Individualizing Nursing Care in the Omics Era.

That’s the nutrition and comfort intervention one of my undergraduate classmates prescribed on a nursing care plan, circa 1972. In response, her incredulous instructor wrote, “I assume the patient likes this?!?” Apparently, the teacher didn’t share the patient’s enthusiasm for the interesting and unique sensory qualities of buttermilk—a combination of sourness, astringency, yellow–white color, lumpiness, and slow thick flow. Some individuals enjoy the buttermilk experience, and others prefer to avoid it at all costs (cf. Reed & Knaapila, 2010), making the buttermilk treatment a classic example of individualized nursing care. To be effective and cost-effective in improving health, however, individualization needs to go well beyond simply honoring preferences to appreciation of why preferences exist, and how and when they “work” when used as interventions. Today’s precision medicine initiatives extend the individualization long valued in nursing to the broader realm of healthcare. Enabled by new insights from the fast-developing omics sciences, precision healthcare aims to tailor prevention and treatment efforts to the array of unique characteristics that make up an individual (www.whitehouse.gov/precision-medicine). In 2003, the announcement that the human genome had been completely sequenced signaled the start of a new era in the life sciences. Genomics exploded as additional subfields— transcriptomics, proteomics,metabolomics, exposomics,microbiomics, epigenomics—emerged and collectively became known as omics. At first blush, introduction of this new and somewhat unfamiliar sounding terminology into the nursing science lexicon suggests an “addition” to current perspectives or implies that viewpoints that have served the discipline well will need to be “set aside.” Neither is the case. Advances in omics are creating the circumstances needed to fully incorporate biology with psychosocial and behavioral aspects of nursing science to create an in-depth, multiscale, dynamic understanding of health and illness. Arising from integrated knowledge documenting biological and psychosocial-behavioral links—frommolecules within cells, to persons within society, over time—care optimized for the individual is envisioned across the range of health services: identification of at-risk individuals, screening and diagnosis, clarification of prognosis, optimization of drug therapy to maximize therapeutic benefit and minimize adverse outcomes (Genomic Nursing State of the Science Advisory Panel et al., 2013), among others.