Doctor of Nursing Practice (DNP) Projects

Access Control

Open Access

Degree Program

Doctor of Nursing Practice

Degree Track

Family Nurse Practioner

Year Degree Awarded



Month Degree Awarded



advance care directives, evidence-based interventions, multimodal interventions, completion rates, end-of-life care


Karen Kalmakis

DNP Project Chair

Karen Kalmakis

DNP Project Outside Member Name

Etsubdenke Areaya


Background: Advance care directives reduce unnecessary suffering, improve life quality, and further engage patients and families in the decision-making process to ensure that end-of-life care preferences are considered and applied. Despite the proven benefits of advance care directives, advance directives completion rates are approximately 33% in the United States. Purpose: The purpose of this quality improvement project was to increase advance directive completion rates among patients at one clinic through an educational intervention. Methods: The intervention was used to educate patients about the benefits of advance care directives, and present opportunities for patients to complete the directive. The intervention included educational pamphlets and posters available in the clinic waiting room. The participants included patients and their families who attend the clinic. Results and Conclusion: The educational campaign resulted in a 20.3% increase in the completion rates of advance directives among the randomly selected health records. Age, gender, and race were found to be influential factors in patients’ attitudes toward completing advance directives. This quality improvement project supports the application of an educational intervention to increase the completion rates of advance directives in clinics caring for patients who are immigrants, refugees, and low-income earners.

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

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