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

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

Journal of Hospice & Palliative Nursing: June 2018 - Volume 20 - Issue 3 - p 219–227
doi: 10.1097/NJH.0000000000000432
Symptom Management Series

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.

Lorri Birkholz, DNP, RN, NE-BC, is director of emergency services, Montrose Memorial Hospital, Colorado; and graduate faculty, lecturer, Old Dominion University, Norfolk, Virginia.

Tina Haney, DNP, CNS, RN, is clinical nurse specialist program director, Old Dominion University, Norfolk, Virginia.

Address correspondence to Lorri Birkholz, DNP, RN, NE-BC, Health Sciences Building #3006, 4608 Hampton Blvd, Norfolk, VA 23529 (

The authors have no conflicts of interest to disclose.

© 2018 by The Hospice and Palliative Nurses Association.