Date of Paper/Work


Type of Paper/Work

Doctor of Nursing Practice Project

Degree Name

Doctor of Nursing Practice



First Advisor

Rebecca Barroso


Doctor of Nursing Practice


Background: Advance care planning (ACP) can help with end-of-life goals-of-care identification and timely hospice enrollment for individuals affected by dementia. Known barriers to effective ACP include nurse knowledge and confidence deficits. Evidence from an academic literature review suggests that providing dedicated ACP education can foster effective nurse-led ACP conversations.

Objectives: Increase the number individuals affected by dementia having documented nurse-led ACP conversations, nurse knowledge and confidence with ACP, and appropriate hospice utilization. Setting/Participants: Eight nurses from three memory care facilities within a Midwestern United States (U.S.) senior housing organization.

Methods: An educational module regarding ACP in dementia care was created and presented to facility nurses. Nurses were also provided with evidence-based ACP guidelines and additional materials to supplement ACP knowledge and assist in ACP conversations. Nurse ACP knowledge and confidence were measured pre- and post-intervention using subsections of the Knowledge, Attitudinal, and Experiential Survey on Advance Directives (KAESAD). ACP documentation and hospice utilization were measured through electronic medical record chart auditing.

Results: At project conclusion, there were increases in ACP document completion and hospice utilization. There were also increases in KAESAD knowledge and confidence scores. Not all results were statistically significant. Although nurses articulated having ACP conversations, there was no change in ACP conversation documentation. Nurse feedback suggested that the education and resources were helpful. However, further experience is needed to acquire greater 5 ACP confidence. Project limitations included documentation barriers, small nurse sample size, short project timeframe, and a virtual project medium.

Conclusions/Implications: Providing ACP education to nurses is important to ensure nurses have the tools needed to assist residents with ACP conversations and to empower the profession to participate in ACP. Nurses may need continual exposure to ACP educational experiences and resources, including simulation opportunities. It is important that nurses work with other disciplines to develop efficient and comprehensive ACP processes.