Use of dependency and prioritization\ud tools by clinical nurse specialists in\ud palliative care: an exploratory study

摘要

Aims: The principal aim was to assess the utility of three needs\udassessment/dependency tools for use in community-based palliative care\udservices. Specific objectives were to assess a sample of patients receiving\udspecialist palliative care community nursing using these tools, to assess\udthe predictive ability of each tool, and to explore the utility of prioritizing\udand measuring patient dependency from a clinical nurse specialist (CNS)\udperspective. Method: In phase 1, 22 community-based CNSs completed\udthe Vale prioritization tool for all patients visited during a 3-month\udperiod (n=162). They also completed either the Graves and Payne (2007)\udor the Birch et al (1997) dependency tool after each visit. In phase 2 a\udfocus group (n=8) and two one-to-one interviews with CNS participants\udexplored the perceived utility of all three tools. Results: The Vale\udprioritization tool appeared to be the most useful for prioritizing patient\udneed and managing workload. Statistical analysis highlighted minimal\uddifferences between the two dependency tools, neither of which\udpredicted length of visit. Three themes were identified from phase 2:\uddifficulties with routine administration, points of divergence between the\udtwo dependency tools, and workload concerns. Conclusion: While the\udVale prioritization tool emerged as the most useful, the findings raise\udquestions about the overall utility and practical application of these kinds\udof tools with community-based palliative care patients. Further research\udis needed to identify/develop, adapt, and evaluate appropriate,\udsetting-specific dependency tools for use with this population.