Publication Date

Spring 2020

Degree Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Danetta Dutra

Second Advisor

Terrell B. Van Aken

Third Advisor

Alonya Elgrably


RDOS, Respiratory Distress, Symptom Management, Medication Order Assessment


One of the most common symptoms at the end of life is respiratory distress. Respiratory distress or dyspnea is a subjective symptom and therefore challenging to assess, especially when the patient is unable to communicate. Controlling symptoms depend on the knowledge and assessment skills of the clinicians and their willingness to administer the necessary pharmacological intervention. Assessment and treatment of this symptom presented a gap in the quality of care for the patients in the hospital of the author. An exhaustive literature review established that this existed also in other clinical settings and led to the Respiratory Distress Observation Scale (RDOS), a validated tool specifically designed for the non-verbal dying patient in respiratory distress, which subsequently was introduced during this quality improvement project to create a common and objective framework for assessment and intervention. The project is theoretically supported by Kolcaba’s comfort theory that looks at the comfort of the patient at any stage of their health or dying process and the comfort of the clinician working with the patient. Methodologically, during the project a chart review measured the presence of the symptom, the medication ordered by the provider and the medication given by the nurse for the determined patient population before and after the implementation; a survey attempting to obtain some insight into the knowledge base and their comfort level with and their attitudes toward working with dying patients was given to the nurses, also pre- and post-implementation. Statistical analysis performed utilizing SPSS statistical software determined that there is a significant difference between the pre/post chart reviews for the chosen variables; the post-implementation survey could not be used due to the lack of respondents, and an analysis of the pre-survey was interesting but allowed obviously no conclusion about possible changes in attitude and/or knowledge.

Included in

Other Nursing Commons


To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.