Using Valid and Reliable Assessment Tools in Palliative Care Lynne Penton RN (EC) MN CON (C )
The Understanding of Health and Illness Underlying the Model Normal path of life with an anticipated future Illness path with an uncertain future Desired change Illness path with an uncertain future CHANGING THE EXPERIENCE OF ILLNESS
The Role of the Registered Nurse (Position Statement on Hospice Palliative Care, College and Association of Registered Nurses in Alberta, 2005) • Aims to improve quality of life through efforts to alleviate physical, emotional, psychological and spiritual suffering • Advocates for and involves the person and the family in health care decision making (CNA, 2002). • Applies a unique body of knowledge, skill and experience to provide individualized and effective hospice palliative care nursing • Uses the process of assessment , planning, implementation and evaluation to provide and improve palliative care (CARNA 2004)
Standards of Care CANO Conceptual Framework 1. Standards of Care – 2. Individual’s and families needs Nursing Role – – – 3. Generalist Specialized Advanced Competencies – – – Knowledge Skill Clinical Judgment
Conceptual Framework of the Standards: Essential Elements STANDARDS OF CARE NURSING PRACTICE ROLES Generalist, Specialized, Advanced FOUNDATIONS OF NURSING ROLE COMPETENCIES FOR GENERALIST SPECIALIZED ADVANCED
Specialized Oncology Nurse (SON) A registered nurse whose primary focus is cancer care. Has enhanced specialty knowledge and skill in the care of individuals with cancer and their families. • BSc. N (preferred) • Oncology nursing certificate • CNA Certification in Oncology Nursing (CON(C)) The SON practices in a cancer care environment • • • Specialized inpatient unit Bone marrow transplant unit Ambulatory cancer care centre Cancer Screening programs Supportive and Palliative Care Programs
CANO Competencies • Comprehensive Health Assessment • Supportive and Therapeutic Relationships • Management of Cancer Symptoms and Treatment Side Effects • Teaching and Coaching • Facilitating Continuity of Care /Navigating the System • Decision Making and Advocacy • Professional Practice and Leadership
Practice Domain #1 • Practice Standard…the specialized oncology nurse conducts timely and comprehensive assessments of the …. using a systematic approach • A specialized oncology nurse demonstrates the standard by…. . Using focused assessment tools CANO 2006
Think measurement …….
Assessment of Symptom Severity ESAS
(ESAS) Edmondton Symptom Assessment Scale, version date: December 11, 2002
Symptoms • • • Pain Tiredness Nausea Depression Anxiety Appetite Feeling of well being Shortness of breath Other
Guidelines for use • • • The severity at the time of assessment Rated from 0 -10 0 means symptom is absent 10 means worst possible severity It is the patients opinion Does not replace holistic clinical assessment • Allows for trends and outcomes
How often ? • Complete and graph the ESAS each telephone or personal visit • If symptoms are well controlled weekly is is ok • In hospitals and other settings complete daily • In ambulatory clinic first day of each visit
Who documents? • Ideally the person fills out their own • May be completed with assistance • Always done on the ESAS Numerical Scale • Never straight onto a graph-must assess the current symptom profile…. may be affected by trending • Is available in other languages
Measurement of Performance PPSv 2
Guidelines for use • Eleven categories measured in 10% stages make a “best fit” determination • Five observable parameters • No half way percentages
Who documents? • Used to determine amount of support a person may need • Initial assessment and then weekly • Recorded by staff who are familiar with status • May assist in measuring workload
How do you use this in practice? • • Use it to talk to disciplines Use it to talk to other nurses Use it to evaluate your interventions Use it to show your patients that you are committed to helping them • Use it to demonstrate and celebrate success
Bottom Line USE IT !
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