The Genetic Information Nondiscrimination Act (GINA)

Experiencing or witnessing a traumatic event can have life long affects on an individual. These experiences can range from working in the military, a natural disaster, near death experiences, accidents and abuse; everyone has a different reaction post events. “PTSD is characterized by a constellation of symptoms that reflect a prolonged adverse response to an extremely distressing event” (Orr, Metzger, Pitman, 2002, p. 272). Symptoms usually begin shortly after a traumatic event is experienced, but it is also possible for symptoms to develop over time or not at all. Additionally, symptoms will arise and subside with certain events in an individuals’ life, these events acting as triggers, which activate symptoms. According to the US Department

of Veterans Affairs, “If symptoms last more than four weeks and interfere with daily living, PTSD is a likely diagnosis” (U.S. Department of Veterans Affairs, 2015). Distinctive symptoms of PTSD are characterized by the following; reliving the traumatic event, avoiding situations that recap the event, negative changes in beliefs or feelings and hyper-arousal. Specifically amongst these categories an individual may experience nightmares, flashbacks, difficulty sleeping, anxiety, restlessness, distress and becoming startled by loud noises (U.S. Department of Veterans Affairs, 2015).
A review on the genetic background of PTSD mentions that extensive research has been done with consideration of the effects of genetic bases on psychiatric disorders and that little relationship is found about polygenic influences on PTSD. Although little evidence is found, “association studies have investigated 8 major genotypes in connection with PTSD. They have tested hypotheses involving key candidate genes in the serotonin (5-HTT), dopamine (DRD2, DAT), glucocorticoid (GR), GABA (GABRB), apolipoprotein systems (APOE2), brain-derived neurotrophic factor (BDNF) and neuropeptide Y (NPY)” (Broekman, Olff, Boer, 2006, p. 348). Furthermore, experiencing a traumatic event is essential for predisposition to PTSD, but it is not necessarily well defined that PTSD will occur from the event or from hereditary factors.
Peggy had undergone a traumatic event and expresses symptoms that are identifiable with PTSD. Due to the fact that an event is essential for this disorder, Peggy is ultimately at risk. Although Peggy’s mother had mentioned having similar experiences and symptoms after being a nurse in the Vietnam War, with limited research, a genetic relationship cannot be noted as a definable risk factor. Even though there is limited verification of a genetic relationship, Peggy’s exposure to her mother who was diagnosed with PTSD, may increase her risk of developing symptoms when being exposed to a traumatic event. American Academy of Experts in Traumatic Stress further reports that, “children of veterans with PTSD are at higher risk for being depressed and anxious than non- combat Vietnam era veteran’s children” (Price, 2014). Another finding from PTSD Research Quarterly is that women have been found to have almost twice as high of a prevalence of PTSD than men, as well as some ethnical pre-dispositions (Halligan, Yehuda, 2000, p. 1). Peggy falls under the following factors, which places her at a position of increased risk for developing PTSD after a traumatic event.
The Genetic Information Nondiscrimination Act (GINA) is “a new Federal law that prohibits discrimination in health coverage and employment based on genetic information” (Department of Health and Human Services, 2009).

Furthermore, GINA protection varies amongst individuals; certain requirements must be met in order for full compliance. Ultimately, the main purpose of GINA is to hinder health insurers or health plan officials from demanding genetic information from an individual or their family members in order to make decisions on certain coverage’s, rates or decisions. Moreover, when seeking jobs, this act will further prohibit employers from requiring genetic tests in order to make hiring, and firing decisions and or determining promotions. Although GINA encompasses the following protection features, it consists of limiting factors. Coverage’s that GINA does not provide protection against are life insurance, disability insurance and long-term care insurance, as well as any particular test or necessary treatment. Additionally, military members who are a part of Tricare, and veterans who receive their care through Veteran Administration are also not covered by GINA. Situations in which health insurers provide coverage to an individual, GINA does not prohibit the health insurer from determining eligibility or premium rates based on the manifestation of a disease or disorder. As far as employment-based coverage, provisions of GINA do not typically apply to employers with less than 15 employees and if a disorder or disease were to be evident, GINA does not protect against increased costs of coverage due to impeding disease. Lastly, implications of GINA do not prohibit health insurers or health plan administrators from using genetic testing as a base or determining factor of health insurance payments (Department of Health and Human Services, 2009). Groups that are not applicable for GINA protection are members of the United States military, veterans obtaining

healthcare through the Department of Veterans Affairs (VA), or to the Indian Health Service. Upon becoming a member of the US service, it is required that all members provide a DNA sample in case a casualty were to occur, the sample being used for identification of remains (Baruch, Hudson, 2008).
PTSD holds a stigma that is comparable or classified as someone with a psychological condition and who is in other words, “crazy”. This social implication may prevent an individual from seeking testing or receiving necessary help in order to abstain from the following stigma. Ethical and legal implications associated with PTSD are obtaining informed consent from the patient and preparation of the client for possible flashbacks and side effects that may coincide with treatment plans. Furthermore, patients hold the right to know backgrounds, competency and skill levels of the provider before beginning the process of treatment and throughout the duration of their treatment. It is noted that a provider should be well experienced in a mental health discipline before taking responsibility of treatment (Striefel, 2009, p. 3).
When considering patients with PTSD, the role of the nurse is to maintain complete awareness of the disorder, along with the application of evidence-based practice in order to keep up with pending research and risk factors. The role of the nurse also includes recognition of symptoms pertaining to PTSD and educating the patient about their disorder. Furthermore, the nurse can assist the patient with interventions such as setting them up with therapy for further evaluations, or providing them with other resources to help them cope with the anxiety and stress that accompanies PTSD.