Global prevalence of genomic knowledge, attitude, and practice across the nursing pipeline: A systematic review and meta-analysis with implications for advanced practice nursing.

BACKGROUND: Advances in genetics and genomics have transformed healthcare, requiring nurses to competently integrate genetic information into clinical practice. However, global evidence on nurses' knowledge, attitudes, and practices (KAP) remains fragmented. METHODS: A systematic review and meta-analysis were conducted following standardized guidelines. Multiple electronic databases were searched to identify cross-sectional studies assessing nurses' KAP related to genetics and genomics. Fifty-five studies were included in the systematic review, with 44 eligible for quantitative synthesis. Pooled prevalence estimates were calculated using random-effects models. Subgroup and meta-regression analyses were performed to explore heterogeneity. RESULTS: The pooled event rate for good genetic knowledge among nurses was 27% (95% CI: 18%-38%), indicating limited competency. In contrast, the pooled prevalence of positive attitudes toward genetics was 71% (95% CI: 63%-77%), reflecting high attitudinal readiness. The pooled prevalence of genetics-related clinical practice was 47% (95% CI: 37%-57%), suggesting moderate implementation. Substantial heterogeneity was observed across outcomes. Subgroup and meta-regression analyses indicated that postgraduate education and regional context were associated with higher knowledge levels. CONCLUSION: Despite generally positive attitudes, significant gaps in genetic knowledge and clinical practice persist among nurses globally. These findings highlight the need for strengthened genomic education alongside organizational and policy-level interventions to translate positive attitudes into routine genomics-informed nursing practice.