55.3
Missing	39	10.1
Attendance to courses that include genomics as a major component
Yes	18	4.7
No	362	94.0
Missing	5	1.3
Intend to learn more about genomics
Yes	285	74.0
No	29	7.5
Do not know	66	17.1
Missing	5	1.3
Be able to attend a course during work hours
Yes	202	52.5
No	129	33.5
Do not know	50	13.0
Missing	4	1.0
To attend a course on own time
Yes	279	72.5
No	58	15.1
Do not know	44	11.4
Missing	4	1.0

4.1. Knowledge level of nurses

The mean of the total knowledge scores were 9.36 ± 1.33/12. The majority of nurses correctly answered that genetic risk (e.g., as indicated by family history) has clinical relevance for breast cancer (98.7%). Only 25.7% of nurses correctly answered that most common diseases such as diabetes and heart disease are caused by a single gene variant (Table 3).

Table 3.

Knowledge items, total score and nurses’ responses.

Total knowledge score $\left(\overline{\mathrm{X}}\pm \mathrm{S}\mathrm{D}\right)$	9.36 ± 1.33
Items	Correct answers
	n	%
1. A family history that includes only 1st degree relatives such as parents, siblings, and children should be taken on every new patient. (Disagree)	107	27.9
2. A family history that includes 2nd and 3rd degree relatives such as grandparents, aunts, uncles, and cousins should be taken for every new patient. (Agree)	240	62.3
3. Family history taking should be a key component of nursing care. (Agree)	348	90.4
4. There is a role for nurses in counseling patients about genetic risks. (Agree)	325	84.4
5. Do you think that genetic risk (e.g., as indicated by family history) has clinical relevance for breast cancer. (Somewhat, A great deal)	380	98.7
6. Do you think that genetic risk (e.g., as indicated by family history) has clinical relevance for colon cancer. (Somewhat, A great deal)	375	96.1
7. Do you think that genetic risk (e.g., as indicated by family history) has clinical relevance for coronary heart disease. (Somewhat, A great deal)	371	96.3
8. Do you think that genetic risk (e.g., as indicated by family history) has clinical relevance for diabetes. (Somewhat, A great deal)	371	96.3
9. Do you think that genetic risk (e.g., as indicated by family history) has clinical relevance for ovarian cancer. (Somewhat, A great deal)	370	96.1
10. Extent to which family history supports clinical decisions (such as administering drugs prescribed). (Essential)	332	86.2
11. The DNA of sequences of two randomly selected healthy individuals of the same sex is 90–95% identical. (False)	126	32.7
12. Most common diseases such as diabetes and heart disease are caused by a single gene variant. (False)	99	25.7

4.2. Competency of nurses

Nurses reported that they always collect information regarding age at diagnosis of condition (55.6%), relationship to the patient (90.6%), and both sides of the family (70.4%) in standard family history assessment when the patients indicate a disorder in the family. Race or ethnic background (29.1%), age at death from a condition (41.8%) were the least used information to collect family history. Only 10.6% of nurses reported having heard or read about the Essential Competencies and Curricula Guidelines for Nurses in Genetics and Genomics (Table 4 – Supplemental file).

4.3. Attitude/receptivity of the nurses

Of the nurses, 75.8% stated that it is very important for the nurses to become more educated about the genomics of common diseases. Integrating genomics of common diseases into practice was reported as an advantage for better treatment decisions by 92.2%, improved services to the patients by 93.8% and better adherence to clinical recommendations among patients by 92.5% of nurses. Nurses reported disadvantages as ‘not reimbursable/too costly’ (13.5%), ‘would increase insurance discrimination’ (21.9%), and ‘increase patient anxiety about risk’ (38.7%) (Table 4 – Supplemental file).

4.4. Confidence of the nurses

Most nurses, 86.5% reported that they are confident in deciding what family history information is needed to tell something about a patient’s genetic susceptibility to common diseases. Also 73.0% were confident in discussing how family history affects recommended screening intervals, and 73.0% in giving patients information about the risks, benefits and limitations of genetic testing for common diseases. Of the nurses, 51.7% were less confident in giving information to patients about the limitations of genetic testing and the risks of genetic testing (54.5%) for common diseases (Table 5).

Table 5.

The nurses’ responses to GGNPS confidence and social system items.

