In the delicate journey of hospice care, where every moment is precious and every decision impactful, the role of skilled nursing professionals becomes a clinical task and a heartfelt commitment to the dignity and comfort of terminally ill patients. As Licensed Practical Nurses (LPNs) and Registered Nurses (RNs), you are the custodians of care who can make the twilight of life’s day serene and meaningful.
Understanding the rhythm of a patient’s final days is akin to reading complex, unspoken language. It’s about recognizing the subtle shifts in their needs and responding with precision and compassion. This is where the Sunset Assessment Scale emerges as a beacon of guidance. It’s not just a tool; it’s a companion in your decision-making process, helping you discern the nuanced needs of those in your care—my thanks to Stacey Rowse, RN, who provided the scale.
The scale is more than a checklist; it’s a narrative of the patient’s current chapter. It accounts for the tangible indicators of health—how much time is spent in the embrace of sleep, the sustenance drawn from daily nutritional intake, the silent tales told by body temperature, and the rhythm and effort of each breath. But it also acknowledges the intangible—the immeasurable weight of a sigh, the unspoken words in a gaze. By integrating these factors, the Sunset Assessment Scale assists you in crafting a care plan that resonates with the individuality of each patient’s experience.
As you embark on this article, let it serve as a map to navigate the complexities of hospice care. Let it empower you to use the Sunset Assessment Scale with an informed and tender hand, ensuring that your visits are timely and imbued with the understanding each patient deserves.
Overview of the Sunset Assessment Scale
In hospice care, where every action carries profound significance, the Sunset Assessment Scale is a testament to patient-centered care’s evolution. Developed through meticulous research and clinical expertise, this scale serves as a cornerstone for nurses like you—compassionate LPNs and RNs who navigate the complexities of end-of-life care with grace and professionalism.
The Sunset Assessment Scale was inception driven by a need for a systematic approach to assessing the fluctuating conditions of terminally ill patients. Its development was a collaborative effort, drawing on the collective wisdom of healthcare professionals dedicated to enhancing the quality of hospice care. The scale’s purpose is twofold: to provide a structured method for evaluating patient needs and to inform the frequency of skilled nursing visits, ensuring that each patient receives the right level of care at the right time.
At its core, the Sunset Assessment Scale is a beacon that illuminates the often overlooked nuances of a patient’s experience. It guides you in measuring the tangible aspects of care—such as activity tolerance, nutritional intake, body temperature, and respiratory function—while also considering the intangible elements that make each patient unique. Doing so empowers you to tailor your visits to the individual needs of those in your care, fostering an environment of comfort and dignity.
As you delve deeper into the intricacies of the Sunset Assessment Scale, remember that it is more than a tool—it reflects your commitment to providing empathetic and evidence-based care to those at the most vulnerable junctures of life.
How to use the Sunset Assessment Scale
Each of the four areas—activity, Daily Nutritional Intake, Body Temperature, and Breathing Pattern and Effort—is scored on a scale of zero (0) to four (4). The points for each area are then added up, producing a total score ranging from zero (0) to sixteen (16).
If your nursing intuition leads you to believe there’s anything else not reflected by the four areas, take the total score and deduct two (2) points from the total.
Then, based on the ending score, if the total is twelve (12) to sixteen (16), the current hospice nursing visit frequency is valid for now; changes are necessary. If the score is eight (8) to twelve (12), notify your IDG (IDT) and or manager with consideration to monitor for impending downward changes in condition. Increasing the skilled nursing frequency if the score is less than eight (8). Do consider the patient having a score of zero (0) to be imminent, the patient with a score of less than or equal to four (4) transitioning, and the person with a score between five (5) and eight (8) to be close to transitioning or at the start of the transitioning process of dying.
The beauty of the Sunset Assessment Scale for Hospice Nurses is that it works within any organization setting without regard to the existing nursing visit frequencies; it is a guide to help you determine increasing nursing visit frequencies.
Conclusion
The Sunset Assessment Scale is a valuable tool for Licensed Practical Nurses (LPNs) and Registered Nurses (RNs) in hospice care, determining the appropriate frequency of skilled nursing visits based on patient needs. This scale assesses four key areas—Activity, Daily Nutritional Intake, Body Temperature, and Breathing Pattern and Effort—assigning scores from zero to four in each area to calculate a total score ranging from zero to sixteen. Two points are deducted from the total score if additional concerns are noted beyond these areas. Based on the total score, specific actions are recommended:
Total score of 12 to 16: Current nursing visit frequency is appropriate.
Total score of 8 to 12: Notify the Interdisciplinary Group (IDG) or manager for monitoring potential changes in the patient’s condition.
Total score less than 8: Increase the skilled nursing visit frequency.
Additionally, patients with scores of zero are considered imminent, those with scores less than or equal to four are transitioning, and individuals scoring between five and eight are close to transitioning or at the beginning of the dying process. The Sunset Assessment Scale provides a structured approach to adjusting nursing visit frequencies, ensuring patients receive the right level of care at the right time. It also reflects a commitment to compassionate and evidence-based care in hospice settings.
