Interpretation
The Delphi survey was conducted with prenatal genetic nursing experts. The outcomes of the study establish a list of 78 competencies for prenatal genetic nursing.
First, Korean nursing educators and nurses have known that nurses in prenatal genetic nursing should be better educated; advances in genetic technologies alone long ago made that evident. But the need for more, new, and better education is all the more urgent because of the dramatic shift in the age at which Korean women are now giving birth [
9,
10,
14]. In Korea, prenatal genetic counselors are lacking, and nurses must fill in the gap [
12,
14]. The Delphi survey is an attempt to articulate the competencies required to fill in the gap for the unique circumstances of prenatal genetic nursing in Korea.
Second, the Delphi survey identifies the most significant domains for competencies as those of knowledge and value. “Experiential genetic nursing knowledge” and “ethics and law” as the 2 most vital domains. “Experiential genetic nursing knowledge” includes 2 sub-categories—knowledge from case study and practicum and clinical genetic nursing knowledge, which are necessary for nurses’ communication with patients and their families and medical and emotional support for them (Supplement 3). In other words, “experiential genetic nursing knowledge” is mainly concerned with knowing experientially how to communicate with, educate, and counsel pregnant women. This implies that clinical genetic nursing knowledge needs to be acquired through case studies and practicums [
15].
Information needs for all categories decreased, but not all of them significantly; the information need for “ethics and law” did decrease significantly. This latter outcome implies that the need for “ethics and law” was largely satisfied by the program. The shortness of the workshop may explain why the information needs for other domains did not decrease significantly.
One subscale, “ethics and law”, should be understood in terms of value, as opposed to factual knowledge, whether technical or not. At base, value is focused on good and bad, right and wrong, legal and illegal. But factual knowledge and value knowledge are intertwined in all healthcare practice, and value itself is idle without knowledge of value. Value-knowledge is central to prenatal genetic nursing. It includes knowledge of ELSIs related to prenatal genetics.
The study demonstrates the need for value competency in prenatal genetic nursing. That means that, nurses need values education as well as experiential genetic nursing knowledge. They need but currently lack the capacity to reason, in a responsible, effective, and value-sensitive way, on prenatal genetic ethical issues. Such a capacity is requisite for the capacity to support patient decision-making.
The case at hand is particularly pointed in the regard. In Korea, termination of pregnancy, due to fetal anomaly, is legally prohibited by the Mother and Child Health Law. A patient’s decision to terminate implies illegal activity, which may harm the patient herself and the fetus. But the decision to terminate is never simple. A patient may be in a unique personal, cultural, or religious situation which may lead to illegal termination [
9,
10,
12].
Third, a framework for a PNGEP is in place. Four domains for structuring a PGNEP, with a special emphasis on the domains of “experiential genetic nursing knowledge” and “ethics and law”, have been developed.
The quasi-experimental study thus supported the validity of the list of competencies that had been identified. It was the participants’ satisfaction with the PGNEP that provided such support. The participants appreciated the value of experiential genetic knowledge and the importance of nurse’ values and ethical decision-making abilities. Such satisfaction also affirms the effectiveness and value of the PGNEP itself. The PGNEP provided at least some needed knowledge of prenatal genetic screening and diagnostic testing. The categories and domains of competencies determined the framework and content of the workshop.
Limitation
This study has potential limitations. First, the measurement tools used were drawn from previous research. They might not be perfect for the specific research pursued here. Ideal would be to develop new tools specifically for the subject area. However, previous research was in a similar subject area, and the measurement tools used were certainly relevant and yielded significant results. Second, the competency components, categories, and domains may change in response to new technology and changing social and political circumstances. The competency components identified are the products of Korea’s unique cultural, social, political, and legal circumstances. Caution is thus needed in generalizing the study’s findings and extending them to other communities.