Date of Graduation

Spring 5-17-2024

Document Type

Project

Degree Name

Doctor of Nursing Practice (DNP)

College/School

School of Nursing and Health Professions

Department/Program

Nursing

Program

Family Nurse Practitioner

First Advisor

Dr. Ricky Norwood

Second Advisor

Dr. Juli Maxworthy

Abstract

Background: Advance care planning (ACP) is a discussion of a patient’s end-of-life healthcare wishes. Its purpose is to indicate these wishes clearly should the patient be unable to make their decisions known to providers and family members due to a sudden health decline or medical emergency. Healthcare providers, specifically nurse practitioners, physician assistants, and physicians in the primary care setting, are well-positioned to facilitate these conversations with their older adult patients. However, research states that limited provider knowledge of and confidence in implementing ACP are significant barriers to its application in practice.

Problem: At a primary care clinic in Midtown Sacramento, CA, there was little emphasis on ACP in the primary care setting. Consequently, the clinic’s providers had insufficient knowledge of ACP and limited confidence in discussing EOL care plans with patients.

Intervention: This Doctor of Nursing Practice (DNP) project provided a 30-minute educational session for clinic providers on ACP. The presentation was conducted with PowerPoint on a live Teams video meeting. The presentation defined ACP, described its importance in primary care, discussed common barriers to its implementation, and offered the providers tools to enhance their ACP practices.

Measures: Using pre- and post-intervention surveys, the project explored the effects of the educational session on provider-reported knowledge of ACP, confidence in having these EOL conversations, and the likelihood of practice change around this aspect of patient care.

Results: Twenty-one clinic providers attended the educational presentation on ACP. The audience consisted of nurse practitioners, physician assistants, and physicians. Twelve providers participated in the pre-intervention survey and eleven participated in the post-intervention survey. Survey results indicated an increase in provider knowledge and confidence around facilitating ACP in the primary care setting and most providers reported being likely to change their ACP practices after the educational session.

Conclusion: Healthcare providers require continuing education on ACP to adequately discuss EOL planning and care alternatives with patients. By obtaining more knowledge on ACP, providers can increase their confidence in integrating ACP into practice, ultimately benefitting patients’ care and quality of life.

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