Doctor of Nursing Practice (DNP) Projects

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Degree Program

Doctor of Nursing Practice

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Public Health Nurse Leader

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advance care planning, advance directives, inpatient, nurses, cancer care unit


Terrie Black

DNP Project Chair

Terrie Black

DNP Project Member Name

Pamela Aselton

DNP Project Outside Member Name

Kathleen Canty


Background: Advance care planning (ACP) and advance directives (AD) inform the provision of health care that aligns with clients’ goals and wishes. Less than 30% of female cancer care clients presented AD when admitted for care to a Magnet® designated hospital located in the Southwest United States (U.S.).

Methods: A quality improvement project took place on a 25 bed in-patient cancer care unit to improve these rates. The nurses received ACP training and used a clinical support tool to facilitate discussions with clients. A Palliative Care Clinical Nurse Specialist assisted as needed.

Results: Seven nurses accomplished a self-paced learning activity during a one-month timeframe. Although the nurses reported increased ACP skills after the training, the AD documentation decreased from 27% to 13% and remained below the 30% national norm. Similarly, combined ACP and AD documentation decreased from 33% to 20%. The nurses stated barriers such as time constraints, limited clinical experiences, and inabilities to accept the additional duties.

Conclusions: Nurses who completed the evidence-based training reported increased knowledge, but were unable to implement the tool within the health care setting. Additional trained ACP facilitators or workload adjustments may be needed as well as additional education to normalize the accomplishments of ACP and ADs.

Implications: The literature review, lessons learned, and recommendations may be used by hospital leaders to improve ACP and AD documentation, promote client-centered care, and increase compliance with federal and state laws and the Joint Commission’s requirements.

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This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

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