Journal of Community Health Nursing
ISSN: 0737-0016 (Print) 1532-7655 (Online) Journal homepage: http://www.tandfonline.com/loi/hchn20
Health Screening on a College Campus by Nursing Students Julia Leatherman & Ruth Davidhizar To cite this article: Julia Leatherman & Ruth Davidhizar (1992) Health Screening on a College Campus by Nursing Students, Journal of Community Health Nursing, 9:1, 43-51, DOI: 10.1207/ s15327655jchn0901_5 To link to this article: http://dx.doi.org/10.1207/s15327655jchn0901_5
Published online: 07 Jun 2010.
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Date: 09 November 2015, At: 02:39
JOURNAL OF COMMUNITY HEALTH NURSING, 1992,9(1),43-51 Copyright O 1992, Lawrence Erlbaum Associates, Inc.
Health Screening on a College Campus by Nursing Students Julia Leatherman, RN, MS, MPA, and Ruth Davidhizar, RN, DNS, CS Downloaded by [Deakin University Library] at 02:39 09 November 2015
Bethel College
The study of community health nursing is an important part of preparation at the baccalaureate level for professional nursing. This is because an understanding of epidemiology and community assessment is essential for the registered, professional nurse who provides comprehensive care in a community setting. Whether the nurse works in a community health setting or in a free standing health-care agency, nurses are part of a comprehensive system of health care and are involved in community care. Nursing student involvement in epidemiology and health screening investigations as a part of the clinical practicum is one way to assist the nursing student to integrate theoretical principles with nursing practice. In fact, several reports of health screening projects by nursing students are reported in the literature, that is, health screenings for muscular dystrophy and lead poisoning studies (Powers, 1981; Roybal, Bauwins, & Fasla, 1975). In the health screening study reported by Roybal et al. (1975), students were not only involved in screening but participated in implementing nursing services. Exposure and participation in a health screening project as a clinical learning experience proved to be a valuable learning tool for students to experience implementation of the nursing process in a community setting. Our experience with a health screening project on a college campus was found to be a unique way to assist nursing students studying community health nursing to integrate and synthesize knowledge of community health nursing in a dynamic and relevant clinical experience. This article describes the initial development of such a program on a college campus. The program continues to the present as a service provided by nursing students in a community health nursing course. HEALTH SCREENING AS A COMMUNITY HEALTH SERVICE Health screening services have been in existence for some time as a part of community haalth care. Health screening is a health-care evaluation service that identifies persons at risk of developing a certain disease who may not be aware of impending illness. Health screenings are not diagnostic but rather serve to identify individuals Requests for reprints should be sent to Ruth Davidhizar, RN, DNS, CS, Assistant Dean and Chair ~, College, 1001 West McKinley Avenue, Mishawaka, IN 46545. for ~ u r d i n Bethel
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Leatherman and Davidhizar
who are at high risk for an illness and who need additional workup for a specific diagnosis (Turner & Chavigny, 1988). In this way, health screening may serve to facilitate the initiation of a preventive program which averts a health crisis. High school and college students often have not found a convenient entry into the health-care system. This population often has outgrown the care given in the pediatric setting. Even if care providers are still available in their home community, with the mobility of modern society, many students have moved or attend school in communities far from the setting where they are known. Some college students who have never encountered illness can identify no primary care provider. Hence, screening programs, such as the one described, frequently provide the entry point into the health-care system. Assessment
Assessment of health problems involves two major activities: collection of relevant data and interpretation of the results. Health screenings may focus on individual health problems (e.g., assessment for glaucoma). On the other hand, health screening may focus on a cluster of health problems, for example, hypertension, diabetes, and elevated cholesterol (Jarvis, 1985). The type of screening done is determined by a variety of factors including the goals of the agency involved in the screening process, the population involved and their health-care needs, and the financial resources available for screening. Screenings may be directed at specific populations, such as the elderly (Young & Gottke, 1985), pregnant women, children, or college students as reported in this article. Screenings may be under the auspices of a health department, community agency, hospital, or in a college setting. In most cases, the degree to which a public health department uses health screenings as a community assessment tool is dependent on the community's health priorities. Financial resources including equipment, laboratory services, and staff must all be considered when health screening programs are designed. Fiscal restraints under which the agency functions often act as the final determining factor of the feasibility of health screening programs (Ervin, 1982). Types of Screenings
Blood pressure screening. According to the U.S. Department of Health and Human Services (1988) as many as 58 million people in the U.S. have elevated blood pressure. Risk of cardiovascular complications related to hypertension increases continuously with increasing levels of both systolic blood pressure and diastolic blood pressure. The U.S. Department of Health and Human Services (1988) indicated that most Americans have had their blood pressure checked within the last year and that there is a relatively minimal risk of persons being unaware of the presence of hypertension. However, this is not true in the college-age population. In spite of the absence of high risk, the presence of some risk indicates the need for
