| Course | NURS 6912 Symptom Management for the Hospice and Palliative Care Clinician |
|---|---|
| Week | Week 1 |
| Paper type | Discussion post with two peer replies |
| Length | About 640 words, 4 pages |
| Format | Discussion post, APA 7 citations |
| School | Walden University |
| Program | Master of Science in Nursing (MSN) |
| Updated | September 2026 |
Free sample paper for NURS 6912 Week 1
Week 1 Discussion: Initial Post
"Restless" Is Not a Pain Score: Measuring Symptoms in a Resident Who Cannot Tell Us
Three chart notes from one week describe the same composite nursing home resident, a woman of 88 in the late stage of Alzheimer disease: "Resident restless this evening." "Restless, calling out." "Restless during care, redirected." Imagine being the covering clinician on Saturday reading those notes. Is she in pain, frightened, hungry, delirious or simply awake? Is she better or worse than Tuesday? The word restless cannot answer either question, and so it cannot tell anyone what to do next. This post argues that symptom assessment in palliative care starts with measurement, and that the right measure depends on whether the person can report her own symptoms.
For people who can self-report, the self-report is the standard. A 0 to 10 numeric rating scale takes seconds and gives a number that can be compared tomorrow. The Edmonton Symptom Assessment System goes further, asking the person to rate pain, tiredness, drowsiness, nausea, appetite, shortness of breath, depression, anxiety and wellbeing on the same scale, so that a clinician can see the whole symptom burden at once and track it over time (Hui & Bruera, 2017).
For people who cannot, such as this resident, observation must stand in. The Pain Assessment in Advanced Dementia scale (PAINAD) scores five behaviors from 0 to 2, among them how she breathes, the sounds she makes, her face, how she holds and moves her body and whether she can be comforted, for a total from 0 to 10 (Warden et al., 2003). Applied to the chart notes, "calling out" is negative vocalization and "restless during care" suggests body language and perhaps facial grimacing during movement. A nurse who scored her during care might find, for example, occasional moaning, a frown and restless movement, easily consoled afterward. That pattern, seen during repositioning, points toward pain with movement rather than toward anxiety.
An observational score has limits. It flags probable pain rather than measuring its intensity, and other distress, such as fear or delirium, can raise it. Herr et al. (2019) recommend a hierarchy for patients unable to self-report: look for causes of pain, observe behaviors with a validated tool, ask family and staff who know the person's usual behavior and, where pain is likely, consider an analgesic trial and see whether the behaviors change. Replacing "restless" with a PAINAD score during care, a note on what was happening at the time and a reassessment after any intervention would give Saturday's clinician something to act on.
Question for the thread: what words in your charting stand in for measurement, and what would you replace them with?
Reply to Keisha
Keisha, you suggested using heart rate and blood pressure as objective signs of pain in residents who cannot speak. I understand the appeal of a number from a machine, but I would be cautious. Vital signs change with many things besides pain, and people with chronic pain may show little change at all. Herr et al. (2019) note that physiologic indicators are not reliable measures of pain on their own. I would use them as context alongside a behavioral tool rather than as the measure itself. Have you seen a case where vital signs were normal but the resident was clearly in pain?
Reply to Owen
Owen, your point that residents with moderate dementia can often still use a simple scale if it is presented slowly is an important addition. The hierarchy I described begins with self-report for exactly this reason, and self-report should be attempted before an observational tool is used. For your residents, a verbal descriptor scale, such as none, mild, moderate or severe, may work better than numbers. I would still score an observational tool alongside it during care, since a resident may deny pain when asked at rest and show it clearly when turned.
