Date of Award

Spring 5-22-2021

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Caroline Etland PhD, RN, ACHPN

Second Advisor

Karl Steinberg MD


According to research literature, 15% of Medicare beneficiaries spend more than 7 days in the intensive care unit before they die. These Medicare beneficiaries receive aggressive, life-prolonging medical treatments that might not be in agreement with their wishes. Approximately 13% of SNF residents have improperly completed POLST forms that can result in intensive treatments that patients did not want. One barrier to the lack of POLST completion in SNFs is staff difficulty with understanding and explaining the form, a result of inadequate education.

In August 2020, the San Diego Coalition for Compassionate Care formed an education program to provide virtual POLST-conversation education to health care workers and patients in SNFs. This evidence-based practice project is a retrospective analysis of the coalition’s program results. Health care workers completed a pre survey, attended a virtual POLST education session, and a post survey. Data from the training session were analyzed for quantitative and qualitative responses from pre- and post-training evaluations. Fifty-one health care workers took part in the survey. Participant’s extreme comfort with talking about wishes for life-sustaining treatment increased by 32.4% after the virtual POLST training and 21. 6% of the participants believed that they would be effective in having POLST conversations. Participants perceived difficulty with approaching APC/POLST conversations improved by 12% and the recognized need for further education on POLST conversations improved by 29%.