Date of Award

Spring 5-28-2022

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Brenda Boone, PhD, RN

Second Advisor

Toluwalase Ajayi, MD


Acute care nurses caring for end-of-life (EOL) patients often feel unprepared for and undereducated about this high-need population. According to current literature, many nurses lack adequate training in providing EOL care. This project aimed to improve symptom management of dying patients by providing acute care nurses education about EOL symptom assessment and medication use for symptom management. The revised Iowa model, which emphasizes clinician involvement, guided this evidence-based practice project. Sixteen acute care nurses received 30-minute in-person education, consisting of instruction in EOL symptom assessment and management via use of the CARES (comfort, airway, restlessness, emotional, self-care) tool and basic pharmacology review of common medications used for EOL symptom management. The thanatophobia scale was administered before, immediately after, and 1 month following the educational session to evaluate nurses’ uncomfortable feelings and sense of helplessness when caring for EOL patients. A benefit of the intervention appeared to be a decrease (though not a statistically significant decrease) in these negative feelings, which may have improved symptom management. Doses of medications used for symptom management in the last days of life were counted via electronic medical record review before and after education. Statistical analysis was not conducted due to the low number of doses. However, medication doses for symptom management appeared to increase after the educational session. The outcomes of this project support the necessity of EOL symptom management education for nurses.