Health Screening on a College Campus
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community-based programs which link patients with medical management (National High Blood Pressure Education Program, 1984). Cholesterol testing. Increased blood cholesterol levels, more specifically increased levels of low density lipoprotein (LDL) cholesterol, are causally related to the in4reased risk of coronary heart disease (CHD). Coronary risk rises progressively hith cholesterol level, particularly when cholesterol levels rise above 200 mg/ dl. Thlere is also indication that reduced incidence of congestive heart failure is related to low levels of cholesterol (National Cholesterol Education Program, 1988). The National Cholesterol Education Program of the National Heart, Lung, and Blood Institute (1988) advocated that serum total cholesterol should be measured on all adults 20 years of age and over at least once every 5 years, In addition, it is recornvended that all adults be evaluated for the presence of other CHD-risk factors, ihcluding hypertension, cigarette smoking, diabetes mellitus, severe obesity, and a history of CHD in the patient or of premature CHD in family members. Blocpd sugar testing. Elevated blood sugar is without symptoms in the early stages iand easily measured at a screening site. One finger stick usually provides sufficient blood for both cholesterol and glucose levels. The most important factor in blood sugar screening is that the person be fasting for at least 2 to 3 hr (Powers, 1981). Intervention and Follow-Up
Health screenings are useless unless some plan has been made for follow-up. Persons w/ho have positive readings need evaluation by a health care professional (Jarvis, 1985). Although health screenings can be valuable aids in identifying high-risk groups, without proper referral and follow-up there will be little long-term benefit to the overall health care of the participants. The referral process should introduce high-risk clients to appropriate health-care treatment. Referral may be made to a variety of community health providers including physicians, clinics, hospitals, health centers, or health departments. Although not allindividuals who are told they are at high risk and should seek treatment can be expected to follow through and actually seek care, the referral process is an important opportunity to provide information about needed health care and services availalile. The way in which the results of the health screening are communicated may si$nificantly influence whether additional health-care action is sought. Thus, it is imp~rtantto convey information in a positive manner. It is helpful to use an open, factual person-to-person approach and to promote responses and questions. Information concerning high-risk status should not be communicated by memo or letter. It is important to ensure that the individual understands the information being corbmunicated and that language, age, culture, or other barriers to communication have been taken into consideration. Follow-up to ensure action has been taken
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Leatherman and Davidhizar
when a high-risk status exists is crucial. Even simple methods such as a phone call one month after the initial screening can provide the incentive to facilitate action by the patient.
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HEALTH SCREENING ON A COLLEGE CAMPUS The present experience in health screening began when we were developing learning experiences for the Community Health Nursing course which was part of the baccalaureate nursing curriculum. Experiences were sought which would not only benefit the student in terms of learning but would also provide needed health service to the community. We felt that a health screening experience would give the nursing students experience with epidemiology and the nursing process ('Itible 1). It was felt a single health screening program would enable nursing students to experience the different stages of the nursing process while using principles of epidemiology. Assessment of health need would occur when participants were evaluated for health risk. Planning and implementation would be demonstrated by giving health referral information and following up with participants that needed health care. The evaluation stage would include reviewing feedback of the experience from self, faculty, staff, and other students, and documenting the number of abnormal results, persons who need follow-up, and who will be doing the follow-up. In addition, nursing students would be able to participate in providing needed health services to the college community, gain experience in identifying individuals at risk, and see prevention as part of the health treatment process (Tbrner & Chavigny, 1988). When designing a clinical experience in epidemiology for nursing students it is important to assess the validity of the project for clinical experience as well as the need for screening in the proposed population. It is also useful to conduct an initial program to provide data for development of the experience into an optimal teaching/learning experience. In this case an initial program was planned in order to collect data about the screening as a clinical learning experience and to see if health needs existed on the college campus. TABLE 1
A Comparison of Nursing Process and the Epidemiologic Model Nursing Process
Epidemiologic Method
Assessment
Establish the existence of an epidemic Verify the diagnosis Do a quick survey of known cases and the community situation Formulate a tentative hypothesis Plan and perform the investigation Analyze and formulate conclusions Follow-up
Formulation of a nursing diagnosis Planning and intervention Evaluation
Note. This table was modified from Community Health Nursing (p. 34) by J. rimer and K. Chavigney, 1988, Philadelphia:Lippincott. Copyright 1988 by Lippincott. Adapted by permission.
