[ANSWERED 2024] When seeking to identify a patient’s health condition, advanced practice nurses can use a diverse selection of diagnostic tests and assessment tools; however, different factors affect the validity

When seeking to identify a patient’s health condition, advanced practice nurses can use a diverse selection

When seeking to identify a patient’s health condition, advanced practice nurses can use a diverse selection of diagnostic tests and assessment tools; however, different factors affect the validity and reliability of the results produced by these tests or tools. Nurses must be aware of these factors in order to select the most appropriate test or tool and to accurately interpret the results.

Not only do these diagnostic tests affect adults, body measurements can provide a general picture of whether a child is receiving adequate nutrition or is at risk for health issues. These data, however, are just one aspect to be considered. Lifestyle, family history, and culture—among other factors—are also relevant. That said, gathering and communicating this information can be a delicate process.

For this Assignment, you will consider the validity and reliability of different assessment tools and diagnostic tests. You will explore issues such as sensitivity, specificity, and positive and negative predictive values. You will also consider examples of children with various weight issues. You will explore how you could effectively gather information and encourage parents and caregivers to be proactive about their children’s health and weight.

To Prepare

• Review this week’s Learning Resources and consider factors that impact the validity and reliability of various assessment tools and diagnostic tests. You also will review examples of pediatric patients and their families as it relates to BMI.
• By Day 1 of this week, you will be assigned to one of the following Assignment options by your Instructor: Adult Assessment Tools or Diagnostic Tests (option 1), or Child Health Case (Option 2).

Note: Please see the “Course Announcements” section of the classroom for your assignments from your Instructor.

• Search the Walden Library and credible sources for resources explaining the tool or test you were assigned. What is its purpose, how is it conducted, and what information does it gather?
• Also, as you search the Walden library and credible sources, consider what the literature discusses regarding the validity, reliability, sensitivity, specificity, predictive values, ethical dilemmas, and controversies related to the test or tool.
• If you are assigned Assignment Option 2 (Child), consider what health issues and risks may be relevant to the child in the health example.
• Based on the risks you identified, consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.
• Consider how you could encourage parents or caregivers to be proactive toward the child’s health.

Assignment (3–4 pages, not including title and reference pages):

Assignment Option 1: Adult Assessment Tools or Diagnostic Tests: Pap Smear

• Include the following:
• A description of how the assessment tool or diagnostic test you were assigned is used in healthcare.
• What is its purpose?
• How is it conducted?
• What information does it gather?
• Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values. Include references in appropriate APA formatting.

Expert Answer and Explanation

Adult Screening using Pap Smear

Clinical assessment entails an analysis of the patient’s medical history and physical health. It serves the role of determining the health risks which may predispose patients to the clinical emergency when they are receiving treatment. It is also important in the sense that it helps assess a patient’s emotional as well as their psychological response to a physiological health event.

A clinician has various options when it comes to the assessment tool they can use to examine a patient, and when selecting such tools, it is imperative that they consider the patient’s age. This is important because some tests such as Pap Smear are only used in clinical cases which involve adults. However, factors such validity and reliability of the test can equally influence the selection of the tool for performing the test (Sachan et al., 2018).

It is important to examine Pap Smear in terms of the purpose it serves, the process of performing it, the type of information it gathers, and assess the tool’s reliability and validity.

How the Assessment Tool is used in Healthcare

The Purpose of the Tool

Pap smear’s role is to gather part of the cervix’s cells with focus on identifying whether the cervix has malignant cells. It is important that once one reaches age 21 years old, they should receive the test, and in this case, it can help determine the presence of the cancer of the risk. They can go for the next test after three years if the current test indicate they don’t have the cancer.

However, the use of the test is not limited to determining the presence of the cervical cancer. It can also help test if one has human papillomavirus (HPV) especially in women above aged 30 years (Sachan et al., 2018). By helping screen for cancer and HPV, it can help inform the clinical intervention decisions for patients with either of these conditions.

How the Test is performed

Cervical cancer is a disease that a clinician can examine using the Pap smear procedure. It involves examining the cervix by inserting speculum inside the vagina. It serves the role of holding the virginal walls apart. When these walls are apart, the clinician use a spatula to collect samples of the cervix cells which they test.

Before going for the tests, one should prepare for it, and part of this preparation involves avoiding of the intercourse as well certain medications such as creams. Sex and the use of these medications can cause obstruction of the abnormal cells. When scheduling the test, a clinical should consider the patient’s menstrual period. In this case, it is important to schedule it when one is not having menses to avoid the obscuring of the malignant cells (Sachan et al., 2018).