Items	n	%
Confidence
Decide what family history information is needed to tell something about a patient’s genetic susceptibility to common diseases.
Confident	333	86.5
Not at all confident	52	13.5
Discuss how family history affects recommended screening intervals.
Confident	281	73.0
Not at all confident	101	27.0
Decide which patients would benefit from a referral for genetic counseling and possible testing for susceptibility to common diseases.
Confident	258	67.0
Not at all confident	125	33.0
Access reliable and current information about genetics and common diseases.
Confident	278	72.2
Not at all confident	107	27.8
Give patients information about the risks of genetic testing for common diseases.
Confident	210	54.5
Not at all confident	175	45.4
Give patients information about the benefits of genetic testing for common diseases.
Confident	281	73.0
Not at all confident	104	27.0
Give patients information about the limitations of genetic testing for common diseases
Confident	199	51.7
Not at all confident	186	48.3
Facilitate referrals for genetic services for common diseases.
Confident	247	64.2
Not at all confident	138	35.8
Social system
Do you intend to learn more about genetics?
Yes	285	74.0
No	29	7.5
Don’t know	71	18.4
Would you be able to attend a course during work hours?
Yes	202	52.5
No	129	33.5
Don’t know	54	14.0
Would you attend a course on your own time?
Yes	279	72.5
No	58	15.1
Don’t know	48	12.4
Do you think your senior staff members see genetics as an important part of your role?
Yes	61	15.8
No	215	55.8
Don’t know	109	28.3
Do you think your senior staff members see genetics as an important part of their role
Yes	86	22.3
No	190	49.4
Don’t know	109	28.3

4.5. Social system

Of the nurses, 74.0% reported that they intended to learn more about genetics, 72.5% would attend a course on their own time, and 52.5% were able to attend a course during work hours. However, only 15.8% of the nurses stated that their senior staff members see genomics as an important part of nursing role and 22.3% of the nurses stated that their senior staff members see genetics as an important part of their senior nursing role (Table 5).

4.6. Decision/adoption

In the past three months, 30.8% of the nurses reported always or often collected a complete family history, 43.8% initiated a discussion with a patient about genomics, 35.6% frequently used family history information when facilitating clinical decisions and 8.0% frequently facilitated referrals to genomic services (Table 6).

Table 6.

The nurses’ responses to GGNPS decision and adoption items.

Decision/adoptiona	n	%
In the past three months, how often have you collected a complete family history from a patient that includes the following components: information on disorders from three generations, and age at diagnosis and death for each affected family member?
Always	28	13.7
Often	35	17.1
Occasionally	47	22.9
Rarely or never	95	46.3
In the past three months, has any patient initiated a discussion with you about genetics?
Yes	91	43.8
No	117	56.3
In the past 3 months, how often have you used family history information when facilitating clinical decisions or recommendations for your patients?
Frequently	52	35.9
Occasionally	49	33.8
Rarely	34	23.4
Never	10	6.9
In the past 3 months, how often have you facilitated referrals to genetic services?
Frequently	16	8.0
Occasionally	43	21.5
Rarely	70	35.0
Never	71	35.5

^aOnly nurses actively see patients answered the questions.

There was a statistically significant relationship between and nurses’ total knowledge questionnaire scores and nurses’ gender (p = 0.011), primary nursing roles (p = 0.011), and whether they actively see patients or not (p = 0.011). Female nurses, nurses in faculty and instructor positions and nurses who do not actively see patients had higher knowledge scores. There was no statistically significant relationship between nurses’ educational level and total years in nursing (p > 0.05) (Table 7).

Table 7.

Comparison of some socio-demographic characteristics and knowledge scores of nurses (N = 385).

	$\overline{\mathrm{X}}$	±SD
Sex
Female	9.39	1.31
Male	8.28	1.54
Z, p*	−2.537	0.011
Highest nursing degree
Associate degree	8.86	2.19
BSN	9.30	1.29
MSN	9.33	1.26
PhD	9.70	1.27
X2, p**	5.303	0.151
Primary role
Clinical nurse	9.15	1.35
Education nurse in clinical setting	8.00	1.41
Head nurse/supervisor	9.26	1.34
Faculty/instructor	9.68	1.32
Graduate students	9.65	0.97
Other	9.28	1.34
X2, p	14.751	0.011 a
Actively seeing patients
Yes	9.19	1.34
No	9.54	1.27
Z, p	−2.531	0.011
Total years of work in nursing
1–5	9.37	1.43
6–10	9.30	1.15
11 and higher	9.37	1.37
X2, p	4.341	0.114

^aThe p value <0.05 was considered statistically significant.

^*Mann-Whitney U test.

^**Kruskal Wallis test.

^aFaculty and instructors had higher knowledge level than clinical nurses.