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Initial Health Screening Event on a College Campus
The initial screening day was conducted by six senior nursing students in a community health nursing course in a baccalaureate nursing program. Planning the health screening event, advertising the event to the college community, conducting the health screening program, and summarizing the results were all part of the clinical assignment of the nursing students. The health problems which were selected as the focus pf this project, hypertension, cholesterol, and blood sugar were chosen because of their status as national health problems and by the availability of equipment and supplies for testing and education. In addition, these three areas involved procedures which could feasibly be done by student nurses, were relatively inexpensive, and could be done in a short amount of time. None of these procedures require a phydician's permission or release. Because of the limitation of the time of the course, follow-up responsibility was assigned to the sponsoring agency, a community hospital. Prior to the initial health screening day nursing students participated at a health screening program being conducted at a local hospital. This hospital had been approached about providing equipment necessary for the campus screening project and Would be later used as an agency with which to link participants needing follow+upand referral. The students reported that involvement in the hospital program was useful in helping them to gain both skill and confidence as they prepared to screen peers, faculty, and staff. Evalui+tion and Follow-up
An evaluation of the initial event showed that 68 individuals participated in the screening process. A total of 34 had moderately high or high cholesterol. Ten individual$ had high blood sugars which could not be readily attributed to recent intake and 7 had blood pressures identified as high. %o blood pressures were high enough to require immediate referral. Follow-up for abnormal blood pressures which were not in the range to require immediate referral was arranged by providing blood pressure rachecks on campus. Follbwing the initial project, the verbal and written comments of students, faculty, college administration, and participants indicated there was interest, need, and potential benefits for both the community health nursing students and the college population. The reports from all groups indicated the usefulness of continuing to plan hiealth screening projects on the college campus. Plans were made to incorporate the health screening into both the community health nursing course and the college calendar the next year. Wh$n the initial health screening project was evaluated it was felt that the community health nursing students and their faculty should assume more responsibility for follow-up. Hence in a second screening, students were involved with follow-up of faculty, staff, and students. One college faculty member whose blood pressure required ongoing monitoring arranged to have a weekly check done by a nursing stu-
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dent. One nursing student continued to follow a family as a part of a family health assessment project where both parents had health needs identified in the health screening, that is, one with elevated cholesterol and one with elevated blood pressure. The total family health assessment done by the nursing student included health assessment of the two teenage children and follow-up to see that the physician referral was completed. Another faculty member became involved in follow-up testing for increased glucose. When the repeat assessment also showed a glucose problem this client sought an evaluation from her family physician and has continued to follow the physician's recommendations. The identification of an elevated cholesterol in a student resulted in a visit to a personal physician for a complete physical and blood work. The assessment of a blood cholesterol of over 280 resulted in a cholesterol reduction program for the student. Modifications and improvements were made in the plan and the second health screening project was conducted the next year utilizing the modified objectives and plan which follow. While evaluation of the program is ongoing, the health screening program continues to be utilized on a yearly basis as a part of the community health nursing course and preventive health care for the college campus. An Ongoing Health Screening Program on a College Campus
The objectives for the health screening program to be done by nursing students in the community health nursing course on the college campus are identified as twofold, and include both objectives which are part of the community health nursing course and those directed at the health needs of individuals on the college campus. Objectives for the community health nursing course are that the student will: (a) apply principles of epidemiology to care and management of the health/wellness status of the community at large; (b) participate in a health screening program; (c) assist families and/or individuals to return or to maintain an optimal level of wellness; and (d) follow-up high-risk reports with educational handouts, person-toperson contact, and referral. Objectives for the health screening program on a college campus include that the students, faculty, and staff will: (a) have the opportunity to participate in health screening involving hypertension, blood sugar, and cholesterol; (b) be given results of screening and informed of needed follow-up, if the results place them at high risk; and (c) be given information about appropriate follow-up available in the community if data obtained indicates high risk. The health screening program is announced to the entire college family (i.e., students, faculty, and staff) by posters on campus, the campus newsletter, and by chapel announcements. Former college students, faculty, and staff participants assist in advertising the event by telling others and are frequently repeat participants. Because the response from students, faculty, and staff has been primarily positive, this has added both interest and enthusiasm. Individuals who wish to participate are
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asked to register and are made aware of the $2.00 fee to assist with costs of equipment and supplies. This fee covers equipment including glucometer strips, cholesterol screening supplies, and educational literature. A room in the campus center is utilized for the health screening project. The nursing students design the health screening around a combination of the nursing procesd and the epidemiology process (see Table 1). In working this kind of clinical experience into the community health nursing curriculum, the student gets to experience epidemiology in many of its facets. Screening results give insight into the health of the community. They can be used to evaluate needed health services, to estimate individual risk from group experience, to identify symptoms, to complete the clinical picture so prevention can be accomplished before the disease is irreversible, and to search for cause (Tbrner & Chavigny, 1988). To follow the nursing process steps in this type of epidemiological situation one needs to assess the validity of the project as a clinical experience, the need for screenihg in the proposed population, and possibly even to use a pilot project for validity. The planning and intervention stages include appropriate advertisement of screenihg date, time, and activities as well as the actual screening described earlier in this article. The evaluation stage includes documenting of results of how many participated, how many had abnormal results, who needs follow-up, and who will do the follow-up. Participants first complete needed paperwork that serves as their informed consent (see appendix 1) and then proceed to a table where one nursing student does a finger stick to obtain blood for the cholesterol and blood glucose testing. Another student is involved in processing the sample obtained. Participants are then taken into a private room where literature on health-related topics is available. Literature on nutrition, exercise, and cholesterol is offered. Blood pressure readings are taken and the results of the three tests explained. The students have previously been certified by the American Heart Association method of blood pressure measurement. That method of three separate measurements several minutes apart minimizes the possiblie negative effects of movement or the finger stick. Participants are given the results of their tests and information is given on risk and appropriate follow-up, when indicated. Community resources both private and public are used as sources of referral, depending on the needs of the participants. Follow+upis planned by the students and faculty. A copy of the results is given to the participants to share with their physician or primary caregiver. The bottom half of the form (appendix) is given to the agency providing the equipment, along with a list of the follow-up activities that will be perforrhed by the nursing students and faculty. When the participant has no personal plhysician or primary care giver the agency is involved in follow-up. Confidentiality is maintained and record storage becomes the responsibility of the agmcies to whom they were given.
