Nanotechnology and Nursing

Nanotechnology is revolutionizing drug delivery and will have an enormous impact on healthcare and nursing.  Healthcare professionals will have to re-educate themselves and adapt to these changes in drug delivery systems. The nurse will need to understand the drug metabolism and pharmacokinetics of nanomedicines in order to achieve appropriate therapeutic dosing.

In cancer treatment, pharmacogenomics are set to alter the kind of cancer treatment information oncology nurses will need to know.  Dr. Lawrence Lesko, PhD, director of clinical pharmacology and biotherapeutics at the Food and Drug Administration, described the change in drug delivery and therapy: “New (personalized) drugs will now be developed by pathways, by going after the biochemical actions set off by genes.” (Yard, D.) In other words, new drugs for treating cancer are focused on genetic keys that are specific to the individual person.  The drugs are tailored for a person’s unique genetic code and a particular cancer’s molecular profile.  With some genetic mutations, some drugs work better than others and therefore, produce better outcomes for the patient.

Nurses in some oncology practices could potentially be responsible for recommending molecular profiling and writing molecular-based treatment regimens.  Research studies have proven the advantages of using molecular profiling to identify precise tumor targets.  The nurse will be involved in administration of the new precision molecular drug therapy.  As such, they will require education in nanomedicine and nanotechnology.  It’s important for nurses to become familiar with the concept of targeted drug therapies so that they can communicate with their patients about these new treatments so that the patients can then make informed treatment decisions. 

Nanotechnology is an ever-expanding field. There are currently many different applications for its use. Here is a brief list:

• nanoparticle eye drops for the treatment of glaucoma-may prevent blindness in millions of people
• silver-based products made from silver nanoparticles
  • infection-inhibiting properties could possibly be applied to bedding to prevent the spread of Methicillin-Resistant Staphlococcus Aureus (MRSA) in hospitals
  • silver-based product could be used to prevent infections in burn patients
• nano-imaging is also expected to improve the monitoring of therapy thus providing direct feedback to the nurse, NP or physician.
• a responsive nano-enabled insulin delivery device that is capable of detecting glucose levels (available within the next 3-5 years for treating diabetes)
• nanotechnology vaccines- to treat diseases such as hepatitis and malaria.  Because of the small amount of vaccine required, the cost for one injection may be as low as one dollar
• to facilitate bone regeneration in the treatment of osteoporosis and certain aspects of regenerative medicine-growing new cartilage in a knee joint
• drug delivery for CNS disorders.  This is important because the brain is a place of refuge for a broad range of pathogens including HIV-1.  Nanotechnology can improve delivery of antiretroviral medications across the blood brain barrier.

Drugs can also be encapsulated in nanoshells, which are molecules covered with silver, gold or other metals.  The nurse or other healthcare provider will have the ability to trigger the nanoshell with infrared light or magnetic fields to release its therapeutic agent at the exact time that it reaches its target in the body.

Nurses are in a prime position to influence and advocate for safe and ethical use of nanotechnologies in the workplace.  Nurses will need to create care plans to assist patients in their more independent role.  Nurses need to be educated on occupational safety guidelines regarding safe handling of nanomaterial in the workplace.  Research is in progress and is high priority for federal agencies, such as NIOSH, National Institute for Occupational Safety and Health (which is a division of the CDC, Center for Disease Control), EPA (Environmental Protection Agency) and the Depts. Of Energy and Defense are all contributing to a body of knowledge regarding the potential effects of engineered nanomaterials and nanopharmaceuticals on humans, animals and the environment.  Research is funded by the National Science Foundation, National Institute of Health and federal agencies mentioned above.  NIOSH is the lead federal agency for conducting research on occupational safety and health with regard to nanopharmaceuticals and nanomaterials. 

Safety and risk management are of utmost importance with this new technology.  The safe and ethical use of nanomaterials is the most immediate concern.  The key risks are related to liability, privacy, financing and the effectiveness and safety of products.  Precautions to avoid inhalation of nanomaterial must be taken.  Current gloves, masks and gowns may not provide sufficient protection.  There are only a few research studies that are available regarding safety of nanoparticles and nanomaterials.  Researchers have discovered that nanoparticles can cause inflammatory reactions and they can potentiate the effect of medications.  The behavior of nanomaterial in humans is not well understood.

Lastly, nanotechnology will have substantial implications for nursing informatics.  These implications would involve the electronic health record design, systems interoperability and safety controls.  The EHR design will need to receive and incorporate the data and information that is being relayed from nanomaterials.  Patient data may be transferred automatically to EHRs, much like Bluetooth devices sense each other.

In conclusion, the implications of this new technology impact healthcare providers, consumers and informatics.  There is a need for education of both consumers and healthcare providers regarding safety, ethical, social and legal ramifications associated with nanomaterials.  The patient will have increased responsibilities, as well as role changes, because he would be the first to view information from these new nano devices. 

References

AZoNano.com:  The A to Z of Nanotechnology.  Nanoparticle treatment for glaucoma may stop

     millions from going blind.  Retrieved on October 14, 2009 from 

     http://www.azonano.com/news.asp?newsID=4290 

Berkowitz,A., Goddard, D., Novel Drug Delivery Systems:  Future Directions, Journal of

     Neuroscience Nursing; Apr 2009; 41

McCauley, L., McCauley, R., Nanotechnology, Are Occupational Health Nurses Ready?, AAOHN

     Journal; December 2005; 53:12, Retreived October 14, 2009  from

     http://www.aohna.ab.ca/members/resources/2008_08_nanotech.pdf 

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The European Technology Platform.  NanoMedicine—Nanotechnology for Health.  Retrieved

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Yard, D.(July 31, 2009), Personalized Medicine is Coming:  Are You Ready? (Do you Need to

     Be?), Oncology Nursing News; July/August 2009; 3:5, Retreived October 14 from

     http://www.oncologynursingnews.com/Personalized-Medicine-Is-Coming-Are-You-Ready-

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