Innovations in Advancing Nursing Genomic Literacy

Abstract

Given the rapid integration of genomics into health care, educational innovation is necessary to equip the nursing workforce with the knowledge and skills required to deliver safe and equitable genomics-informed care. This commentary presents an online, open-access genomics education resource for nursing students, outlining the curriculum structure, pedagogical approach, core content, and strategies to support nurse educator implementation. By offering a customizable, credit-based curriculum aligned with existing competencies, this resource addresses the high-priority need for a harmonized genomic nursing curriculum that can be disseminated internationally. As such, this course helps to overcome some of the global challenges to integrating genomics into nursing education and practice.

Implications for Practice, Education, Research, or Policy

The availability of an open-access, evidence-based, and competency-aligned genomics curriculum resource provides nurse educators with a scalable resource to facilitate the integration of foundational genomics content into existing nursing programs, supporting the development of genomic literacy for nurse educators and nursing students.

Further research is needed to assess the effectiveness of this educational innovation in improving nurses’ genomic literacy.

For the past 20 years, nurse leaders have advocated for the nursing profession to develop genomic literacy, identifying entry-to-practice education as a crucial starting point (Limoges et al., 2025). However, global challenges to improving nurses’ genomic literacy persist (Limoges et al., 2024; Thomas et al., 2023). These barriers stem, in part, from the exclusion of genomics from curriculum frameworks and the shortage of subject matter experts to develop and deliver this education (Majstorović et al., 2021).

Alongside the persistent barriers in progressing nurses’ genomic literacy, the volume and utility of genomics findings for clinical care have accelerated, rapidly transforming the health-care landscape, and outpacing the current workforce capacity for service delivery (Lee et al., 2024). As nurses comprise approximately 57% of the global health-care workforce (World Health Organization, 2025), they will be vital to meeting the escalating demands for genomics services as these become more integrated into mainstream health care (Limoges et al., 2025). To ensure nurses are prepared to provide safe and equitable care in rapidly evolving care environments, educational innovations are required to upskill the workforce, including nurse educators, and provide resources to facilitate genomics integrating in nursing curricula (Limoges et al., 2025; Thomas et al., 2023; Zureigat et al., 2022).

This commentary presents an online, open-access genomics education resource for nursing students, outlining the curriculum structure, pedagogical approach, core content, and strategies to support nurse educator implementation. This open-access genomics textbook and course provide a free, adaptable, evidence-based curriculum to advance genomic literacy in nursing. They are available at https://ecampusontario.pressbooks.pub/personalizedhealthnursing/. In this discussion, the following definitions are used: Genetics includes the study of individual genes and their function, inheritance, and variation (Talking Glossary of Genetic Terms, n.d.). Genetics typically focuses on single genes or small groups of genes to diagnose genetic conditions. Genomics is a broader and more current term that describes the study of all an organism's DNA (their genome), their interactions, and environmental effects on gene expression (Talking Glossary of Genetic Terms, n.d.). Genomics is used to examine conditions that are multifactorial. Genomic literacy is the ability to access, interpret, comprehend, and apply genomic information to inform decisions related to health and health care (Dante et al., 2025).

The genomics education course and textbook were designed to address the global need to advance the integration of genomics into nursing education and practice by providing an innovative and readily adaptable foundational curriculum resource. This resource combines open-access genomic content, competency alignment, and comprehensive course materials for immediate adoption or modular integration. Reporting of this educational innovation for genomics-informed nursing follows the Reporting Item Standards for Education and its Evaluation in Genomics (RISE2 Genomics) (Nisselle et al., 2021). RISE2 Genomics enables transparency, comprehensiveness, and consistency in reporting educational initiatives, enhancing the ability to compare and replicate interventions in genomics education (Nisselle et al., 2021).