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CONCLUSIONS
As a result of the experience in this college setting it is possible to draw the following conclusions and recommendations for designing health screening programs in other college settings. The first step is careful and adequate planning. The date selected must fit into the overall college calendar. The location should be convenient for students as well as faculty and staff and should be visible if walk-in appointments will be accepted. The hours planned should meet the needs of nontraditional students on campus and include late afternoon and evening times. Preplanning, which includes an appointment calendar, allows for convenient spacing among participants. Adequate health screening requires that those involved have the skill to do the indicated assessments and that they are comfortable in both the techniques involved and with communicating the results and their implications to participants. It was useful to have the nursing students and faculty member participate in the screening done at a nearby agency in order to become more comfortable with the process. Follow-up is an important part of the health screening process. In the initial project follow-up was left to a community agency. The matter of follow-up was modified following evaluation of the initial program to more actively involve the students and faculty. In order to link the health screening project done on the college campus with the health-care community, networking is necessary and should be done by the nursing faculty. In this case, by discussing the project with community agencies, equipment, supplies, and educational materials were obtained at a reduced cost. Involving the community agencies in planning the health screening project also has the advantage of increasing commitment to assist in follow-up and referral.
REFERENCES Ervin, N. (1982). Public health nursing: An administrator's view. Nursing Outlook, 30(7), 370. Jarvis, L. (1985). Community health nursing: Keeping the public healthy. Philadelphia: Davis. National Cholesterol Education Program. (1988, January). Report on the expert panel on detection, evaluation, and treatment of high blood cholesterol in adults Bethesda, MD: U.S. Department of Health and Human Services, National Heart, Lung, and Blood Institute. National High Blood Pressure Evaluation Program. (1984. October). Potient tracking for high blood pressure control (NIH Publication No. 84-2204). Bethesda, MD: U.S. Department of Health and Human Services, National Heart, Lung, and Blood Institute. Powers, K. (1981). Epidemiology: First hand study by community health nurses. Issues in Comprehensive Pediatric Nursing, 5(4), 21 1-217. Roybal, S., Bauwins, E., & Fasla, M. (1975). Community-assessment: An epidemiologic approach. Nursing Outlook, 23(6), 365-358. lbrner, J., & Chavigny, K. (1988). Community health nursing. Philadelphia: Lippincott. U.S. Department of Health and Human Services. (1988, May). The 1988Report of the Joint National Committee on Detection, Evaluation, and Deatment of High Blood Pressure (NIH Publication No. 88-1088). Washington, DC: National Institutes of Health. Young, C. L., & Gottke, S. A. (1985). Multiphasic health screening for the rural elderly. Home Healthcare Nurse, 3(3), 4 1-46.
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APPENDIX Client's Copy: CHOLESTEROL
BLOOD SUGAR HEMOGLOBIN BLOOD PRESSURE
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18-59 60- +
DESIRABLE BORDERLINE HIGH FASTING MALE FEMALE SYSTOLIC: LESS THAN 140 LESS THAN 160
-BELOW 200 -200-239 -240-ABOVE -60- 120 -151 + O R - 1 2 -135 + O R - 1 5 DIASTOLIC: LESS THAN 90 LESS THAN 90
REQUESTED
DONE
Agency Pollow-up BLOOD PRESSURE CHOLE$TEROL BLOOD SUGAR HEMOGLOBIN NAME ADDRESS STREET FAMILY PHYSICIAN
CITY
ZIP
DO YOU RECEIVE OUR NEWSLETTER? DO YOU WISH TO RECEIVE OUR NEWSLETTER?
