Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Nancy Magnuson, DSN, CS, FNP-BC


Tonya Haynes, DNP, RN

Deborah Jeffery, DNP, MBA, NP-C



Problem: The Visiting Nurse Association of Greater St. Louis (VNA) has a grant-funded, palliative care program called Advanced Illness Management (AIM). The Integrated Palliative Outcome Scale (IPOS) is a tool for providers to identify symptoms. The VNA implemented the IPOS in 2017. A previous quality improvement project revealed that IPOS symptoms were addressed less than 95% of the time leaving patients to suffer from burdensome symptoms, thereby reducing their quality of life.

Methods: Providers were educated on the importance of addressing all symptoms with pharmacologic or nonpharmacologic interventions and the impact the interventions have on the AIM program, grant funding, and the quality of life for patients. The education also included a “cheat sheet” of possible interventions and documentation tips.

Results: The sample included 33 visits among 4 providers. There was improvement from the baseline audit in the areas of weakness, poor mobility, and depression. Weakness was addressed 93% of the time compared to 83%. Patient anxiety was addressed 60% compared to 88%. Family anxiety was addressed 72% of the time in both audits. Poor mobility was addressed 100% of the time compared to 67%. Depression was addressed 100% of the time compared to 63%. Not at peace was addressed 25% compared to 83%.

Implications for Practice: This project demonstrated the need for additional training to address psychosocial symptoms. Providers expressed concern over the extra time needed for documentation. Additional efforts should focus on reducing documentation time to allow more time for providers to address burdensome symptoms.