Learning Objectives
By the end of this section, you will be able to:
- Identify nursing considerations for young and middle-aged adults
- Recognize interdisciplinary team referrals for young and middle-aged adults
Nurses are instrumental in preventing accidents and illnesses among typically healthy young and middle-aged adults, with health promotion standing out as one of their paramount responsibilities. Educating individuals on age-appropriate health screening and coordinating care at the first sign of illness are crucial for early disease detection and minimizing the health consequences of disease. Through rapport and nonjudgmental relationship building with patients, nurses can identify risks and prevent injuries associated with drug use, mental health disorders, and metabolic diseases. Education on health-supporting habits is one of the primary tasks for nurses caring for young adults, as forming healthy habits in young adulthood correlates with a longer, healthier life. By using screening tools for mental health and substance use disorders, nurses can ensure that patients have the support tools they need to make choices that support their wellness throughout life.
Nursing Considerations for the Young and Middle-Aged Adult
Nurses can lead education, health promotion, and risk prevention by understanding the biggest challenges for young and middle-aged adults. Nurses can strive to provide individualized and compassionate care in a nonjudgmental and inclusive environment, accepting each individual and the specific challenges they face. Essential aspects of nursing care in the adult population include self-care habits, such as healthy eating, exercise, and disease prevention. To address psychological challenges, nurses can recognize the need for mental health screenings. Nurses will also collaborate with specialists and ancillary healthcare professionals, including primary care providers, mental health specialists, disease-specific specialists, nutritionists, social workers, physical therapists, and occupational therapists.
Teach Self-Care Responsibilities
Young adulthood is an opportune time for nurses to focus on promoting adult self-care responsibilities. This is especially true for young emerging adults. One of the most basic self-care responsibilities is seeking appropriate health care for acute injuries or illnesses. Sleep hygiene is also of great importance, as chronic lack of sleep is associated with various health risks and conditions. Acute sleep deprivation results in poor judgment and coordination, which may result in injuries and poor work performance. Chronic lack of sleep is associated with many specific health consequences, including depression, anxiety, obesity, hypertension, and diabetes (Alexander, 2024). Nurses can encourage and teach simple sleep hygiene measures, such as limiting screen use within one hour of sleep, using meditation exercises, keeping a consistent bedtime, getting exposure to sunlight, not eating within two hours of going to bed, and managing caffeine intake.
Additional self-management practices that nurses can promote include time management, financial management, and unplugging from devices and screens. Nurses should freely offer patients advice on encouraging lifelong hobbies and finding a community with shared interests. Self-management also involves awareness of emotional well-being. Nurses can guide patients to recognize new or worsening mental health concerns and encourage them to seek professional care from a mental health specialist as needed.
Good health habits built in early adulthood set the stage for positive health habits throughout adulthood, which may help reduce the risk of disease over time. Nurses should encourage self-screening techniques, such as breast self-exams (BSEs) and testicular self-exams (TSEs). While these tests are not a replacement for mammograms or regular checkups with a healthcare provider, they encourage individuals to monitor their health and maintain an awareness of their bodies. Patients come to understand their body’s norms and can immediately report changes to their healthcare provider. While focusing on building healthy habits in young adulthood is the most efficient way to help create lifelong self-care routines, adults of any age can be encouraged to learn and improve these habits.
Provide Health-Related Screenings
A primary role of nurses in health promotion is to ensure that individuals know which health screenings are recommended for them and when. As individuals get older, additional health screenings will become important. The United States Preventive Services Task Force (USPSTF) provides screening guidelines based on research and healthcare organization specialty guidelines, such as the American Heart Association and the American Congress of Obstetricians and Gynecologists. These include blood tests, cytology, radiology, genetic counseling, and procedures (Table 40.5).