An innovative feature of this genomics educational resource is that it provides a customizable curriculum tailored to accredited academic nursing programs that offer credit-based courses, aligned with pre-existing genomic competencies. The textbook represents a curation of scholarly content, integrating peer-reviewed open educational resources, original writing, and current scientific literature. This approach improves instructional efficiency by presenting synthesized material in a structured framework that enhances the coherence of complex genomic concepts. Although the book references the Canadian health-care context, the textbook can be easily edited in the Pressbooks platform (https://pressbooks.com/) by anyone wishing to adapt it for use in other regions. Similarly, although the target audience is nurses, the book can be aligned with the scope of practice of other health professions or as a component for interprofessional education.

The most significant advantage of an online textbook is that it can be updated in real time with the emergence of new scientific evidence. For example, the book was published in early 2025, and later that year the American College of Medical Genetics and Genomics (ACMG) released an updated version (V3.3) of its list of genes and associated diseases recommended for return as secondary findings from clinical whole genome testing (and clinical whole exome testing, where only the protein-coding regions of the genome are tested) (Lee et al., 2025). The book was immediately updated to reflect the latest ACMG version. Furthermore, in September 2025, Section 1.2 of the book was updated to reflect the change in the number of genes known across the human genome, which increased from 20,000 to 80,000. An update and change log tracks revisions, enabling instructors to quickly update their course materials using these resources. Given the rapid pace of genomic discovery, curricular materials that can be iteratively updated without cost or institutional licensing barriers are essential for ensuring course materials remain current, and faculty workload is minimized.

Curriculum Structure and Pedagogical Approach

The curriculum was initially developed for students in the final year of the Georgian College Honours Bachelor of Science - Nursing Program located in Ontario, Canada. It is a 13-week, 28-h, asynchronous course titled “Precision Healthcare: Genomics-Informed Nursing.” It provides foundational knowledge in genomics aligned with the nursing scope of practice. A dedicated section for educators prefaces the content, offering recommended materials to extend the course hours or credits, making the resource readily scalable.

The course was developed around the objectives that, at the end of the course, students should be able to:

identify patterns and trends related to modifiable and non-modifiable risk factors for the development of disease;

theorize how emerging health-care technologies, science, and innovations can transform health care;

analyze emerging research to understand the implications of strategies to promote health and limit the burden of disease;

critically reflect on the importance of genomic and health literacy to support personalized health care;

identify resources and support that would enable nurses to assist with informed decision-making.

Additionally, as the course was developed for a college in Ontario, the learning objectives were mapped to the College of Nurses of Ontario (CNO) entry-to-practice competencies (College of Nurses of Ontario, 2023). However, provincial regulatory bodies across Canada derive their competencies from the national framework of entry-level competencies (ELCs) for the Practice of Registered Nurses (Canadian Council of Registered Nurse Regulators, 2018). Consequently, competencies are largely comparable nationwide. Accordingly, educators in other Canadian jurisdictions, and internationally, can adapt the learning objective mapping to align with their respective regulatory or accreditation competencies. Each unit of the textbook begins with an overview of the unit's topics, key terminology, and an explicit list of competencies from the American Nurses Association's (2023) Essentials of Genomic Nursing Competencies and Outcome Indicators and the 2023 Genomic Competency Framework for UK Nurses (NHS England, 2023), which readers will work toward developing. These competency frameworks were used because there are currently no Canadian-specific genomics competencies for nurses (Limoges et al., 2025).

The textbook and quiz assignment were designed to address the lower levels of the cognitive domain of Bloom's taxonomy (e.g., knowledge and comprehension). In comparison, higher-order cognitive processes, including application, analysis, and synthesis, are targeted through structured group discussions grounded in complex patient scenarios, a case study assignment, and the development of a research-informed e-poster presentation on a selected gene variant (Bloom, 1956). The course design utilizes principles of andragogy to encourage self-directed learning and emphasize the practical relevance of the material. Open-access materials are freely available under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) license. Additionally, the Access to editing tools, Level of expertise required, Meaningfully editable, and Self-sourced (ALMS) Framework was used to ensure the resources meet the five “R” criteria for open educational resources – the ability to reuse, revise, remix, retain, and redistribute (Wiley, 2026). Universal design for learning principles aim to meet the needs of various learners, and best practices for accessibility were applied in the textbook design.

