The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [37]
Ongoing assessment
Continuous assessment of the patient’s health status accompanied by monitoring and observation of specific problems identified in a mini, comprehensive or focused assessment.
(Ahern and Philpot 2002, Holmes 2003, White 2003)
Preprocedural considerations
Assessment tools
The use of assessment tools enables a standardized approach to be used to obtain specific patient data. This can facilitate the documentation of change over time and the evaluation of clinical interventions and nursing care (Conner and Eggert 1994). Perhaps more importantly, assessment tools encourage patients to engage in their care and provide a vehicle for communication to allow nurses to follow patients’ experiences more effectively. An example of this comes from the European-wide cancer nursing WISECARE project (Kearney 2001). Nurses developed systematic measurements for four chemotherapy treatment-related symptoms and this enhanced care by directly linking nursing interventions to patients’ reports of their experience. Improvements in outcomes were demonstrated and patients perceived their feelings and experience had been better considered in their treatment plan (Kearney 2001).
Assessment tools in clinical practice can be used to assess patients’ general needs, for example the supportive care needs survey (Bonevski et al. 2000), or to assess a specific problem, for example the oral assessment guide (Eilers et al. 1988). The choice of tool depends on the clinical setting although in general, the aim of using an assessment tool is to link the assessment of clinical variables with measurement of clinical interventions (Frank-Stromborg and Olsen 2004). To be useful in clinical practice, an assessment tool must be simple, acceptable to patients, have a clear and interpretable scoring system and demonstrate reliability and validity (Brown et al. 2001).
Nurse researchers and clinicians have developed a broad spectrum of tools to assess the problems frequently encountered by patients (Box 2.5). More tools are used in practice to assess treatment-related symptoms than other aspects of care, possibly because these symptoms are predictable and of a physical nature and are therefore easier to measure. The most visible symptoms are not always those that cause most distress, however (Holmes and Eburn 1989), an acknowledgement of the patient’s subjective experience is therefore an important element in the development of assessment tools (McClement et al. 1997, Rhodes et al. 2000).
Box 2.5 Examples of assessment tools used in cancer care
Generic assessment tools
Cancer Rehabilitation Evaluation System (CARES) (Ganz et al. 1992)
Problems checklist (Osse et al. 2004)
Supportive Care Needs Survey (SCNS) (Bonevski et al. 2000)
Specific assessment tools
Piper Fatigue Scale (Piper 1997)
Oral assessment (Eilers et al. 1988)
Chemotherapy Symptom Assessment Scale (C-SAS) (Brown et al. 2001)
Pain and Assessment Records (PSAR) (Bouvette et al. 2002)
The use of patient self-assessment tools appears to facilitate the process of assessment in a number of ways. It enables patients to indicate their subjective experience more easily, gives them an increased sense of participation (Kearney et al. 2000) and prevents them from being distanced from the process by nurses rating their symptoms and concerns (Brown et al. 2001). Many authors have demonstrated the advantages of increasing patient participation in assessment by the use of patient self-assessment questionnaires (Rhodes et al. 2000). A number of patient self-report tools have been developed for cancer patients as a result, and whilst many have been established for research purposes, an increasing number are being used very effectively in everyday clinical practice (Box 2.6).
Box 2.6 Examples of specific patient self-assessment tools used in cancer care
Self Report Health History (SRHH) (Skinn and Stacey 1994)