| Screening Test | Young Adult Screening Recommendations | Middle-Aged Adult Screening Recommendations |
|---|---|---|
| BRCA genetic counseling | Brief familial risk tool, if positive, genetic counseling recommended | Brief familial risk tool, if positive, genetic counseling recommended |
| Breast cancer screening—mammography |
|
Once every two years between ages 50 and 74 years |
| Cervical cancer (persons assigned female at birth)—Pap smear cytology | Begin at age 21 to 29 years, every three years | Continue Pap smear cytology testing from ages 25 to 65 years, every three years |
| Sexually transmitted infection | Based on sexual activity and risk | Based on sexual activity and risk |
| Lipids—screening blood test | Begin screening at age 20 years | Continue yearly through age 80 years |
| Diabetes—screening blood test | Starting at age 20 years | Continue yearly through age 80 years |
| Colon cancer—colonoscopy | Earlier screening based on family or personal history | Start routine screening at age 45 years |
| Prostate (persons assigned male at birth)—PSA blood test | N/A | Start routine screening at age 50 years |
| Lung cancer screening—low-dose CT scan | N/A | Begin screening at age 50 years based on risks and smoking history |
| Osteoporosis—dual-energy x-ray absorptiometry scan | N/A |
|
| Abdominal aortic aneurysm (AAA)—AAA ultrasound | N/A | Begin at age 65 years based on risk |
| Hepatitis C/HIV | Begin at age 18 years; all adults screened once | Additional screening based on risk |
Cultural Context
Cultural Beliefs in Breast Cancer Screening
The USPSTF recommends regular breast cancer screening for all persons AFAB beginning at age 40 years. A recent study found that the participation rate of Korean American persons AFAB in breast cancer screening is low in the United States. While access to care may explain part of the low screening rates, culture may also play a role. Cultural factors that affect whether individuals seek breast cancer screening can include the following:
- low level of family encouragement
- embarrassment
- lack of preventive health orientation
- crisis-oriented healthcare perspective
- language barriers
- belief in fatalism
Maintaining an accepting, nonjudgmental attitude toward patients’ preventive care choices is crucial for nurses. Nurses can provide adequate, timely education on preventive screening, such as breast cancer screening. It may be necessary to include education on preventive screenings during visits for other health concerns, especially for individuals who do not actively seek preventive care.
Teach Disease Prevention
Nurses are vital sources of information about disease prevention. This includes education on health promotion and screening as well as preventing specific acute and chronic diseases, such as diabetes, cardiovascular diseases, sexually transmitted infections (STIs), and community-acquired diseases. These may include teaching about the following:
- physical exercise
- mental health coping strategies
- prevention of STIs
- vaccine recommendations for preventing disease
- nutritious food choices that may help prevent disease
While many individuals will not achieve or maintain prime health status, an essential part of nursing is educating patients about choices that will support their best possible health. That said, health looks different for each individual and is based on their genetic and lifestyle risk factors.
Link to Learning
Familiarize yourself with the CDC’s STI fact sheets to help guide patient discussions on STI prevention, risks, and treatments.
Encourage Physical Activity
Physical movement is one of the most influential aspects of a healthy lifestyle and disease prevention. The benefits of physical exercise are well-known and include the following(WHO, 2022):
- reduces disease risk
- improves brain health
- increases muscle strength
- increases bone strength
- boosts mood and health neurochemicals
- relieves stress, anger, and anxiety
- reduces or maintains healthy weight
- improves sleep quality
Physical movement and exercise plans should be based on a patient’s preferences and abilities and are not a one-size-fits-all plan. Adults of all ages should aim for 150 minutes of moderate-intensity physical movement per week, in addition to at least two days of muscle-strengthening activities (Table 40.6). While this goal is the standard recommendation, nurses can encourage each individual to create a physical movement plan according to their schedule and preferences. Many people find that mixing up activities within a predictable routine helps them consistently fit exercise into their daily lives. Gym memberships are one option; however, individuals should be encouraged to move their bodies even if a gym membership is not something they can afford or want to invest in. Modifications or individual health needs or limitations need to be considered to ensure an individual can stick with a movement plan over time. The goal of the plan should be health promotion and strength building.
