Date of Conferral
Doctor of Nursing Practice (DNP)
Emergency department (ED) nurses are in a unique position to discuss with patients who have life-limiting illnesses. However, due to lack of training, ED nurses are often reluctant to have these conversations. Although ED patients receive written information about advanced directives, there is a gap in practice with discussing palliative and end-of-life care, resulting in increased potential for patient isolation, inconsistencies in treatment modalities, and delayed opportunities for patient-centered goal setting. Therefore, the purpose of this project was to address what resources are available to guide evidence-based practice for ED nurses in a small inner city hospital to implement nurse-directed palliative care discussions. A review of the literature was completed to analyze the nurse’s role for palliative and end-of-life discussions. ED nurses’ concerns were identified through ongoing discussions and conveyed to the DNP student by the ED education specialist during the interview process. In conjunction with an ED education specialist and validated by the institution’s leadership and palliative care team, evidence-based clinical practice guidelines (CPG) were created. Validity was determined by the AGREE II instrument. Watson’s caring theory and Lewin’s change theory provided a foundation for the development of the CPG to facilitate a caring environment within the ED setting and to empower ED nurses with knowledge, skills, and resources. This project contributes to social change by providing educational opportunities to meet the needs of complex patient populations by offering a paradigm shift in nursing care from a bio-medical focus to include comfort and holistic care, thus promoting shared decision-making regarding quality of life and end of life care.