Date of Award

December 2020

Document Type


Degree Name

Doctor of Philosophy (PhD)


School of Nursing

Committee Member

Margaret A Wetsel

Committee Member

Linda Ward

Committee Member

Matthew Boyer

Committee Member

Stephanie Davis


ABSTRACTThis dissertation begins with the introduction of genetics, genomics, and the Healthcare Genetics (HCG) model. The five concepts of the HCG model, genetics/genomics, education, environment, clinical testing and therapeutics, and ethical/legal/social implications (ELSI) are defined. These concepts are threaded throughout the manuscripts and dissertation chapters. Chapter II defines molecular testing and differences between single-gene and multi-gene testing. The Kaplan Meier Curve and its use in research, to illustrate survival over time, is discussed. The chapter provides specific examples of both predictive and prognostic genomic testing used in breast, lung, colon, and prostate cancers. Chapter III examines the application of the Theory of Planned Behavior (TPB) in genomic nursing practice. The TPB constructs—attitude, subjective norms, and perceived behavioral control—are described along with genomic research examples. The chapter concludes with three exemplars that illustrate the importance of genomic-competent care in nursing practice. Chapter IV presents a mixed-methods study that explored nurses’ use of genomics in practice and identified barriers to genomic-competent care. The quantitative and qualitative results found that gaps exist between genomic education and practice. The most commonly cited barriers were a lack of knowledge, support, and costs. Chapter V begins with a summary of the previous four chapters. Limitations are described related to the content of Chapters I through III and the research study presented in Chapter IV. Chapter V concludes with recommendations for future research based on this dissertation.



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