Study Notes for NUR 204: Interventions of Health Promotion

INTERVENTIONS OF HEALTH PROMOTION

IN-CLASS MODULE NUR 204

Instructor: Janine Barnett, MSN, RN, TTS

Session ID: bnurse1

OBJECTIVES

Discuss screening and its role in secondary prevention and health promotion.
Identify screening recommendations.
Differentiate between various complementary and alternative therapies and define the nurse's role in the integration of these therapies into practice.

SCREENING IN HEALTH PROMOTION

Primary Objective

The main goal of screening is to detect a disease in its early stages when treatment can effectively mitigate its progression, which may necessitate more intensive interventions. Some diseases may have a preceding phase characterized by asymptomatic pathogenesis or latency.

Secondary Objective

Another important aim of screening is to reduce the cost of disease management that may be required if the disease progresses to a later stage.

DISTINCTION BETWEEN SCREENING AND DIAGNOSTIC TESTS

Screening focuses on individuals who are asymptomatic and aims to detect disease early.
Diagnostic Tests are utilized on symptomatic individuals to confirm or exclude a diagnosis.
Screening is typically less invasive and simpler to perform compared to diagnostic tests.

ADVANTAGES AND DISADVANTAGES OF SCREENING

Advantages

Simplicity: Some screening tests are straightforward to conduct.
Cost-effectiveness: They can be economically beneficial when detecting diseases early.
Individual vs. Population Screening: Screening can involve either a single test or multiple tests targeted at entire populations.
Health Education Opportunity: Provides a moment for health education.

Disadvantages

False Positives: Instances where the test indicates disease presence when it is not there.
False Negatives: Cases where the test fails to detect an existing disease.

MISCONCEPTIONS IN SCREENING TEST RESULTS

Example 1: Pregnancy Test

A patient takes a home pregnancy test, which yields a negative result. However, later, abdominal pain prompts an ultrasound that confirms pregnancy. This case illustrates a False Negative result.

Example 2: Glucose Screening

A patient receives positive results from a glucose screen. Despite this initial finding, further testing confirms the absence of diabetes. This scenario represents a False Positive result.

TERMS AND DEFINITIONS

Morbidity: The state of having a specific disease.
- Comorbidity: The coexistence of multiple diseases in a single patient.
Mortality: Refers to the number of deaths attributed to a specific disease.
Incidence: The rate of new disease cases within a defined population over a specified time period.
Prevalence: The proportion of a population that has a particular disease at a given time, encompassing both new and existing cases.

SCREENING RELIABILITY AND VALIDITY

Reliability

Intraobserver Reliability: Indicates consistency when the same observer measures repeatedly over time.
Interobserver Reliability: Reflects the agreement among different observers measuring the same phenomenon.

Validity

Sensitivity: The ability of a screening test to correctly identify those with the disease (few false negatives).
Specificity: The ability of a test to identify correctly those without the disease (few false positives).

CONSIDERATIONS FOR SCREENING

Factors to determine if screening should be performed include:

The significance of the disease being screened for.
The ability of the screening to detect the disease effectively.
The availability of effective treatments.
The cost associated with screening.

US PREVENTIVE SERVICES TASK FORCE (USPSTF)

The USPSTF is an independent panel of experts who review evidence regarding the effectiveness of clinical preventive services and develop screening recommendations. Key elements include:

Covering over 80 preventive service topics across various stages of life.
Providing recommendations graded A, B, C, D, or I based on evidence strength.
Recommendations apply only to individuals without disease symptoms.
The evolution of screening guidelines influenced by scientific advancements, such as updates to mammography and PSA screening.

USPSTF GRADING SYSTEM

Grade	Definition	Suggestions for Practice
A	High certainty of substantial net benefit.	Offer or provide the service.
B	Moderate certainty of moderate net benefit.	Offer or provide the service.
C	Moderate certainty of small net benefit, selective use recommended.	Offer for selected patients based on individual circumstances.
D	High/moderate certainty of no net benefit or that harms outweigh benefits.	Discourage the use of the service.
I	Insufficient evidence to assess benefits and harms.	Read clinical considerations and ensure patient understanding.

SCREENING RECOMMENDATIONS AND GUIDELINES

The USPSTF regularly updates guidelines based on new evidence and scientific findings to improve public health outcomes and strategies for screening various diseases (e.g., breast cancer, STIs, hearing loss in older adults, etc.).

COMPLEMENTARY AND ALTERNATIVE THERAPIES (CAT)

Definitions

Complementary Therapies: Used in conjunction with conventional treatment.
Alternative Therapies: Used instead of standard medical treatments.

Nurse's Role in CAT

Encourage open, honest communication with patients regarding their use of CAT.
Familiarize oneself with evidence related to various CAT.
Assist patients in making informed choices about complementary and alternative therapies.