References
Herr, K., Coyne, P. J., Ely, E., Gélinas, C., & Manworren, R. C. B. (2019). Pain assessment in the patient unable to self-report: Clinical practice recommendations in support of the ASPMN 2019 position statement. Pain Management Nursing, 20(5), 404-417. https://doi.org/10.1016/j.pmn.2019.07.005
Hui, D., & Bruera, E. (2017). The Edmonton Symptom Assessment System 25 years later: Past, present, and future developments. Journal of Pain and Symptom Management, 53(3), 630-643. https://doi.org/10.1016/j.jpainsymman.2016.10.370
Warden, V., Hurley, A. C., & Volicer, L. (2003). Development and psychometric evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. Journal of the American Medical Directors Association, 4(1), 9-15. https://doi.org/10.1097/01.JAM.0000043422.31640.F7
NURS 6912 Week 1 instructions, in plain terms
The first discussion in this symptom course generally asks how you assess symptoms in palliative care, often with attention to patients who cannot describe their own experience. Plan on a short initial post that draws on two or three sources, with replies to classmates later in the week. Start from a concrete case, a chart note or a patient, so the argument has something to fix. Distinguish self-report measures from observational ones and explain when each applies. Name a validated tool for each group and show it working on the case. Acknowledge what an observational score can and cannot tell you. Close with the exact change you would make in practice, such as a new charting habit.
How this NURS 6912 Week 1 example is built
The post opens by quoting the three chart notes and asking what a covering clinician could do with them. A paragraph on self-report cites Hui and Bruera on the Edmonton Symptom Assessment System. A paragraph on residents who cannot self-report cites Warden and colleagues on PAINAD and applies its items to the behaviors in the notes. The fourth paragraph names the limits of observational scores and cites Herr and colleagues' hierarchy for patients unable to self-report, ending in a highlighted recommendation for charting. A question to classmates follows. The reply to Keisha cautions against using vital signs as a pain measure; the reply to Owen supports trying a verbal descriptor scale first.
Where the marks sit in the NURS 6912 Week 1 rubric
Assessment discussions in palliative courses usually reward correct tool selection, accurate description of each tool, application to the case and thoughtful peer engagement. Tool selection earns credit when the writer matches the measure to the patient's ability to report. Accuracy matters because rubrics often check whether a tool's items and scoring are described correctly. Application is where most posts separate themselves, since scoring the case's own behaviors shows understanding rather than recall. Acknowledging a tool's limits signals clinical judgment. Replies are credited for adding evidence or a refinement, not agreement. Sources should be current or foundational and cited in APA, and posts should meet the section's timing rules.
NURS 6912 Week 1 help from the desk
Posts at this stage lose points by describing a pain scale in general terms without applying it to anyone. Another frequent loss is recommending vital signs or a single observation as proof of pain in someone who cannot speak. Some writers list several tools without explaining which patient each suits. Replies that praise the original post without adding anything earn little. Pick a case, sort patients by their ability to self-report, apply one validated tool to the case's actual behaviors, state its limits and propose a specific change to charting or practice. For a post built on the population in your prompt, such as children or ventilated patients, the desk can prepare a draft. Check that each tool you name is validated for that group.
Get a NURS 6912 Week 1 example written to your instructions
Drop your Week 1 discussion prompt and rubric into the request, noting the symptom or population it centers on. The initial post applies named instruments to that case, two evidence-backed replies sit beneath it, and the draft arrives within 24-48 hours at no cost on a first request. Classmates' posts, if pasted, become the replies' targets.
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NURS 6912 Week 1 questions, answered
What is PAINAD?
The Pain Assessment in Advanced Dementia scale, an observational tool that rates breathing, negative vocalization, facial expression, body language and consolability. The example applies it to the composite resident's described behaviors. It suggests whether pain is likely rather than measuring intensity the way self-report does, and your post earns more by saying so than by overstating what a total means.
Why not use vital signs to judge pain?
Because heart rate and blood pressure respond to many things besides pain, including fever, anxiety and medication, and they often stay normal in persistent pain. The second reply in the example makes that case with a source. A classmate relying on vital signs is a common thread in this week, and answering it with evidence tends to score well.
Does the post cover patients who can rate their own pain?
Yes. Self-report is presented first, as the reference standard, using a numeric rating scale and the Edmonton Symptom Assessment System for broader symptom burden. PAINAD enters only where self-report fails. Keeping that order matters, because your rubric will likely favor a post that treats observational tools as substitutes rather than as the default for anyone who is older or unwell.
Where can I find a free NURS 6912 Week 1 sample paper?
The initial post on replacing restless with a PAINAD score, both replies and three references are all on this page at no charge. A post for the patient group your prompt describes can be requested.
What does the NURS 6912 Week 1 post recommend charting instead of restless?
A PAINAD score taken during care, a note of what was happening at the time and a reassessment after any intervention, so the next clinician can compare and act.