ISSN: 0737-0016 (Print) 1532-7655 (Online) Journal homepage: http://www.tandfonline.com/loi/hchn20
Health Screening on a College Campus by Nursing Students Julia Leatherman & Ruth Davidhizar To cite this article: Julia Leatherman & Ruth Davidhizar (1992) Health Screening on a College Campus by Nursing Students, Journal of Community Health Nursing, 9:1, 43-51, DOI: 10.1207/ s15327655jchn0901_5 To link to this article: http://dx.doi.org/10.1207/s15327655jchn0901_5
Published online: 07 Jun 2010.
Submit your article to this journal
Article views: 3
View related articles
Citing articles: 2 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=hchn20 Download by: [Deakin University Library]
Date: 09 November 2015, At: 02:39
JOURNAL OF COMMUNITY HEALTH NURSING, 1992,9(1),43-51 Copyright O 1992, Lawrence Erlbaum Associates, Inc.
Health Screening on a College Campus by Nursing Students Julia Leatherman, RN, MS, MPA, and Ruth Davidhizar, RN, DNS, CS Downloaded by [Deakin University Library] at 02:39 09 November 2015
Bethel College
The study of community health nursing is an important part of preparation at the baccalaureate level for professional nursing. This is because an understanding of epidemiology and community assessment is essential for the registered, professional nurse who provides comprehensive care in a community setting. Whether the nurse works in a community health setting or in a free standing health-care agency, nurses are part of a comprehensive system of health care and are involved in community care. Nursing student involvement in epidemiology and health screening investigations as a part of the clinical practicum is one way to assist the nursing student to integrate theoretical principles with nursing practice. In fact, several reports of health screening projects by nursing students are reported in the literature, that is, health screenings for muscular dystrophy and lead poisoning studies (Powers, 1981; Roybal, Bauwins, & Fasla, 1975). In the health screening study reported by Roybal et al. (1975), students were not only involved in screening but participated in implementing nursing services. Exposure and participation in a health screening project as a clinical learning experience proved to be a valuable learning tool for students to experience implementation of the nursing process in a community setting. Our experience with a health screening project on a college campus was found to be a unique way to assist nursing students studying community health nursing to integrate and synthesize knowledge of community health nursing in a dynamic and relevant clinical experience. This article describes the initial development of such a program on a college campus. The program continues to the present as a service provided by nursing students in a community health nursing course. HEALTH SCREENING AS A COMMUNITY HEALTH SERVICE Health screening services have been in existence for some time as a part of community haalth care. Health screening is a health-care evaluation service that identifies persons at risk of developing a certain disease who may not be aware of impending illness. Health screenings are not diagnostic but rather serve to identify individuals Requests for reprints should be sent to Ruth Davidhizar, RN, DNS, CS, Assistant Dean and Chair ~, College, 1001 West McKinley Avenue, Mishawaka, IN 46545. for ~ u r d i n Bethel
Downloaded by [Deakin University Library] at 02:39 09 November 2015
44
Leatherman and Davidhizar
who are at high risk for an illness and who need additional workup for a specific diagnosis (Turner & Chavigny, 1988). In this way, health screening may serve to facilitate the initiation of a preventive program which averts a health crisis. High school and college students often have not found a convenient entry into the health-care system. This population often has outgrown the care given in the pediatric setting. Even if care providers are still available in their home community, with the mobility of modern society, many students have moved or attend school in communities far from the setting where they are known. Some college students who have never encountered illness can identify no primary care provider. Hence, screening programs, such as the one described, frequently provide the entry point into the health-care system. Assessment
Assessment of health problems involves two major activities: collection of relevant data and interpretation of the results. Health screenings may focus on individual health problems (e.g., assessment for glaucoma). On the other hand, health screening may focus on a cluster of health problems, for example, hypertension, diabetes, and elevated cholesterol (Jarvis, 1985). The type of screening done is determined by a variety of factors including the goals of the agency involved in the screening process, the population involved and their health-care needs, and the financial resources available for screening. Screenings may be directed at specific populations, such as the elderly (Young & Gottke, 1985), pregnant women, children, or college students as reported in this article. Screenings may be under the auspices of a health department, community agency, hospital, or in a college setting. In most cases, the degree to which a public health department uses health screenings as a community assessment tool is dependent on the community's health priorities. Financial resources including equipment, laboratory services, and staff must all be considered when health screening programs are designed. Fiscal restraints under which the agency functions often act as the final determining factor of the feasibility of health screening programs (Ervin, 1982). Types of Screenings
Blood pressure screening. According to the U.S. Department of Health and Human Services (1988) as many as 58 million people in the U.S. have elevated blood pressure. Risk of cardiovascular complications related to hypertension increases continuously with increasing levels of both systolic blood pressure and diastolic blood pressure. The U.S. Department of Health and Human Services (1988) indicated that most Americans have had their blood pressure checked within the last year and that there is a relatively minimal risk of persons being unaware of the presence of hypertension. However, this is not true in the college-age population. In spite of the absence of high risk, the presence of some risk indicates the need for
