Date of Award
Spring 5-22-2025
Document Type
Doctor of Nursing Practice Final Manuscript
Degree Name
Doctor of Nursing Practice
Department
Nursing
First Advisor
Rahel Bahru MSN, RN
Second Advisor
Joseph Burkard, DNSc, CRNA, AACN Health Policy Fellow
Abstract
Abstract
Problem Statement: Healthcare providers focus on delivering quality and patient-centered care. Yet, without any direction, healthcare providers treat patients as a full code until someone can speak on the patient’s behalf. Therefore, it is crucial that patients make their wishes known.
Description of Innovation: On a cardiac step-down unit, registered nurses were educated on the PREPARE advance directive. Upon admission to the unit, patients were asked if they had an advance directive. If the patient did not have an advance directive, they were educated on the importance of having an advance directive. Then they were given the PREPARE For Your Care Pamphlet, advance directive form (in their preferred language), and shown the PREPARE website via an iPad— as a resource to help the patient (and their loved ones) fill out their advance directive.
Outcomes: Baseline patient advance directive completion was 8%. After three months of implementation, advance directive completion increased to 27% for September, 16% for October, and 40% for November. Prior to this intervention, RN’s confidence to speak about ACP was 50%, post intervention it was 72%. Prior to intervention, 54% of RN’s reported know how to locate ACP documents, post intervention RN’s reported 92%. Prior to intervention, 50% of nurses stated they knew how to document advance care planning education, post intervention it was 92%. Pre intervention, 7% of RN’s strongly agreed that they had adequate knowledge regarding advance directives, post intervention 24% of RN’s strongly agreed that they had adequate knowledge regarding advance directives.
Implications/Significance: When advance directives are in place, it helps reduce hospital costs, helps decrease out-of-pocket costs for the patient, and provides patient-centered care.
Recommendations: In order to encourage nurses to discuss advance directives, the following recommendations are suggested: 1) Educate nurses on the importance of advance directives 2) Make advance directive resources available and easily accessible 3) Use audit tool to reinforce compliance 4) Hospital wide implementation. Despite this study being aimed at the geriatric population, it is important to note that advance directives would be beneficial to all.
Digital USD Citation
Lince, Hilda A., "Increasing Advance Directive Completion: A Future Initiative for All" (2025). Doctor of Nursing Practice Final Manuscripts. 317.
https://digital.sandiego.edu/dnp/317
Copyright
Copyright held by the author
