Date of Award

Spring 5-27-2017

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Joseph Burkard, DNSc, CRNA


According to expert reports and recent research, frequent clinician-patient conversations about individual end-of-life preferences are necessary to avoid unwanted treatment and to ensure that desired treatments are received. The ongoing diffusion of Physician Orders for Life-Sustaining Treatment (POLST) educational initiatives in skilled nursing facilities (SNFs) are vital to success of California’s POLST program, which is now recognized as only 1 of 3 mature POLST programs in the country. The purpose of this evidence-based practice project was to answer the question: Among staff in a skilled nursing facility, does implementing a formal POLST education program compared to current practice improve staff knowledge, comfort level and documentation of the POLST form? A pre- and post-education questionnaire was used. Results indicated a POLST education program significantly improved staff knowledge and promoted much-needed awareness of underutilized POLST educational resources (retrieved from the Coalition for Compassionate Care of California,, available for SNF residents, families, practitioners and staff. As a result, these efforts provide higher quality end-of-life decision making which is essential with future uploading of these order forms into an electronic POLST registry (SB 19: e-POLST Registry Pilot) to be stored during nursing facility resident’s care transitions.