Health Screening on a College Campus
45
Downloaded by [Deakin University Library] at 02:39 09 November 2015
community-based programs which link patients with medical management (National High Blood Pressure Education Program, 1984). Cholesterol testing. Increased blood cholesterol levels, more specifically increased levels of low density lipoprotein (LDL) cholesterol, are causally related to the in4reased risk of coronary heart disease (CHD). Coronary risk rises progressively hith cholesterol level, particularly when cholesterol levels rise above 200 mg/ dl. Thlere is also indication that reduced incidence of congestive heart failure is related to low levels of cholesterol (National Cholesterol Education Program, 1988). The National Cholesterol Education Program of the National Heart, Lung, and Blood Institute (1988) advocated that serum total cholesterol should be measured on all adults 20 years of age and over at least once every 5 years, In addition, it is recornvended that all adults be evaluated for the presence of other CHD-risk factors, ihcluding hypertension, cigarette smoking, diabetes mellitus, severe obesity, and a history of CHD in the patient or of premature CHD in family members. Blocpd sugar testing. Elevated blood sugar is without symptoms in the early stages iand easily measured at a screening site. One finger stick usually provides sufficient blood for both cholesterol and glucose levels. The most important factor in blood sugar screening is that the person be fasting for at least 2 to 3 hr (Powers, 1981). Intervention and Follow-Up
Health screenings are useless unless some plan has been made for follow-up. Persons w/ho have positive readings need evaluation by a health care professional (Jarvis, 1985). Although health screenings can be valuable aids in identifying high-risk groups, without proper referral and follow-up there will be little long-term benefit to the overall health care of the participants. The referral process should introduce high-risk clients to appropriate health-care treatment. Referral may be made to a variety of community health providers including physicians, clinics, hospitals, health centers, or health departments. Although not allindividuals who are told they are at high risk and should seek treatment can be expected to follow through and actually seek care, the referral process is an important opportunity to provide information about needed health care and services availalile. The way in which the results of the health screening are communicated may si$nificantly influence whether additional health-care action is sought. Thus, it is imp~rtantto convey information in a positive manner. It is helpful to use an open, factual person-to-person approach and to promote responses and questions. Information concerning high-risk status should not be communicated by memo or letter. It is important to ensure that the individual understands the information being corbmunicated and that language, age, culture, or other barriers to communication have been taken into consideration. Follow-up to ensure action has been taken
46
Leatherman and Davidhizar
when a high-risk status exists is crucial. Even simple methods such as a phone call one month after the initial screening can provide the incentive to facilitate action by the patient.
Downloaded by [Deakin University Library] at 02:39 09 November 2015
HEALTH SCREENING ON A COLLEGE CAMPUS The present experience in health screening began when we were developing learning experiences for the Community Health Nursing course which was part of the baccalaureate nursing curriculum. Experiences were sought which would not only benefit the student in terms of learning but would also provide needed health service to the community. We felt that a health screening experience would give the nursing students experience with epidemiology and the nursing process ('Itible 1). It was felt a single health screening program would enable nursing students to experience the different stages of the nursing process while using principles of epidemiology. Assessment of health need would occur when participants were evaluated for health risk. Planning and implementation would be demonstrated by giving health referral information and following up with participants that needed health care. The evaluation stage would include reviewing feedback of the experience from self, faculty, staff, and other students, and documenting the number of abnormal results, persons who need follow-up, and who will be doing the follow-up. In addition, nursing students would be able to participate in providing needed health services to the college community, gain experience in identifying individuals at risk, and see prevention as part of the health treatment process (Tbrner & Chavigny, 1988). When designing a clinical experience in epidemiology for nursing students it is important to assess the validity of the project for clinical experience as well as the need for screening in the proposed population. It is also useful to conduct an initial program to provide data for development of the experience into an optimal teaching/learning experience. In this case an initial program was planned in order to collect data about the screening as a clinical learning experience and to see if health needs existed on the college campus. TABLE 1
A Comparison of Nursing Process and the Epidemiologic Model Nursing Process
Epidemiologic Method
Assessment
Establish the existence of an epidemic Verify the diagnosis Do a quick survey of known cases and the community situation Formulate a tentative hypothesis Plan and perform the investigation Analyze and formulate conclusions Follow-up
Formulation of a nursing diagnosis Planning and intervention Evaluation
Note. This table was modified from Community Health Nursing (p. 34) by J. rimer and K. Chavigney, 1988, Philadelphia:Lippincott. Copyright 1988 by Lippincott. Adapted by permission.
