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

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

Disclosures

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

In This Article

Results

Participant Demographics

Aggregate and group-specific sociodemographic data are summarized as follows. Cumulatively, the average (mean) age of participants was 46.68 (SD, 12.69) years. Ages spanned 44 years with a minimum age of 26 years and a maximum age of 70 years. In addition, 100% of the study participants were female. The mean years of nursing experience was 16.97 (SD, 14.73). Years of nursing experience spanned 49 years with a minimum of 1 year to a maximum of 50 years. The mean years of hospice/end-of-life care experience was 6.06 (SD, 6.88) years and a range of 27 years. Minimum years of hospice/end-of-life care experience was none with a maximum of 27. Nurses with their highest level of nursing education at the associate degree in nursing level comprised the majority population (43.6%) in this study, followed by 30.8% diploma RNs, 20.5% bachelor of science in nursing, and 5.1% master of science in nursing.

In addition, the participants were asked to provide information on their employment status, primary shift worked, current national specialty certifications, previous ELNEC training, and prior RDOS training and to self-rate their current level of confidence in assessing and managing end-of-life dyspnea in patients who cannot self-report. Seventy-eight percent of participants did not have a current national specialty certification; 92.3% had not received prior ELNEC education, and 84.6% had no prior education on the RDOS tool. Self-reported experiential confidence levels in assessing and managing end-of-life dyspnea results were as follows: very confident, 41%; mostly confident, 38.5%; somewhat confident, 17.9%; and not confident, 2.6%, prior to the RDOS education. Detailed participant demographic data are summarized in Table 1.

Research Questions and Item Analysis

Research question 1: Did nurses demonstrate differences in their assessment skills of end-of-life dyspnea in nonverbal patients following a structured training program on the use of the RDOS? Data to determine pre-education and posteducation assessment skills were collected from answers provided by the participants on pretest/posttest question 1 ("Does the patient appear comfortable?") and question 3 ("What is your differential diagnosis?"). Data from pretest/posttest answers to questions 1 and 3 were analyzed both individually and as cumulative data based on correct answer totals using descriptive statistics. After receiving the RDOS 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.

Specific to test question 1, the results of the Wilcoxon signed rank test were not significant, V = 232.50, P = .052, and for question 3, the results of the Wilcoxon signed rank test were not significant, V = 84.00, P = .090.

Research question 2: Did nurses demonstrate differences in their treatment selections of end-of-life dyspnea in nonverbal patients following a structured training program on the use of the RDOS? Data to determine pre-education and posteducation treatment skills were collected from answers provided by the participants on pretest/posttest question 5 ("What intervention is the most appropriate?") along with their calculated RDOS score on the posttest.

There were statistically significant differences in the treatment selections on the pretest/posttest using the Wilcoxon signed rank test (P = .016), indicating these differences were not likely due to random variation. Table 2 shows detailed pretest/posttest results.

Research question 3: Did nurses demonstrate a difference in their ability to assess degrees of dyspnea following a structured training program on the use of the RDOS? Data to determine dyspnea recognition were collected from answers provided by the participants on pretest/posttest question 2 ("Degree of assessed dyspnea: none, mild, moderate, severe"). In addition, the documented RDOS score provided by the nurses was analyzed to show the descriptive statistics of mean, minimum, and maximum. Specific to the improvement in the nurse's ability to correctly determine the patient's level of dyspnea, there were statistically significant differences between the pretest and posttest responses. The differences between the preprogram/postprogram are numerated in Table 3, and the individual item analysis is presented in Table 2. Participants could identify severe distress when the RDOS score was greater than 10, but there was less accuracy with mild, moderate, and severe distress when the numerical value was less than 10.

Research question 4: Did the nurses who had been trained to use the RDOS report ease of use and satisfaction in the tool? Data to determine ease of use and satisfaction with the tool were collected from 8 items on the program evaluation form. These results were analyzed to show mean percentages by group and cumulatively. The study evaluation forms were analyzed using descriptive statistics to determine the participant's views on the RDOS tool and its potential benefit to their end-of-life nursing practice. Evaluation results are summarized in the following. Specific to the tool, 97.4% of the 39 participants responded that they strongly agreed or agreed that the RDOS was easy to complete and easy to understand and that they would recommend it as an assessment tool for end-of-life dyspnea. As for the RDOS being time efficient, 89.7% of participants responded that they strongly agreed or agreed. When asked if the RDOS could improve end-of-life dyspnea management/treatment, consistency, and documentation, 89.7% of participants responded as strongly agreed or agreed; yet, only 87.2% believed that the RDOS could improve their personal dyspnea assessment skills. Evaluation responses of disagree or strongly disagree were reported only by the hospice nurse population related to the RDOS's ability to improve their dyspnea assessment skills. More than 80% of participants had no previous exposure to the RDOS, and the clear majority (97.4%) responded positively in finding the tool to be easy to complete and easy to understand and that they would recommend it as an assessment tool for end-of-life symptom management.

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