Evidence based assessment tools
Assigned readings:

Mayer, D. M., & Murphy, R. (2013). Palliative Care at the End of Life: A Rural Family Perspective. In C.A.

    Winters (Ed.), Rural nursing: Concepts, theory, and practice (pp. 119 – 129). New York: Springer.

Larsen, P.D. (2019). Palliative Care. In P.D. Larsen (Ed.), Chronic illness: Impact and

    intervention. (pp. 525 – 545). Burlington, MA: Jones & Bartlett

Review the Clinical Practice Guidelines for Quality Palliative Care (the next link in this module). 

Peruse the resources linked into this module.

Key Points

The objective of palliative care is to alleviate symptoms without curing the medical condition.
Fundamental elements of palliative care include management of a persons physical, psychosocial, spiritual, and practical needs along with ongoing communication between the providers of care and the patient and family (Winters, p. 119).
Unique challenges and opportunities are associated with palliative care in rural areas.
Although the terms ‘hospice care’ and ‘palliative care are sometimes used interchangeably, they are not identical.
Hospice care is generally reserved for persons whose life expectancy is less than six months, while palliative care includes the entire continuum of care for someone with a chronic illness.
Early integration of palliative care can serve to increase quality of life for patients with chronic illness.
In palliative care, support of patient and family caregivers is a high priority
Palliative care serves to manage transitions of care
Palliative care typically results in cost savings 
“Receiving palliative care may or may not mean that patients are near the end of their life” (Larson, p. 527)
“Patients may receive curative treatments during palliative care, but not during hospice care”  (Larson, p. 527)
Carefully note the broad statements by the Center to Advance Palliative Care on p. 527
As you know well, caring for individuals and families who live with chronic illness is complex! Each situation is unique. It can be easy to make assumptions when caring for individuals with chronic illness.  For example, it is easy to think that all individuals with dementia benefit from similar plans of care. Or that individuals with COPD are more alike than unique!  A “cookie cutter” approach is not helpful when caring those in chronic illness situations!!

Your last major assignment in this course will be to develop a care plan (based on a case study). As part of that care plan, you will be required to further assess the patient/family using evidence based tools. Remember that any care plan is only as good as the assessment it is built on! Please carefully review the document addressing evidence based tools (linked into this module).  Then explore the web looking for evidence based assessment tools that would be valuable as you plan care in complex situations. 

There are a few links to a variety of assessment tools in this module, but that is only a start!  Go to Google Scholar and more to explore!

Assignments: 

Find one evidence based assessment tool you were not already familiar with.  Post a description of the tool and what it assesses in the discussion forum. If you can upload the whole tool into the discussion board, that is ideal, but not possible for all of them.    And, be sure to share your thoughts on how the tool could be valuable in promoting patient and family centered care.  The rubric for this assignment is in the syllabus appendices. Appendix E: Evidence Based assessment tool assignment
A patient and family centered care plan is only as good as the assessment it is based on. Using evidencebased assessment tools, relevant to the unique situation can help the nurse uncover data that can be
easily overlooked. You will find one evidence- based assessment tool that you have very limited or no
familiarity with. You will share with your peers in the discussion board.  1,Tool  described. Include (at a
minimum) items that are assessed, and
approximate length of time needed to
complete the assessment.
Uploads the assessment tool to the
discussion forum OR posts a link to the
tool descriptors.2.
Addresses when this assessment would
be appropriate to use, and how it might
be helpful in facilitating improved
outcomes.

Using evidence based, validated assessment tools

I am confident that you are familiar with a variety of standardized assessment instruments. For example, some nurses working with chronically ill persons utilize fall risk assessment tools and/or tools that assess risk for skin break down almost daily in their work.

Why use them in the care of those with chronic illness or receiving palliative care?

I will use the Braden Scale for Predicting Pressure Sore Risk as an example (here is a link if you want a refresher  (www.in.gov/isdh/files/Braden_Scale.pdf).

When the nurses suspects from the presenting history and/or physical assessment that a person may be at risk for developing a pressure ulcer, a more thorough assessment is imperative.  Using an evidence-based tool facilitates the inclusion of signs and symptoms that might otherwise be overlooked (Morrison, 2013).  For example, looking at an initial history, you may see that a patient has limited mobility, thus putting them at risk for skin breakdown.  Then it is critical to assess for additional symptoms that might increase the risk, such as limited sensory perception, moisture, poor nutrition, etc. etc.

It is imperative that the nurse identifies all factors that put people at risk for any health care concern.  It is only when nurses understand the risk/contributing/causative factors that they can plan specific patient centered interventions.  For example, knowing that a person is at risk for pressure wound development related to limited mobility and very poor nutrition, the plan should specifically address mobility and nutrition.  Then going on to make this even more patient centered, the nurse must determine what types of nutrition the patient would accept and most likely consume.  It doesnt make sense to offer vanilla liquid supplements to a person who will only consume strawberry supplements.

Remember that effective care planning is based on a thorough and comprehensive assessment.  Nurses need to be aware of what the problems and causative factors are before they can do anything to address them!!  Care plans are only as good as the assessment they are built on!

Remember that persons and families living with chronic illness often have a multitude of physical, emotional, psychosocial, spiritual, etc. needs that might be addressed by nursing interventions.  The Clinical Practice Guidelines for Quality Palliative Care (4th ed.)(linked into Module 11)  include a host of examples of standardized assessment tools specific to the domains beginning on page 70.  Additionally, the following link takes you to a starting place to find evidence based assessment tools to utilize as you complete assessments. Use of these tools serves to discover concerns and contributing factors that might otherwise be overlooked.

http://npcrc.org/content/25/Measurement-and-Evaluation-Tools.aspx    Note there are five categories of assessment tools listed on the left each category expands to give you access to evidence based tools appropriate to use in palliative care.  And of course there are many more not included on this site.

Remember that care plans must be specific and patient centered.  I remember well one of my professors who told us over and over Your goals and interventions must be specific enough so that if you are gone for a week, the nurse who takes your place will not miss a beat.  That is specific and important!  Goals such as feelings of powerlessness will be reduced or adherence to the care plan will improve dont offer specific guidance.  They are only as good as the assessment they are built on!

Morrison, R. S. (2013). Research priorities in geriatric palliative care: An introduction to a new series. Journal of Palliative Medicine, 17(7), 726-729