Using a Dyspnea Assessment Tool to Improve Care at the End of Life

Lorri Birkholz, DNP, RN, NE-BC; Tina Haney, DNP, CNS, RN


Journal of Hospice and Palliative Nursing. 2018;20(3):219-227. 

In This Article

Abstract and Introduction


Dyspnea is experienced by 15% to 70% of patients at end of life. Because of cognitive changes before death, patients may be unable to self-report dyspnea, which requires nurses to accurately assess and initiate symptom management. This study compared practicing nurses' experiential practice in the assessment and management of dyspnea in patients unable to self-report to practice using of the Respiratory Distress Observation Scale (RDOS). This pre-experimental pretest/posttest study evaluated nurse outcomes following a structured educational program aimed at preparing them to use the RDOS. Nurses (n = 39) who provide end-of-life care were recruited for the study. After receiving the educational program, there was not a significant difference in the nurse's ability to assess the patient's overall level of perceived comfort and determine a differential diagnosis. There was, however, improvement in the nurse's ability to correctly determine a patient's level of dyspnea (P = .021) and also in their ability to select appropriate treatment options. This study demonstrates applicability of the RDOS to the end-of-life population replacing experiential practice with an evidence-based tool for the assessment and treatment of dyspnea in patients who cannot self-report.


Many nurses rely on experiential practice when assessing and treating patients, which can result in care inconsistencies.[1] It is unknown whether the nurse's assessment and treatment options guided by previous experience are consistent with the use of a validated assessment and treatment tool. This study compared experiential assessment and treatment of end-of-life dyspnea in standardized patient scenarios that could not self-report before and after incorporating the Respiratory Distress Observation Scale (RDOS) into their practice. To date, no studies have been done with the end-of-life population comparing the nursing assessment and management of dyspnea using experiential practice and practice after the incorporation of the RDOS tool. The purpose of this study was to compare experiential end-of-life dyspnea assessment and management before and after nurses received a structured educational program on the RDOS focused on preassessment/postassessment skills, treatment selections, identifying degrees of dyspnea, and ease of use/satisfaction with the scale.