Palliative Care Nursing: Principles and Evidence for Practice

By Sheila Payne; Jane Seymour et al. | Go to book overview

9
Approaches to assessment in
palliative care

Deborah Fitzsimmons and Sam H. Ahmedzai

With the establishment of clinical governance and evidence-based practice, there is a need and demand for relevant and rigorous assessment of the outcomes of care on the patient experience. In recent years, there has been considerable debate within the literature as to what are the most important and relevant outcomes upon which to assess patient experience in palliative care, and what are appropriate methods to assess these outcomes of care. In this chapter, we review the current perspectives of patient-based outcome assessments in palliative care and reflect critically upon their application to palliative care nursing practice.


The purpose of assessment in palliative care

Assessment of the patient and family is viewed as of central importance to the multidisciplinary management of the patient with palliative care needs. To undertake an assessment, the palliative care nurse needs to be equipped with an in-depth knowledge base of the impact of advanced illness on the patient and family, and have skills in recognizing potential and actual health needs of patients and their families. Once a thorough assessment is undertaken, the nurse, in collaboration with the multidisciplinary team, can plan and implement appropriate care. The goals or outcomes of this care provision can then be evaluated. This is often done by evaluating the impact of care on patient-based outcomes such as symptom relief and quality of life. Several fundamental concepts underpin this practice (see Box 9.1).

Assessment is the first stage of the 'nursing process', which was devised to provide a more systematic approach to the provision of nursing care (Yura and Walsh 1967). It is important to recognize, however, that assessment is not a discrete step in the provision of nursing care but a dynamic process. In palliative care, patients' health needs can change rapidly,

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