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How to use DisDAT

When to use DisDAT

When the team believes the client is NOT distressed:

The use of DisDAT is optional, but it can be used as a:

  • baseline assessment document
  • transfer document for other teams

When the team believes the client IS distressed:

If DisDAT has already been completed it can be used to compare the present signs and behaviours with previous observations documented on DisDAT. It then serves as a baseline to monitor change.

If DisDAT has not been completed:

a) When the client is well known DisDAT can be used to document previous content signs and behaviours and compare these with the current observations
b) When the client or the distress is new to the team, DisDAT can be used document the present signs and behaviours to act a baseline to monitor change.

We have found that it is possible to partly complete DisDAT when speaking to a carer over the telephone. While this does not give a full picture it can provide sufficient information to allow assessment of the distress. This is particularly useful when an individual is admitted to hospital.

    1. Observe the client when content and when distressed - document this on the inside pages of DisDAT. Anyone who cares for the patient can do this.
    2. Observe the context in which distress is occurring.
    3. Identify possible causes of distress. Use the clinical decision distress checklist on the back page of DisDAT to help you.
    4. Use the monitoring sheets if the cause is not obvious. Sometimes the cause of distress only becomes clear by monitoring daily (or even hourly for 24 hours) to show a pattern of distress.
    5. Which monitoring sheet? There are a choice of three! It does not matter which you use as each type is capable of monitoring the signs and behaviours. Just pick whichever one makes most sense to you, and whichever one you feel most comfortable in using.
    6. Treat or manage the likeliest cause of the distress.
    7. Monitor the distress: if necessary use the monitoring sheets if you want to see how the distress changes over time.
    8. What then? If the distress resolves, the process stops. If not, you start an intervention for the second possible cause of distress
    9. The goal is a reduction in the number or severity of distress signs and behaviours.

     

  • Is the new sign or behaviour repeated rapidly?

    • Consider: pleuritic pain (in time with breathing)

    • Consider: colic (comes and goes every few minutes)
    • Consider: repetitive movement due to boredom or fear.

     

    • Consider: infection, COPD, pleural effusion, tumour
Worsened or precipitated by movement?
    • Consider: movement-related pains

     

    • Consider: food refusal through illness, fear or depression
    • Consider: food refusal because of swallowing problems
    • Consider: upper GI problems (oral hygiene, peptic ulcer, dyspepsia) or abdominal problems.
    • Consider: frightening or painful situations

     

  • Associated with vomiting?

    • Consider: causes of nausea and vomiting associated with elimination (urine or faecal)?
    • Consider: urinary problems (infection, retention)
    • Consider: GI problems (diarrhoea, constipation)
 Present in a normally comfortable position or situation?
    • Consider: pains at rest, infection, nausea.

     

    • Most information comes from the whole team in partnership with the family.

    • The assessment form need not be completed all at once and may take a period of time.

    • Reassessment is essential as the needs of the client or patient may change due to improvement or deterioration.
    • 
Distress can be emotional, physical or psychological. What is a minor issue for one person can be major to another.
    • 
If signs are recognised early then suitable interventions can be put in place to avoid a crisis.