| Strength Training Exercises | Moderate Aerobic Exercises | Vigorous Physical Exercises | Mind-Body Exercises |
|---|---|---|---|
| Pilates | Swimming | Biking | Yoga |
| Weightlifting | Brisk walking | Uphill hiking | Tai chi |
| Body-weight training | Water aerobics | High-intensity interval training (HIIT) | Pilates |
| Resistance training | Dance | Running | Qigong |
| Tennis | Lap swimming | ||
| Yard care | Basketball | ||
| Tennis |
Exercise is a powerful way to combat the changes associated with aging. Exercise builds muscle, increases metabolism, helps control blood sugar, increases bone density, and relieves stress. However, fewer than half of midlife adults regularly exercise, and only about 24 percent exercise frequently and strenuously enough to achieve health benefits (Elgaddal et al., 2022). The best exercise programs are those that can be engaged in regularly, regardless of the activity. However, a well-rounded program that is easy to follow may include activities such as walking and weight training. Having a safe, enjoyable place to walk can make a difference in whether a patient takes walks consistently as part of their daily habits. Weightlifting and stretching exercises at home can also be part of an effective movement program. Exercise is beneficial in reducing stress in midlife. Walking, jogging, cycling, or swimming can release the tension caused by stressors. Learning relaxation techniques can also have health benefits. Exercise can be considered preventive health care. Promoting exercise can reduce healthcare costs by reducing chronic disease risk and incidence and improve quality of life on an individual as well as societal level.
Teach Coping Mechanisms
Nurses often encounter adults in the setting of acute illness or chronic illness, so teaching coping skills is another important task when providing care. Nurses can set an example by encouraging coping skills in themselves and coworkers. Nurses are subject to high levels of stress and compassion fatigue, which occurs when individuals in a caregiving role experience signs of burnout and emotional fatigue from caring for others. A state of emotional, physical, and mental exhaustion caused by prolonged stress and excessive workload is called burnout and is often associated with work-related responsibilities and caregiving roles. Coping mechanisms can help manage disorders such as depression and anxiety as well as have a bolstering effect when faced with acute stressors such as new medical diagnoses or injuries. Nurses can focus on teaching active and passive coping strategies to patients. Nurses should encourage adults to seek active coping strategies, such as support groups, calming techniques, yoga, meditation, social support groups, problem-solving, and active lifestyle change planning. Passive coping strategies refer to methods individuals use to deal with stress or difficult situations by avoiding or withdrawing from them rather than actively addressing or attempting to resolve them. Sometimes, engaging in passive strategies such as distraction, mindfulness, and relaxation is helpful before jumping into active coping.
Interdisciplinary Team Referrals
Nurses ensure that individuals receive proper referrals from interdisciplinary team members. These referrals are needed to address many aspects of patient care. In young and middle-aged adults, specialty healthcare providers are necessary to address specific health disorders beyond the scope of a primary care provider. Nurses help facilitate referrals by ensuring proper screening and documentation are completed, scheduling appointments, and communicating with patients and office staff. Communication with the interdisciplinary team members can be by phone, email, and internal communication networks in larger healthcare facilities. Nurses can also ensure that patients understand the reason for the referral, know what to expect during the referral process, and have a plan for continuity of care in the interim. Referrals to other interdisciplinary team members correlate with specific patient needs such as mental health treatment, nutrition guidance, and case management services to address socioeconomic impacts of health.
Mental Health
Screening with mental health questionnaires, such as the PHQ-9, guides nurses and healthcare providers through identifying individuals who need more specialized care. When caring for patients with mental health disorders, it is important to convey that they are not alone in their feelings and experiences. It is also critical to support appropriate medication adherence to help patients manage the symptoms of mental health disorders.
Depending on the mental health disorder, a specialist referral may be necessary. While depression and anxiety are frequently treated successfully in the primary care setting, a focus on behavioral health or mental health care is necessary for individuals with treatment-resistant disorders (such as depression) or complex disorders such as bipolar disorder, schizophrenia, and ADHD.