Although not shown in the table, there was no relationship between knowledge score and having genomics in the nursing curriculum, having attended any course that includes genomics after graduation and the intention of learning more about genomics.

5. Discussion

This study aimed to evaluate Turkish nurses’ genomic competency in practice and factors affecting their knowledge in genetics and genomics. This is the first study that assessed the nurses’ genetic competency in practice among Turkish nurses, to the best of our knowledge.

In this study, the knowledge level of nurses was found moderate (9 out of 12) measured by the GGNPS. Similarly, in Calzone et al.’s study, the knowledge level in genomics was found moderate (8.99 out of 12) among nurses by using the GGNPS (Calzone et al., 2013). A study conducted with the nurses using the GGNPS reported that nurses had knowledge deficits (Coleman et al., 2014). In the Turkish studies, there was no study assessing nurses’ genomic knowledge in practice with a validated tool; however, they reported a moderate or lower knowledge of the genomic basis of diseases among nurses (Seven et al., 2015; Tomatir et al., 2006).

Although Turkish nurses had moderate knowledge levels, there were some areas that most of the nurses did not answer correctly. Only 32.7% of nurses knew that ‘The DNA of sequences of two randomly selected healthy individuals of the same sex are not 90–95% identical’ and only 25.7% of nurses knew that ‘Most common diseases such as diabetes and heart disease are not caused by a single gene variant’ statements. It is essential for nurses to know the genetic basis of the diseases. Most nurses knew that genetic risk has clinical relevance for breast, ovarian, and colon cancer, but most of them were not aware of the genetic basis of heart diseases and diabetes in this study. Some studies reported a similar knowledge deficit in the genetic basis of diabetes and heart disease (Calzone et al., 2018b; Coleman et al., 2014). Calzone et al.’s study reported that nurses educational levels, having genomics in their curriculum and education after licensure were effective in increasing the number of correct responses among nurses (Calzone et al., 2018b). These findings show the need for educational activities after graduation. There are also some studies that have assessed the effectiveness of education, and almost all of them reported increased knowledge after education (Kronk et al., 2018; Rogers et al., 2017). Therefore, it is important to tailor these available educational methods to Turkish nurses to fill the knowledge gap in genomics.

In this study, gender, primary role, and whether the nurse is actively seeing patients were the factors affecting genomic knowledge. Genomic knowledge level of the female nurses was higher than male. In Almomani et al.’s study, gender was found affecting factor of genomic knowledge among healthcare professionals indicating female healthcare professionals were more knowledgeable than males (Almomani et al., 2020). Contrary to these findings, no relationship was found between gender and the genomic knowledge scores (Li et al., 2015). Although it is not clear how gender may affect overall genomic knowledge, further studies would be helpful to understand this relationship.

In this study, faculty/instructors and graduate students’ had higher knowledge levels than other group of nurses. Faculty/instructors may have more opportunities to follow the literature and have educational sources resulting in higher knowledge levels. This finding is also similar in nurses who do not see patients actively; they were found to have higher levels of knowledge in this study. This may indicate that nurse faculty and instructors who do not see patients actively have higher knowledge levels. However, further research is necessary to address this question, because clinical nurses are front-line health care staff caring for individuals and increasing their knowledge level is critical to integrate genetics into practice, which can be influenced by nursing faculty and instructors.

Regarding competency, most of nurses reported that they collect family history including age, relationship to the patients, age at the death from a condition and both side of the family. However, only 27.9% of nurses knew that a family history does not include only 1st degree relatives such as parents, siblings, and children should be taken on every new patient. Race/ethnic background was the least information collected during the family history.

This shows the knowledge gap that is necessary for family history collection in practice. Similarly, studies in the literature found lower knowledge or clinical assessment skills of family history collection (Calzone et al., 2013; Calzone et al., 2012). Family history is the gateway to recognizing inherited disorders in individuals, and healthcare providers rely on the family history as the most traditional diagnostic tool in clinical genetics (Rich et al., 2004) and this does not rely on technology and is no cost except provider time. Nurses, as a first contact point in various health care settings, should be equipped with necessary knowledge and skills to collect accurate family history (Boyd et al., 2017; Hickey et al., 2018).

Most nurses, 75.8% stated that it is vital for the nurses to become more educated about the genomics of common diseases. The majority of nurses reported integrating genomics of common diseases into practice as an advantage for better treatment decisions, improved services to the patients, and better adherence to clinical recommendations. In a large-sample study, nurses stated the advantages of integrating genomics into their practice was better treatment decisions and improved services to the patients, respectively (Calzone et al., 2018b). According to Coleman et al.’s study, it was very important for most nurses to become more educated about the genomics of common diseases. Also, they found that better decisions about recommendations for preventive services (87%), better treatment decisions (73%), improved services to patients (68%) were the most frequent advantages of integrating genomics into practice (Coleman et al., 2014).

