A Nursing Reflective Journal Example: Complexities of BRCA Gene Mutations

Understanding BRCA Gene Mutations

This article presented information about women who tested positive for a BRCA 1 or BRCA 2 gene mutation. The author not only discussed the gene mutations associated with cancer but also how the gene mutation or cancer can affect the relationships you have.

Everyone has BRCA genes, BRCA 1 and BRCA 2, that function as tumor-suppressor genes or genes that keep cells from diving too quickly. When these genes develop a mutation, cell division can become out of control which can lead to cancer.

These mutations can be inherited; if one parent has the mutation, each child will have a fifty percent chance of having the gene mutation (Hamilton, 2012). The BRCA 1 mutation has a higher association with breast cancer and ovarian cancer than the BRCA 2 mutation (Porth, 2015). Breast cancer can display itself as a mass in the breast or lymph nodes of the axillary region, puckering of the skin on the breast, nipple retraction, or unusual discharge from the nipple. The mass is usually painless and firm, with poorly defined borders that are commonly in the upper outer quadrant of the breast.

Patient-Centered Medical Management

Mammography is the only screening technique that is effective during the early detection of breast cancer. Treatment methods for breast cancer include surgery, chemotherapy, and radiation therapy, along with hormonal treatment. Combination therapy, as in mastectomy with lymph node dissection paired with chemotherapy or radiation therapy, often has successful outcomes compared to treatments with just one or the other (Porth, 2015). Participants in the study who had children stated that they felt that the primary goal of treatment was to “stay alive” for them. Some elaborated, saying they took prophylactic measures due to their mutation to try and prevent their cancer, but it did not take away from their feeling of guilt because the gene mutation was still passed on to their children (Hamilton, 2012). In medicine, it is important to educate our clients about all their options and continue to answer any questions they have.

Patient-Centered Nursing Management

Genetic testing has shown its importance in those with gene mutations. As the author references in her article, “a young woman testing positive for a BRCA mutation never presents alone, even if she’s the only person in the room…” genetic testing can reveal information across many generations. It is vital for a nurse to be supportive and caring during this time. In the following paragraph, the author also references how seventy-nine percent of baccalaureate nursing programs did not meet the requirement for genetics and genomics (Hamilton, 2012). Not only is it important for the nurse to be supportive and caring towards the individual getting the testing done, but it is important for them to understand the underlying science of what the individual may be going through.

Application to Nursing Practice

The article provides the readers with suggestions for good nursing practice that are supported by the Essential Nursing Competencies and Curricula Guidelines for Genetics and Genomics. Among these suggestions include some bullet points about understanding the different types of mutations and the timelines for different treatment options, but many of them revolve around the psychological aspect of having a BRCA 1 or BRCA 2 mutation. Through the research that the author conducted, she found that many women who were single and tested positive for the mutation were concerned about when and how to discuss this with their partner or future partners, and even married women were concerned about telling their families. The recommendations talk about finding support groups to offer to clients, helping and supporting the screening process, finding insurance coverage, having a role play to figure out how to tell people in different scenarios, and even “finding answers to questions you can’t answer.”

Conclusion

In conclusion, this article focuses on the fact that young women can be and are affected by breast cancer and the BRCA 1 and BRCA 2 gene mutations. Going through something like this will take a toll not only on you physically but also psychologically. This article brought to light how these diagnoses can affect these young women. It also showed that a lot of baccalaureate nursing programs are lacking in genetics competencies, which are important so that we can further support our clients in the field. There are steps and actions we can take to further the support we offer to our clients through these paths to have a positive outcome. They have never experienced this before, and as nurses, it is our responsibility to make them confident in their knowledge of their cancer and supported by their medical team.

References

1. Hamilton, R. (2012). Impact of BRCA1/BRCA2 Mutation Testing on Patients With Breast Cancer. Journal of Clinical Oncology, 30(18), 2125-2133.
2. Porth, C. M. (2015). Pathophysiology: Concepts of altered health states. Lippincott Williams & Wilkins.

Did you like this example?

252

13