Course Content

The textbook's content is multi-modal, incorporating text, links to current academic publications, videos, images, and practice questions to enhance engagement and reinforce learning. The book opens with an overview of genetics and genomics and a discussion on the role of the nurse as a key member of the interprofessional team delivering genomics services. For example, nurses with genomic literacy can analyze data obtained from family histories and physical assessments to assess for genetic risk factors. Nurses can facilitate access to genetic testing, and provide education, translating complex topics into information patients can understand. Nurses may administer treatments that are guided by genome sequencing and developed using genomics technologies, such as gene therapy to treat cancer (e.g., CAR-T therapy) or sickle cell disease. Furthermore, genomics-informed nurses can assist patients in navigating the unique and complex ethical challenges that arise related to genomics.

Additional unit topics include the role of the nurse, a review of molecular genetics, the exposome, genetic disorders, genomics in nursing research, assessing genetic risk, genetic testing, pharmacogenomics, and the ethical, legal, and social issues arising from genomics (these topics are also woven throughout the book). Two units focus on application, with optional learning activities and time dedicated to working on theory application through the course assignments. There is a unit on genomics applications, which includes genomics and global health, cancer genomics, and applications by specialty (maternity, pediatrics, mental health, neurology, and cardiology). The final chapter concludes by looking to the future of genomics and nursing, addressing topics such as gene editing, other genomic technologies (including vaccine production, transgenic animals, and cloning), and health system readiness for the genomic era. Each unit ends with a summary and additional recommended readings and resources.

In addition to the online textbook, available course materials include assignments, rubrics, and a quiz bank, which can be shared upon confirmation of the requester's faculty status. The quiz reviews chapters one through four and is summative. To facilitate peer-to-peer interaction in the asynchronous environment, two distinct discussion assignments are provided, with a different case assigned to each student group. Each student in a group answers a question related to the case from a list of options and must reply to one of their peers, thereby extending the discussion. Another assignment has students select a gene variant from a list of actionable variants and create a scholarly e-poster in accordance with the assignment criteria and rubric. For this assignment, it is suggested that each student be randomly assigned to peer review two other posters as part of their assessment. This allows each student to learn about three different gene variants. The course concludes with students selecting a case study to complete.

Nurse Educator Implementation Strategies

Nurse educators can implement this curriculum through several pragmatic approaches that accommodate varying levels of genomic expertise and institutional readiness. Faculty without prior genomics preparation can utilize the instructor-oriented preface, competency mapping, and textbook readings to advance their own foundational knowledge before teaching the material. Programs may adopt the full course or incrementally integrate units, cases, or assignments into existing courses, such as pharmacology, pathophysiology, pediatrics, mental health, or maternity. Faculty can also use the modular structure to scaffold learning across curricula by introducing core concepts earlier in the program and reserving application-focused assignments for senior students. The open-access licensing permits adaptation to local regulatory, professional, and cultural contexts, enabling alignment with regional standards and practice expectations while maintaining a consistent, evidence-informed foundational curriculum.

Future Directions

Evaluation of genomics education implementation outcomes has been identified as a gap in the literature (Thomas et al., 2023). It will be necessary to conduct longitudinal research to assess how this course impacts students’ clinical practice and their ability to “think genomically.”

Conclusion

Addressing the gap in educational curricula for genomics nursing has been identified as a high-priority area (Limoges et al., 2025; Thomas et al., 2023). This resource directly addresses the call from nurse leaders for a harmonized genomics nursing curriculum content that can be disseminated nationally and internationally (Limoges et al., 2025). As such, this genomics-informed nursing curriculum can help address global challenges in integrating genomics into nursing education and practice, as well as improving nurses’ genomic literacy. Additionally, as this resource is modular and competency-based, it can be adapted across jurisdictions with differing scopes of practice or for other health professions.