Managing symptoms is core business for palliative care. Nurses have a role to play in helping to achieve the best symptom control and optimum quality of life for patients.
Working with patients often on a daily basis, nurses are best placed to assess and monitor pain and symptoms and advocate for patients in regards to their care and management. Many services use pain assessment tools or the SAS (Symptom Assessment Scale) in their practice which facilitates tracking of symptoms from the patients’ perspective.
It is also important to recognise that not all symptoms will be physical, but could be psychological, social or spiritual, or have psychological, social or spiritual components. In many cases a mix of pharmacological and non-pharmacological approaches are available to support symptom management.
PCOC Symptom Assessment Scale (SAS) (172kb docx)
In the following you can click on the symptom term to learn more about that symptom. For a person with palliative care needs common symptoms include: [1,2]
To learn more about the latest evidence relevant to management of palliative care symptoms, including assessment and treatment, visit the CareSearch Clinical Evidence pages and relevant sections in the GP Hub. There you will also find more information on the use of complementary medicines.
The clinical assessment of a patient needs to be impeccable, comprehensive, systematic and ongoing; however barriers to this often exist, such as lack of time and training.  As with the principles of person centred care in dementia, assessment needs to be tailored and individualised to the patient.
A structured approach to assessment often involves using clinical assessment tools which should be used appropriately and with caution, and not as a substitute for a comprehensive, holistic assessment.  Tools should also be reliable and valid, and not adapted to meet local needs unless they are re-validated within that population or setting. 
Pain assessment tools
When making clinical judgements, nurses draw from many sources including their formal nursing education and/or from their experience gained over time in practice.  Clinical decision making can be defined as choosing between alternatives, a skill that improves as nurses gain experience, both as a nurse and in a specific specialty. 
Clinical decision making requires good quality judgment including critical thinking.  An earlier definition of critical thinking in nursing is: '…..Critical thinkers in nursing practice the cognitive skills of analysing, applying standards, discriminating, information seeking, logical reasoning, predicting and transforming knowledge' [8 p357] It has also been highlighted that reflection on practice can be as a result of a breakdown in clinical judgement. 
Visit St. Oswald's Hospice’s website for 15 minute online tutorials
Read the Canadian Virtual Hospice Clinical Practice Guidelines on symptoms
More symptom management resources
Last updated 20 August 2021