title: Routine dyspnea assessment and documentation: Nurses' experience yields wide acceptance.
abstract: BACKGROUND
  Dyspnea (breathing discomfort) is a common and distressing symptom. Routine assessment and documentation can improve management and relieve suffering. A major barrier to routine dyspnea documentation is the concern that it will have a deleterious effect on nursing workflow and that it will not be readily accepted by nurses. Nurses at our institution recently began to assess and document dyspnea on all medical-surgical patients upon admission and once per shift throughout their hospitalization. A year after dyspnea measurement was implemented we explored nurses' approach to dyspnea assessment, their perception of patient response, and their perception of the utility and burden of dyspnea measurement.
  
  
  METHODS
  We obtained feedback from nurses using a three-part assessment of practice: 1) a series of recorded focus group interviews with nurses, 2) a time-motion observation of nurses performing routine dyspnea and pain assessment, and 3) a randomized, anonymous on-line survey based, in part, on issues raised in focus groups.
  
  
  RESULTS
  Ninety-four percent of the nurses surveyed reported administering the dyspnea assessment is "easy" or "very easy". None of the nurses reported that assessing dyspnea negatively impacted workflow and many reported that it positively improved their practice by increasing their awareness. Our time-motion data showed dyspnea assessment and documentation takes well less than a minute. Nurses endorsed the importance of routine measurement and agreed that most patients were able to provide a meaningful rating of their dyspnea. Nurses found the patient report very useful, and used it in conjunction with observed signs to respond to changes in a patient's condition.
  
  
  CONCLUSIONS
  In this study, we have demonstrated that routine dyspnea assessment and documentation was widely accepted by the nurses at our institution. Our nurses fully incorporated routine dyspnea assessment and documentation into their practice and felt that it improved patient-centered care.
authors.affiliation: Lois E. Silverman Department of Nursing, Beth Israel Deaconess Medical Center, 330 Brookline Avenue Reisman 1113, Boston, MA 02215 USA.
authors.forename: Kathy M
authors.initials: KM
authors.lastname: Baker
authors.affiliation: Lois E. Silverman Department of Nursing, Beth Israel Deaconess Medical Center, 330 Brookline Avenue Reisman 1113, Boston, MA 02215 USA ; Connell School of Nursing, Boston College, Chestnut Hill, MA USA.
authors.forename: Susan
authors.initials: S
authors.lastname: DeSanto-Madeya
authors.affiliation: Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA USA ; Harvard Medical School, Boston, MA USA.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Banzett
keywords: Dyspnea; Dyspnea assessment; Nurse assessment of dyspnea