Congress Abstracts 2005

40

SYMPTOM ASSESSMENT: A LOOK AT THE CONGRUENCY OF THE PATIENT NURSE PERSPECTIVES. Mercy Cherian, RN, OCN^®, Rosanne Arlington, RN, MSN, CNS, ONC, OCN^®, and JoAnn Mick, RN, MSN, AOCN^®, MBA, University of Texas M.D. Anderson Cancer Center, Houston, TX.

Nurses often use their observational skills to assess patients’ symptoms and to feel “comfortable” with what they “see.” However, there is evidence that patients often try to appear normal and not publicly demonstrate symptomatology. Failure of oncology nurses to directly seek input from patients about symptoms that the patients may be experiencing can lead to erroneous assessment of and inappropriate or inadequate intervention for the symptoms.

The purpose of this project was to help oncology nurses identify incongruities between their perceptions of symptoms and those of cancer patients, to highlight the importance of consistent objective assessments including input from patients, and to implement an assessment process that provides an accurate symptom assessment.

Interventions included a survey of all staff nurses and patients to determine congruence of symptom rating. Each nurse was asked to rate patients’ level of pain, fatigue, nausea, depression, anxiety, drowsiness, shortness of breath, appetite, sleep and sense of well-being. The patients (45 to date and 100 eventually) were then surveyed to determine their self-reported rating, using a symptom-assessment tool.

Surveys of patients and nurses using the M. D. Anderson’s Symptom Assessment Tool showed that nurses and patients evaluated symptoms at the same level 35% of the time but only when both patients and nurses rated a symptom as “0.” Nurses underrated symptoms 42% of the time compared with patients; the symptoms that were underrated most frequently were fatigue, depression, anxiety, appetite, and sense of well-being.

This project demonstrated the importance of directly soliciting input from patients with cancer to accurately determine the presence and rating of symptoms. Use of this process may help nurses in other oncology settings improve assessments of symptoms and ultimately pay greater attention to patients’ needs.