Setting goals and assessing outcomes are essential elements in palliative care. This paper describes a multiprofessional project, conducted under the auspices of clinical audit, which attempted to evaluate important outcomes of care. Over a six-month period there were 123 consecutive admissions to the hospice. These patients and their carers, as well as the staff, were encouraged to set explicit goals for, and evaluate outcomes of, their care. As anticipated, we encountered many difficulties in this, but there were benefits. We were able to record goals of admission from the patient in 97 cases (79%), their main carer in 74 cases (63%) and from hospice staff in 120 cases (98%). Patient and carer goals were often more functional and specific whereas the staff goals tended to be more problem or symptom focused. The achievement of these goals was evaluated by patients, carers and staff at discharge or death (where possible) with the majority being fully or partially met. Only 15 patients and 9 carers thought that some or all of their goals had not been achieved with just 4 recording that their goals had changed. Overall, it was a worthwhile (although time-consuming) exercise and, as a result of the 'audit', clear goals and outcomes from patient, carer and staff perspectives are now routinely recorded for all admissions to the hospice and are used to focus multiprofessional patient review. Having analysed the process as well as the results of the 'audit', we would encourage others not to be daunted from undertaking similar projects.
Reflexivity was an essential and dynamic component of this study, which involved constant interplay between the author and the research.
Discharging patients from community specialist palliative care services is a contentious issue. Although some specialist nursing teams discharge patients at the earliest opportunity and are open to re-referral, others retain patients as "pending", i.e. patients do not receive regular contact or intervention but remain on the caseload until a need arises. This anomaly is not surprising given the lack of evidence of good practice in the discharge of patients who no longer have specialist needs. This article describes an audit by a community specialist palliative care nursing team of patients discharged from their caseloads over a 6-month period from January to June 2002. The aims of the audit were to compare the reasons for discharge given by the nurse specialists with existing discharge criteria and to provide data for guidelines for good practice in discharging patients. The rate of re-referral for the discharged cohort was also measured. There were 199 patient discharges in the audit period with 23 being re-referred within 6 months of discharge. The reasons for discharge were generally broader than the discharge criteria and the nurses frequently emphasized to the patient, the family and primary carers that re-referral was welcomed as needs arise. The need for multicentre discharge audits was also highlighted.
A self-assessed activity analysis of a team of community palliative care nurse specialists was undertaken as part of a wider review of their service. Although it was not a research project, it proved to be a pragmatic and worthwhile means of analysing the work of individual nurse specialists and measuring what they actually do. The results and outcomes are presented in order to share the experience and to break down some of the isolation of community palliative nursing practice. The study found quite wide variations in practice between the individual nurse specialists but that most spent a high proportion of their time on clinical work at the expense of other aspects of the nurse specialist role, such as education, research and audit. It also found that most of the nurse specialists worked many more than their contracted hours and took very few breaks during the working day. The study promoted discussion within the team, changes have been introduced and the study will be repeated in two years' time.
Measuring outcomes of care is an essential component of clinical governance. This article describes a pragmatic approach to auditing symptom control outcomes in a community specialist palliative care nursing team. Using a palliative care assessment tool, it demonstrates that the team make a positive difference to the patient's experience of most symptoms and a plan for further development of practice is formulated in response to the results of the audit. Unexpected outcomes reveal some of the realities of community specialist palliative care and demonstrate that audit is worthwhile despite some of the pitfalls in this area of practice.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.