Screening for mental health and other behavioral conditions guides nurses in determining if a referral to a mental health specialist is indicated. Mental health specialists and psychiatrists are the key players in diagnosis and treatment. Other patients may need more assistance with counseling and adjunctive care, in which case referral to a counselor or cognitive behavioral therapist (CBT) is essential.
There is much research interest in developing more effective medications for mental health conditions, but individuals must have access to the newest treatments. Healthcare providers need to be skilled and knowledgeable in prescribing treatments. Even individuals who successfully manage their medications in the primary care setting may benefit from CBT or other types of counseling and therapy that require specially trained providers. The addition of CBT to pharmaceutical therapy significantly increases the likelihood of depression remission and sustained improvement (Gautam et al., 2020).
Nutrition
As individuals age, their caloric needs typically decrease. In response to weight gain, many Americans turn to dieting. However, simply reducing food intake does not guarantee a balanced diet, often resulting in vitamin and mineral deficiencies. Consequently, middle-aged individuals frequently encounter such deficiencies when restricting their calorie intake. To address this issue, providers often advise middle-aged patients to incorporate vitamin supplements into their diets.
Nurses play a key role in providing nutrition education. Nurses can help patients develop healthy eating habits that align with their preferences and health conditions, such as diabetes, hypertension, high cholesterol, or gastric disorders. Focusing on whole foods, fruits and vegetables, and whole grains and encouraging the limitation of processed, refined, and manufactured foods are general dietary recommendations that benefit nearly all patients.
Specialists
Specialists in many fields collaborate with nurses on the patient care team (Table 40.7). While many disorders in young and middle-aged adults are managed through a primary care provider, specialty physician consultation is often needed, particularly if the diseases are resistant to the usual treatment or require more advanced interventions or experimental therapies. In addition, consultation with experts in diabetes care, cancer care, and mental health is essential for providing optimal patient care.
| Specialist Care | Diseases Treated |
|---|---|
| Endocrinology |
|
| Rheumatology |
|
| Hematology |
|
| Cardiology |
|
| Dermatology |
|
| Gynecology |
|
| Urology |
|
| Infectious disease |
|
| Gastroenterology |
|
| Orthopedics |
|
Clinical Safety and Procedures (QSEN)
QSEN Competency: Teamwork and Collaboration
Definition: Function effectively in an interdisciplinary team, focusing on appropriate communication and individualized patient care.
Knowledge: Nurses working in various settings must collaborate with diabetes educators. This may include collaboration for individuals with new-onset diabetes, treatment-resistant disease, and those struggling to cope with the disease. A team approach will provide the patient with the most up-to-date care options and foster relationships with specialized providers such as diabetes educators who focus exclusively on promoting health in this population.
Skill: Nurses can be alert for signs of a patient struggling with diabetes management. The nurse can lead by suggesting a referral to a diabetes educator to collaborate on treatment. The nurse will keep the patient at the team’s center, always providing input and encouraging choices to empower them to feel a sense of control over their health.
Attitude: Maintain good communication between the healthcare provider, diabetes educator, and patient, particularly during treatment changes and follow-up.
Social Worker
Social workers are key collaborators for nurses, particularly in challenging cases. Social workers help guide care and resources for patients with substance use disorders, inadequate housing, financial distress, and life-threatening diseases. Social workers are also beneficial for adults with underlying mental health or chronic physical disorders that require long-term and complicated treatment plans. For example, nurses may work directly with social workers to create a long-term plan for a patient discharged from the hospital. In this case, the social worker evaluates the needs of the patient and family prior to discharge and helps the patient navigate community resources to meet their needs, such as financial relief, respite care, or nutrition services. Social workers will communicate with nurses working in inpatient, outpatient, long-term care, and specialty care settings and provide invaluable information about the ongoing and changing needs of the patient. Social workers and nurses work together to create care plans focusing on the whole person.