The Type of information the Tool gathers

The Pap smear collects various details. For instance, it can look for a pre-cancer or a cervical cancer that is about to develop. Still, it gathers information regarding any change on the cervix which may eventually develop into the cancer of the cervix due to inappropriate clinical intervention. Besides, it gathers information on the HPV virus which can result to the abnormal cell changes.

The cell-cell communication is important when it comes to the normal growth of the cells. In a case where a patient is HPV-positive, the virus infects their cells (Sachan et al., 2018). This alters intercellular communication, and causes the uncontrolled multiplication of the cells.

Validity and Reliability of the Tool

Before one selects a test for assessing health needs, one has to first assess the test in terms of its quality, and the two concepts, validity and reliability, can help one assess these tests. The former determines the level to which the test is accurate while the latter assesses the test’s consistency. The current publications examine the quality of the Pap smear in terms of the reliability and validity dimensions, and there is common agreement among researchers that the test is valid and reliable.

According to the National Cancer Institute (NCI), the test’s internal and external validity are good. This means that the test is reliable, and one can depend upon it to test for the presence of the cancer. The regular use of this test can help lower the cervical cancer cases and deaths by 80% (National Cancer institute, 2020). According to some publications, however, the test is not stand-alone, and it may require additional tests to confirm the presence of the abnormal cells.

The test has a sensitivity of 93%, and this implies that it is likely to be reliable when used to screen for the presence of the cancer of the cervix. Majority of the existing research studies which explore the quality of the Pap smear indicate that the test is effective, and it can diagnose the cancer with high accuracy. An example is the study which Aarecida and Mitteldorf (2016) performed.

Issues with Sensitivity, Reliability and Predictive Values

As with most instruments, the use of the cervical cytology presents issues pertaining to the sensitivity, reliability and predictive values. The test can result to abnormal test results, and this can be attributed to the HPV-triggered changes in the cell. A wide spectrum of factors can affect the sensitivity and reliability of this test.

For instance, a thick smear that is excessive can negate the accuracy of the test outcomes. The same applies when the foreign materials obscure the cervix or when it is stained. Barut et al. (2015) reported a 0.57% sensitivity in a cytology-based screening to determine the presence of cancer. This sensitivity is way too low when compared to that acquired from the study by Nkwabong and colleagues (2018).

The Pap smear is associated, still, with reliability issues. Various factors can obscure the cervix, and these factors range from the blood to the chemicals on the cervix. At different cervix conditions, the Pap test can give inconsistent results. Therefore, the current studies may not reflect the actual reliability values. These cervix’s conditions can equally cause inconsistency in the predictive values. This is why there is no consistency in study outcomes for studies which explore the reliability, sensitivity and predictive values of the Pap smear.

Conclusion

In conclusion, factors such as the reliability of a test determine the type of a test a provider uses to screen a patient. Although age is equally an important consideration, an instrument’s reliability or sensitivity plays a major role in influencing the decision to use it. This is noticeable with the Pap smear test which despite being reliable, presents sensitivity and reliability issues.

Different studies on the quality of the Pap smear yield different results, and this means that the review of the various studies is necessary to understand whether this test can bring significant results when it comes to screening of the cervical cancer.

References

Aarecida, C., & Mitteldorf, T.S. (2016). Cervical Cancer Screening: From Pap smear to Future Strategies. J. Bras. Patol. Med. Lab., 52 (4). Doi: https://doi.org/10.5935/1676-2444.20160040.

Barut, M. U., Kale, A., Kuyumcuoğlu, U., Bozkurt, M., Ağaçayak, E., Özekinci, S., & Gül, T. (2015). Analysis of Sensitivity, Specificity, and Positive and Negative Predictive Values of Smear and Colposcopy in Diagnosis of Premalignant and Malignant Cervical Lesions. Medical science monitor : international medical journal of experimental and clinical research, 21, 3860–3867. Doi: https://doi.org/10.12659/msm.895227.

National Cancer institute (2020). Cervical Cancer Screening-Health Professional Version. https://www.cancer.gov/types/cervical/hp/cervical-screening-pdq.

Nkwabong, E., Badjan, I.B., Sando, Z. (2018). Pap Smear Accuracy for the Diagnosis of Cervical Precancerous Lesions. Sage Journals, 49 (1), 34-39. Doi: https://doi.org/10.1177/0049475518798532.

Sachan, P. L., Singh, M., Patel, M. L., & Sachan, R. (2018). A Study on Cervical Cancer Screening Using Pap Smear Test and Clinical Correlation. Asia-Pacific journal of oncology nursing, 5(3), 337–341. Doi: https://doi.org/10.4103/apjon.apjon_15_18.

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Rubric Detail

Name: NURS_6512_Week_3_Assignment_1_Rubric_Option_1