Disease screening nurse work content

The core work content of disease screening nurses is to focus on the goal of early diagnosis and early treatment of specific diseases and complete the four core tasks of education and guidance, standardized operations, quality control, and follow-up intervention throughout the screening process. They are the key hub connecting screening subjects, clinicians, and the public health system.

Last week, I met an old aunt at the community cancer screening site. As soon as she came in, she slapped her ID card on the table and said, "Nurse, please draw my blood quickly, I have to pick up my grandson. ”I was not in a hurry to place an order, but asked a few more questions first: "Auntie, you tested positive for HPV16 last year. Did you go for a colposcopy later?" ”The aunt was stunned for a moment and said she had forgotten about it a long time ago, and she was not feeling unwell anyway. I quickly dug out last year's screening records for her and advised her to have a follow-up colposcopy in addition to the routine screening this time. Fortunately, she listened. Later, pathology revealed that it was a low-grade precancerous lesion, and timely intervention was performed to avoid big trouble later.

Many people still have the same impression of us as “registering information, taking blood samples, and calling for guidance.” In fact, the work focus of screening nurses in different scenarios is very different. If you are in a cancer screening center in a tertiary hospital, you have to memorize the indicators of high-risk groups for each type of cancer. When you meet a person coming for a physical examination, you need to glance at his past and family history to accurately remind him whether he should do the corresponding screening items. ； If you do chronic disease screening in grassroots communities, you will most likely have to serve as a "health promoter". When you meet the uncles and aunts who like to join in the fun and come to check their blood pressure, you will have to explain the dangers of high-salt diet and tips on sugar control. Otherwise, many people will forget about it after checking, and there will be no intervention effect at all.

Oh, yes, there is actually no completely unified standard for the boundaries of our responsibilities in the industry. There are two schools of thought that have been arguing for a long time. One group is the conservative "operational group". They believe that screening nurses only need to do the prescribed actions - register correct information, collect specimens accurately, and provide guidance in place. Don't give medical advice casually, as they will easily be held responsible if something goes wrong. ； The other group is the more proactive "interventionist" group. They feel that we are the ones who have the most contact with the public during the entire screening process. If we can ask more questions about family history and mention more precautions, we can prevent many risks of missed diagnosis. After all, if we are discovered one day earlier, the cost of subsequent treatment and the quality of life will be much worse. I prefer the latter. When I was undergoing low-dose CT screening for lung cancer, I met a man who was accompanying his wife to check for breast cancer. He looked in his early 40s and had half a cigarette case exposed in his pocket. I casually asked him how many years he had been smoking. He said 20 years, at least one pack a day. , and had a history of COPD, I advised him to get a lung cancer screening. He thought it was a waste of money, but he agreed after a long time. As a result, an 8mm ground glass nodule was found, and he underwent minimally invasive surgery. He is recovering very well now, and even sends me WeChat greetings during the holidays.

Don’t think that we are just busy at the screening site. A lot of work that is not done in front of the stage cannot be seen by outsiders at all. For example, preparations must be made one week before the screening, and reminder calls must be made to high-risk groups in the jurisdiction one by one. Some people cannot be reached on the phone, and community workers must be asked to come to the door to inform them. ； The week after the screening is the busiest. You have to sort out the list of abnormal results and notify them one by one to go to the higher-level hospital for follow-up. Some people think they have no symptoms and refuse to go. You have to call repeatedly to persuade. Last time I met a 29-year-old young man whose fasting blood sugar was found to be 6.9mmol/L. What should I say? Even he refused to undergo a glucose tolerance test, saying that I was young and could handle it. I browsed through my circle of friends for half a month and found a case of diabetic ketoacidosis from a 30-year-old in the same community. Then I persuaded him to go for a review. Fortunately, it was just abnormal glucose tolerance. I adjusted my diet and exercise in time, and now it is back to normal.

People in the industry often say, "If one person is missed in screening, half of the family will be ruined." This is really not an alarmist statement. Take HPV screening as an example. Whether the swab touches the squamous-column junction of the cervix and whether it has been rotated 10 times during sampling will directly affect the accuracy of the results. If the operation is not standardized and a false negative is detected, it will delay the patient's real problem. So we all work with each other in private. Whoever has a higher positive rate of sampling will get together to learn from it. Even though it is just a small detail, it is related to real human lives.

I have been working as a screening nurse for almost 7 years, and I would be lying if I said I was not tired. During the large-scale screening, I had to shout hundreds of words a day, and it was common to become hoarse and unable to speak. But every time I see someone discover early lesions early because of my extra questions and advice, I feel that this job has a different weight than simply giving injections and dispensing medicine in the ward.