In this study, most of the nurses (86.5%) stated they are confident to decide what family history information is needed, discuss how family history affects recommended screening intervals, and give patients information about the risks, benefits, and limitations of genomic testing for common diseases. However, most nurses (46.3%) rarely or never collected a complete family history nor did they facilitate referrals to genomic services (35.5%) in the past three months. One-third of the nurses stated that they collected a complete family history form and one-fourth of them used family history information to facilitate clinical decisions. In Lopes-Júnior et al.’s study, parallel with our study results, 60% of the nurses didn’t use family history and reported insufficient knowledge (Lopes-Júnior et al., 2017). In the literature, most studies and reviews determined that nurses haven’t sufficient knowledge regarding collecting detailed family history, drawing pedigree, and using it in the clinical practice (Calzone et al., 2013; Calzone et al., 2018c; Prolla et al., 2015; Seven et al., 2015). In addition one study found only one-third of the nurses felt confident to decide what family history information is needed to assess a patient’s genetic susceptibility to common diseases such as cancer, heart disease, and diabetes (Calzone et al., 2013). According to our results, nurses were not at all or little confident to give patients information about the risks, benefits, and limitations of genetic testing for common diseases. However, interestingly, the nurses in our study had the self-confidence to collect family history, give information about the risks, benefits, and limitations of genomic testing for common diseases, but to the rate of integration into clinical practice is low. In Turkey, nurses’ roles regarding family history collection are not clear. Besides, nurses perceive that their senior staff doesn’t see genomics as the nurses’ role. These factors may be influencing the limited use of family history taking.

In this study, only one-third of the nurses (34.5%) reported that genomics was included in their nursing curriculum and most 94.0% did not attend any course that includes genomics as a major component. Similarly, a prior study conducted with the nurses in Turkey reported 18.3% had a genomic course consisting of only a few hours in courses such as obstetrics during their nursing education (Seven et al., 2015). Other studies in different countries also reported that 57.4% of the nurses did not have genomic in the nursing curriculum (Lopes-Júnior et al., 2017) or two third of nurses did not attend a genomic course since licensure (Calzone et al., 2013; Coleman et al., 2014). Although this low coverage of genomics in nursing program or participation in courses after graduation, in this study 74% of the nurses intended to learn more in genetics even in their own time (72.5%). Some other studies reported that nurses intended to learn more about genomics (Calzone et al., 2013; Lopes-Júnior et al., 2017; Seven et al., 2015). Nurses’ positive attitude and motivation to learn more about genomics could be a facilitator to improve their knowledge, however, to integrate this knowledge into practice requires us to address possible barriers in clinical settings. For example, in this study, only 22.5% of nurses reported that they perceive that their senior staff members see genetics as an important part of their roles and only 15.8% senior staff members sees genetics as an important part of nursing roles in practice. Similarly, some studies reported that most nurses’ reported that they thought senior staff didn’t consider genomics as important for the senior staffs’ role nor the nurses’ roles in clinical settings (Calzone et al., 2018b; Calzone et al., 2012). Increasing the nurses’ senior staff’s awareness about integrating genomics into nursing practice may facilitate improved knowledge and integration of genetics into practice.

5.1. Limitations and strengths

We recognize some limitations of this study. This study was conducted via a web-based online survey with convenience sampling, and data collection coincided with the first peak of the COVID-19 pandemic. These factors may have affected the response rate or who participated in the study.

The study’s strength is to provide a baseline assessment of practices of Turkish nurses in genetics and genomics. Moreover, using an online survey for data collection allowed us to reach out to nurses from different cities in Turkey, strengthening the generalizability of the findings for Turkish nurses.

6. Conclusions

This study shows that despite the moderate level of knowledge score, there are critical knowledge gaps, including basic genomics, the genomic basis of common diseases, and lack of skills such as family history collection preventing the application of genomics in clinical settings. The social system is also the key to integrating genomics into practice; therefore, education efforts should also be focused on administrators and nursing senior staff to facilitate this process. Although limited coverage of genomics in formal education, nurses were willing to learn more about genomics. Therefore, developing tailored educational activities for these nurses and providing them with necessary educational sources is important to integrate genomics into daily nursing practice.