Assessment Tools and Diagnostic Tests

When seeking to identify a patients 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.

In this Discussion, 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.

To prepare:

Review this weeks Learning Resources, and consider the factors that impact the validity and reliability of various assessment tools and diagnostic tests.

Prostate-specific antigen (PSA) test

Search the Walden Library and credible sources for resources explaining the tool or test you selected. What is its purpose, how is it conducted, and what information does it gather?

Examine the literature and resources you located for information about the validity and reliability of the test or tool you selected. What issues with sensitivity, specificity, and predictive values are related to the test or tool?

Are there any controversies or issues related to any of these tests or tools?

Consider any ethical dilemmas that could arise by using these tests or tools.

Post on or before Day 3 a description of how the assessment tool or diagnostic test you selected is used in health care. Based on your research, evaluate the test or the tools validity and reliability, and explain any issues with sensitivity, reliability, and predictive values. Include references in appropriate APA formatting.

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.

Chapter 2, Cultural Awareness

This chapter highlights the importance of cultural awareness when conducting health assessments. The authors explore the impact of culture on health beliefs and practices.

Chapter 3, Examination Techniques and Equipment

This chapter explains the physical examination techniques of inspection, palpation, percussion, and auscultation. This chapter also explores special issues and equipment relevant to the physical exam process.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2012). Advanced health assessment and clinical diagnosis in primary care (4th ed.). St. Louis, MO: Mosby, Elsevier.

Chapter 1, Clinical Reasoning, Differential Diagnosis, Evidence-Based Practice, and Symptom Analysis

This chapter introduces the diagnostic process, which includes performing an analysis of the symptoms and then formulating and testing a hypothesis. The authors discuss how becoming an expert clinician takes time and practice in developing clinical judgment.

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2009). DeGowins diagnostic examination (9th ed.). New York, NY: McGraw Hill Medical.

Chapter 3, The Physical Screening Examination

In this chapter, the authors describe methods for physical examination and procedures for screening physical examinations. In addition, this chapter explains the necessary preparations and equipment for conducting exams.

Chapter 17, Principles of Diagnostic Testing

The authors use this chapter to discuss the principles of diagnostic testing. The chapter specifies tools that may be used in the selection and interpretation of tests.

Chapter 18, Common Laboratory Tests

This chapter details normal and pathologic results for common tests of the blood, urine, cerebrospinal fluid, and serous fluid. Additionally, this chapter describes reasons for ordering different types of lab tests.

Laine, C. (2012). High-value testing begins with a few simple questions. Annals of Internal Medicine, 156(2), 162163.

Retrieved from the Walden Library databases.

This article supplies a list of questions physicians should ask themselves before ordering tests. The authors provide general guidelines for maximizing the value received from testing.

Qaseem, A., Alguire, P., Dallas, P., Feinberg, L. E., Fitzgerald, F. T., Horwitch, C., & Weinberger, S. (2012). Appropriate use of screening and diagnostic tests to foster high-value, cost-conscious care. Annals of Internal Medicine, 156(2), 147149.

Retrieved from the Walden Library databases.

This article highlights the increasing cost of health care and stresses the need for high-value and cost-conscious testing. The authors provide a list of 37 situations in which more testing provides no benefit or may be harmful.

Shaw, S. J., Huebner, C., Armin, J., Orzech, K., & Vivian, J. (2009). The role of culture in health literacy and chronic disease screening and management. Journal of Immigrant & Minority Health, 11(6), 460467.

Retrieved from the Walden Library databases.

This article examines cultural influences on health literacy, cancer screening, and chronic disease outcomes. The authors postulate that cultural beliefs about health and illness affect a patients ability to comprehend and follow a health care providers instructions.

Wians, F. H. (2009). Clinical laboratory tests: Which, why, and what do the results mean? LabMedicine, 40, 105113.

Retrieved from http://labmed.ascpjournals.org/content/40/2/105.full

This article analyzes the laboratory testing cycle and its impact on diagnostic decision making. This article also examines important diagnostic performance characteristics of laboratory tests, methods of calculating performance, and tools used to assess the diagnostic accuracy of a laboratory test.

Assessment Tools and Diagnostic Tests

Clinicians and researchers including Advance Practice Nurses use various instruments to measure the physical environment, the physical condition of an individual, or certain abstract concepts in order to draw certain inferences regarding the patient. The utilized instruments have to be valid and reliable as prerequisites for their use (Ruijie, 2013). Reliability is concerned with random errors and a reliable instrument should provide similar results on repeated experiments. Validity is concerned with systematic errors and a valid instrument should measure what is intended to measure (Ruijie, 2013).

Sensitivity in an assessment tool refers a tool’s ability to classify an individual pertaining to a certain clinical condition (as being diseased). Specificity, on the other hand, is the ability of an assessment tool to classify correctly an individual as being disease-free. Sensitivity and specificity are inversely related, therefore, as sensitivity increases, specificity decreases and vice versa (Akoben, 2007). A positive predictive value of an assessment tool refers to the percentage of patients having a positive test and actually has the disease while a negative predictive value is the percentage of patients with a negative test and do not have the disease (Akoben, 2007).

For example, PSA tests are used to measure the amount of prostate-specific antigen in the blood. PSA enters the bloodstream and can be detected using this test. The blood levels may be high or low depending on the condition that is prostate infection, inflammation, and cancer. Sensitivity here refers to the likelihood that in case there is a cancer, there will be an abnormal PSA test (Thompson et al., 2005). For example, in diagnosing cancer in men, a PSA value that is 90% sensitive will be elevated in 90% of men with cancer. Sensitivity, on the other hand, is the likelihood that if one does not have cancer the PSA test will be normal. The risk of prostate cancer reduces with lower PSA levels. A PSA value having 90% specificity has a 10% risk, therefore, the need to advice a man without prostate cancer to have a biopsy. The negative and positive predictive values here depend on the population (Thompson et al., 2005).

References

Akoben, A. K. (2007). Understanding Diagnostic Tests 1: Sensitivity, Specificity and Predictive              Values. Acta Pædiatrica, 96, 338–341.

Ruijie, L. (2013). Reliability and Validity in Measurement Tools. Health Services & Outcomes                Research, 1, 1.

Thompson, I. M., Ankerst, D. P., Chi, C., Lucia, M. S., Goodman, P. J., Crowley, J. J., et al.                     (2005). Operating Characteristics of Prostate-Specific Antigen in Men with an Initial                    PSA Level of 3.0 ng/ml or Lower. Journal of the American Medical Association, 291              (1), 66-70.

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