Evaluating an holistic assessment tool for palliative care practice
Article first published online: 17 SEP 2013
Journal of Clinical Nursing
Aims and objectives
To
evaluate a holistic assessment tool for palliative care practice. This
included identifying patients' needs using the holistic tool and
exploring the usability, applicability and barriers and facilitators
towards implementation in practice.
Background
The
delivery of effective holistic palliative care requires a careful
assessment of the patients' needs and circumstances. Whilst holistic
assessment of palliative care needs is advocated, questions exist around
the appropriateness of tools to assist this process.
Design
Mixed-method research design.
Methods
Data collection involved an analysis of piloted holistic assessments undertaken using the tool (n = 132) and two focus groups with healthcare professionals (n = 10).
Results
The
tool enabled health professionals to identify and gain an understanding
of the needs of the patients, specifically in relation to the physical
healthcare needs.
Differences, however, between the analysis of the tool documentation and focus group responses were identified in particular areas. For example, 59 (68·8%) respondents had discussed preferred priorities of care with the patient; however, focus group comments revealed participants had concerns around this.
Similarly, whilst over half of responses (n = 50; 57·5%) had considered a prognostic clinical indicator for the patient as an action, focus group results indicated questions around healthcare professionals' knowledge and perceived usefulness of such indicators.
Positive aspects of the tool were that it was easy to understand and captured the needs of individuals. Negative aspects of the tool were that it was repetitive and the experience of assessors required consideration.
Differences, however, between the analysis of the tool documentation and focus group responses were identified in particular areas. For example, 59 (68·8%) respondents had discussed preferred priorities of care with the patient; however, focus group comments revealed participants had concerns around this.
Similarly, whilst over half of responses (n = 50; 57·5%) had considered a prognostic clinical indicator for the patient as an action, focus group results indicated questions around healthcare professionals' knowledge and perceived usefulness of such indicators.
Positive aspects of the tool were that it was easy to understand and captured the needs of individuals. Negative aspects of the tool were that it was repetitive and the experience of assessors required consideration.
Conclusion
The
tool evaluation identified questions regarding holistic assessment in
palliative care practice and the importance of communication.
Relevance to clinical practice
A
holistic assessment tool can support patient assessment and
identification of patients' needs in the ‘real world’ of palliative care
practice, but the ‘tool' is merely an aid to assist professionals to
discuss difficult and sensitive aspects of care.
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