Date of Award


Document Type

Open Access Dissertation


College of Nursing

First Advisor

Stephanie Burgess


The purpose of this quality improvement project is to compare the provider’s perception following an educational model of using single symptom management versus multi-symptom management during the end-of-life transition in adult patients for improved quality of life outcomes. The appraised evidence indicates that it is critical to have anticipatory medications at the patient’s residence to manage multiple symptoms rather than focusing exclusively on a single symptom management such as pain management. In February 2016, the author conducted an educational model among hospice providers for increasing knowledge and awareness of multi-symptom management. Thirty (n = 30) Clinical Nursing Directors, Licensed Practical Nurses, Medical Directors, and Registered Nurse Case Managers from hospice organizations located in South Carolina were surveyed pre and post intervention regarding their perception of symptoms, the most prominent distressful symptoms that are experienced by hospice patients, and the pharmaceutical preference to manage distressful symptoms. With a response rate of 77%; (n=23) participants pre-test responses indicated that pain (35%) was the most prominent symptom among patients; Dyspnea/SOB (44%) was identified as the most distressful symptom for patients; and anxiety/restlessness and increased respiratory secretions received (35%) as the most distressful symptoms for patients’ families and/ or caregivers witnessed during a patient’s last two weeks of life. Hospice provider’s post-test responses indicated that the most prominent symptom was dyspnea/SOB (30%) followed by pain (22%). Additionally, the presence of anxiety/restlessness had increased by almost (10%) in the post-test results (26%). Healthcare providers reported the most distressful symptom for the patient was dyspnea/SOB (44%) with the same response rate both pre-test and post-test. However, the prevalence of pain as the most distressful symptom’s response rate decreased from pre-test (17%) to post-test (9%). The presence of perceived increased respiratory secretions response rate increased from pre-test (13%) to post-test (22%). This project was consistent with the evidence that multi-symptom management is critical in end of life transitions and care providers must focus on multi-symptoms rather than single symptom.


© 2016, Ashley N. B. Sirianni

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Nursing Commons