Health Screening on a College Campus
47
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Initial Health Screening Event on a College Campus
The initial screening day was conducted by six senior nursing students in a community health nursing course in a baccalaureate nursing program. Planning the health screening event, advertising the event to the college community, conducting the health screening program, and summarizing the results were all part of the clinical assignment of the nursing students. The health problems which were selected as the focus pf this project, hypertension, cholesterol, and blood sugar were chosen because of their status as national health problems and by the availability of equipment and supplies for testing and education. In addition, these three areas involved procedures which could feasibly be done by student nurses, were relatively inexpensive, and could be done in a short amount of time. None of these procedures require a phydician's permission or release. Because of the limitation of the time of the course, follow-up responsibility was assigned to the sponsoring agency, a community hospital. Prior to the initial health screening day nursing students participated at a health screening program being conducted at a local hospital. This hospital had been approached about providing equipment necessary for the campus screening project and Would be later used as an agency with which to link participants needing follow+upand referral. The students reported that involvement in the hospital program was useful in helping them to gain both skill and confidence as they prepared to screen peers, faculty, and staff. Evalui+tion and Follow-up
An evaluation of the initial event showed that 68 individuals participated in the screening process. A total of 34 had moderately high or high cholesterol. Ten individual$ had high blood sugars which could not be readily attributed to recent intake and 7 had blood pressures identified as high. %o blood pressures were high enough to require immediate referral. Follow-up for abnormal blood pressures which were not in the range to require immediate referral was arranged by providing blood pressure rachecks on campus. Follbwing the initial project, the verbal and written comments of students, faculty, college administration, and participants indicated there was interest, need, and potential benefits for both the community health nursing students and the college population. The reports from all groups indicated the usefulness of continuing to plan hiealth screening projects on the college campus. Plans were made to incorporate the health screening into both the community health nursing course and the college calendar the next year. Wh$n the initial health screening project was evaluated it was felt that the community health nursing students and their faculty should assume more responsibility for follow-up. Hence in a second screening, students were involved with follow-up of faculty, staff, and students. One college faculty member whose blood pressure required ongoing monitoring arranged to have a weekly check done by a nursing stu-
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dent. One nursing student continued to follow a family as a part of a family health assessment project where both parents had health needs identified in the health screening, that is, one with elevated cholesterol and one with elevated blood pressure. The total family health assessment done by the nursing student included health assessment of the two teenage children and follow-up to see that the physician referral was completed. Another faculty member became involved in follow-up testing for increased glucose. When the repeat assessment also showed a glucose problem this client sought an evaluation from her family physician and has continued to follow the physician's recommendations. The identification of an elevated cholesterol in a student resulted in a visit to a personal physician for a complete physical and blood work. The assessment of a blood cholesterol of over 280 resulted in a cholesterol reduction program for the student. Modifications and improvements were made in the plan and the second health screening project was conducted the next year utilizing the modified objectives and plan which follow. While evaluation of the program is ongoing, the health screening program continues to be utilized on a yearly basis as a part of the community health nursing course and preventive health care for the college campus. An Ongoing Health Screening Program on a College Campus
The objectives for the health screening program to be done by nursing students in the community health nursing course on the college campus are identified as twofold, and include both objectives which are part of the community health nursing course and those directed at the health needs of individuals on the college campus. Objectives for the community health nursing course are that the student will: (a) apply principles of epidemiology to care and management of the health/wellness status of the community at large; (b) participate in a health screening program; (c) assist families and/or individuals to return or to maintain an optimal level of wellness; and (d) follow-up high-risk reports with educational handouts, person-toperson contact, and referral. Objectives for the health screening program on a college campus include that the students, faculty, and staff will: (a) have the opportunity to participate in health screening involving hypertension, blood sugar, and cholesterol; (b) be given results of screening and informed of needed follow-up, if the results place them at high risk; and (c) be given information about appropriate follow-up available in the community if data obtained indicates high risk. The health screening program is announced to the entire college family (i.e., students, faculty, and staff) by posters on campus, the campus newsletter, and by chapel announcements. Former college students, faculty, and staff participants assist in advertising the event by telling others and are frequently repeat participants. Because the response from students, faculty, and staff has been primarily positive, this has added both interest and enthusiasm. Individuals who wish to participate are
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asked to register and are made aware of the $2.00 fee to assist with costs of equipment and supplies. This fee covers equipment including glucometer strips, cholesterol screening supplies, and educational literature. A room in the campus center is utilized for the health screening project. The nursing students design the health screening around a combination of the nursing procesd and the epidemiology process (see Table 1). In working this kind of clinical experience into the community health nursing curriculum, the student gets to experience epidemiology in many of its facets. Screening results give insight into the health of the community. They can be used to evaluate needed health services, to estimate individual risk from group experience, to identify symptoms, to complete the clinical picture so prevention can be accomplished before the disease is irreversible, and to search for cause (Tbrner & Chavigny, 1988). To follow the nursing process steps in this type of epidemiological situation one needs to assess the validity of the project as a clinical experience, the need for screenihg in the proposed population, and possibly even to use a pilot project for validity. The planning and intervention stages include appropriate advertisement of screenihg date, time, and activities as well as the actual screening described earlier in this article. The evaluation stage includes documenting of results of how many participated, how many had abnormal results, who needs follow-up, and who will do the follow-up. Participants first complete needed paperwork that serves as their informed consent (see appendix 1) and then proceed to a table where one nursing student does a finger stick to obtain blood for the cholesterol and blood glucose testing. Another student is involved in processing the sample obtained. Participants are then taken into a private room where literature on health-related topics is available. Literature on nutrition, exercise, and cholesterol is offered. Blood pressure readings are taken and the results of the three tests explained. The students have previously been certified by the American Heart Association method of blood pressure measurement. That method of three separate measurements several minutes apart minimizes the possiblie negative effects of movement or the finger stick. Participants are given the results of their tests and information is given on risk and appropriate follow-up, when indicated. Community resources both private and public are used as sources of referral, depending on the needs of the participants. Follow+upis planned by the students and faculty. A copy of the results is given to the participants to share with their physician or primary caregiver. The bottom half of the form (appendix) is given to the agency providing the equipment, along with a list of the follow-up activities that will be perforrhed by the nursing students and faculty. When the participant has no personal plhysician or primary care giver the agency is involved in follow-up. Confidentiality is maintained and record storage becomes the responsibility of the agmcies to whom they were given.
