From the Guidelines
The priority in nurse screening assessments for adults should be identifying immediate health risks and establishing baseline health status, with a focus on screening for common chronic conditions such as breast, cervical, colorectal, and lung cancer, as recommended by the American Cancer Society 1. A comprehensive assessment should begin with vital signs (blood pressure, heart rate, respiratory rate, temperature, and oxygen saturation) and pain evaluation, as these can quickly identify critical issues requiring immediate intervention. Following this, nurses should focus on assessing the patient's chief complaint, current medications, allergies, and relevant medical history. Particular attention should be paid to screening for breast cancer in women aged 40-54 years with mammography, cervical cancer in women aged 21-65 years with Pap test and HPV DNA test, colorectal cancer in adults aged 45-75 years with fecal immunochemical test or colonoscopy, and lung cancer in current or former smokers aged 55-74 years with low-dose helical CT 1. Mental health screening is equally important, with questions about mood, anxiety, and suicidal ideation. Nutritional status, functional ability, and social determinants of health (housing stability, food security, transportation access) should also be evaluated as these significantly impact overall health outcomes. This prioritization ensures that life-threatening conditions are identified first, while still capturing comprehensive information needed for effective care planning. The assessment should be tailored to the individual's age, gender, and specific risk factors to ensure relevant health concerns are not overlooked. For example, women aged 40-44 years should have the opportunity to begin annual screening mammography, while women aged 55 years and older should transition to biennial screening or have the opportunity to continue screening annually 1. Similarly, adults aged 45-75 years should undergo regular screening with either a high-sensitivity stool-based test or a structural exam, depending on patient preference and test availability 1. By following these guidelines, nurses can ensure that adults receive comprehensive and targeted screening assessments that prioritize their immediate health risks and establish a baseline for future care.
From the Research
Priority in Nurse Screening Assessments for Adults
The priority in nurse screening assessments for adults should be to identify diseases that have a significant negative impact on health, an identifiable asymptomatic period, and improved outcomes with early intervention 2.
- Characteristics of a disease that make it amenable to screening include:
- Significant negative impact on health
- Identifiable asymptomatic period
- Improved outcomes with early intervention
- A useful screening test must have:
- Sensitivity and specificity for the disease being screened
- Cost effectiveness
- Acceptability to patients
Considerations for Screening Tests
When evaluating screening tests, nurses should consider the potential for false-positive and false-negative results, as well as test bias, including screening bias, length bias, and lead-time bias 2.
- False-positive results can cause harm from anxiety and unnecessary procedures
- False-negative results can worsen outcomes by leading to delayed diagnosis and treatment
- Test bias can undermine the validity of a screening trial
Evidence-Based Screening Tools
Nurses can use evidence-based screening tools to assess the critically ill older adult, taking into account the distinguishing features inherent to older adults 3.
- Relevant screening tools can help identify comorbidities, such as hypertension and diabetes, which are common in older adults
- Early identification and management of these conditions can help prevent cardiovascular disease and other complications 4, 5
Person-Centred Care
Nurses should prioritize person-centred care when assessing patients' needs and planning effective care, ensuring that all nursing interventions are evidence-based 6.
- Assessing people's needs and care planning should be tailored to the individual patient
- Care planning should involve the patient and their family, and should be regularly reviewed and updated.