Capstone project-wk 3 (combining 1-3)

Leslie Hill 

RE: Group A Practice Experience Discussion - Week 2

COLLAPSE

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To start the week out, I realized that my subject had to change based on the instructor's feedback and the information I had available to me. I sat down with my mentor, the administrator of the company, and the person in charge of quality for the hospice company I work for. We looked over the QAPI (Quality Assessment and Performance Improvement) scores for the last three quarters and realized that we did not meet our goal of having a skilled nurse visit at least 3 to 6 days before death. Having an increase in nursing visits in hospice is imperative to confirm that the patient is comfortable and has no new symptoms related to death and to help prepare the family.

Like other fields in nursing, hospice relies heavily on good assessment skills and good communication with the patient and family. We are also required to use the Edmonton Symptom Assessment Scale each visit. This scale is a series of 10 questions with a rating of 0-10 (What is Edmonton Symptom Assessment System (ESAS) - Meaning and definition - Pallipedia, n.d.). It is required at each visit to ask the patient or caregiver to rate pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being, and shortness of breath. In theory, the higher the number, the lower the quality of life (Chow et al., 2019). This, therefore, is a predictor of decline and indicates that nursing visits need to increase.

The question is, why did we fail at determining the decline in our end of life patients. There are times when, of course, you can not predict death. In speaking with my mentor, we feel it may be other factors involved in overlooking the decline in our patients. We may not be paying attention to the details of the nursing assessment, such as minor changes in lung sounds, perfusion, blood pressures, or breathing patterns, which may be expected for some patients but not in others. Another factor that would cause the nurse to overlook minor details is not communicating with the patient or families and explicitly asking them the questions in the ESAS each visit or just filling it out based on the nurse's judgment. We also discussed if the nurse understood the importance of the ESAS and how it can be a good predictor of decline in our client base.

References

Chow, S., Wan, B. A., Pidduck, W., Zhang, L., DeAngelis, C., Chan, S., Yee, C., Drost, L., Leung, E., Sousa, P., Lewis, D., Lam, H., Chow, R., Lock, M., & Chow, E. (2019). Symptoms Predictive of Overall Quality of Life Using the Edmonton Symptom Assessment Scale in Breast Cancer Patients Receiving Radiotherapy. Clinical Breast Cancer, 19(6), 405–410. https://doi-org.ezp.waldenulibrary.org/10.1016/j.clbc.2019.05.007

What is Edmonton Symptom Assessment System (ESAS) - Meaning and definition - Pallipedia. (n.d.). Pallipedia.Org. Retrieved October 23, 2020, from https://pallipedia.org/edmonton-symptom-assessment-system-esas/#:~:text=Edmonton%20Symptom%20Assessment%20System%20%28ESAS%29%20This%20tool%20is

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