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CONCLUSIONS
As a result of the experience in this college setting it is possible to draw the following conclusions and recommendations for designing health screening programs in other college settings. The first step is careful and adequate planning. The date selected must fit into the overall college calendar. The location should be convenient for students as well as faculty and staff and should be visible if walk-in appointments will be accepted. The hours planned should meet the needs of nontraditional students on campus and include late afternoon and evening times. Preplanning, which includes an appointment calendar, allows for convenient spacing among participants. Adequate health screening requires that those involved have the skill to do the indicated assessments and that they are comfortable in both the techniques involved and with communicating the results and their implications to participants. It was useful to have the nursing students and faculty member participate in the screening done at a nearby agency in order to become more comfortable with the process. Follow-up is an important part of the health screening process. In the initial project follow-up was left to a community agency. The matter of follow-up was modified following evaluation of the initial program to more actively involve the students and faculty. In order to link the health screening project done on the college campus with the health-care community, networking is necessary and should be done by the nursing faculty. In this case, by discussing the project with community agencies, equipment, supplies, and educational materials were obtained at a reduced cost. Involving the community agencies in planning the health screening project also has the advantage of increasing commitment to assist in follow-up and referral.
REFERENCES Ervin, N. (1982). Public health nursing: An administrator's view. Nursing Outlook, 30(7), 370. Jarvis, L. (1985). Community health nursing: Keeping the public healthy. Philadelphia: Davis. National Cholesterol Education Program. (1988, January). Report on the expert panel on detection, evaluation, and treatment of high blood cholesterol in adults Bethesda, MD: U.S. Department of Health and Human Services, National Heart, Lung, and Blood Institute. National High Blood Pressure Evaluation Program. (1984. October). Potient tracking for high blood pressure control (NIH Publication No. 84-2204). Bethesda, MD: U.S. Department of Health and Human Services, National Heart, Lung, and Blood Institute. Powers, K. (1981). Epidemiology: First hand study by community health nurses. Issues in Comprehensive Pediatric Nursing, 5(4), 21 1-217. Roybal, S., Bauwins, E., & Fasla, M. (1975). Community-assessment: An epidemiologic approach. Nursing Outlook, 23(6), 365-358. lbrner, J., & Chavigny, K. (1988). Community health nursing. Philadelphia: Lippincott. U.S. Department of Health and Human Services. (1988, May). The 1988Report of the Joint National Committee on Detection, Evaluation, and Deatment of High Blood Pressure (NIH Publication No. 88-1088). Washington, DC: National Institutes of Health. Young, C. L., & Gottke, S. A. (1985). Multiphasic health screening for the rural elderly. Home Healthcare Nurse, 3(3), 4 1-46.
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APPENDIX Client's Copy: CHOLESTEROL
BLOOD SUGAR HEMOGLOBIN BLOOD PRESSURE
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18-59 60- +
DESIRABLE BORDERLINE HIGH FASTING MALE FEMALE SYSTOLIC: LESS THAN 140 LESS THAN 160
-BELOW 200 -200-239 -240-ABOVE -60- 120 -151 + O R - 1 2 -135 + O R - 1 5 DIASTOLIC: LESS THAN 90 LESS THAN 90
REQUESTED
DONE
Agency Pollow-up BLOOD PRESSURE CHOLE$TEROL BLOOD SUGAR HEMOGLOBIN NAME ADDRESS STREET FAMILY PHYSICIAN
CITY
ZIP
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