Date of Award

Spring 6-6-2024

Scholarly Projects

Projects: SPU Access Only

Degree Name

Doctor of Nursing Practice (DNP)



Faculty Chair

Bomin Shim

Faculty Reader


Executive Summary

High Quality Palliative and End-of-Life Care in the Critical Care Unit: A Quality Improvement Project

Background and Significance: Critical care units are where the most critically ill patients go to receive treatment and hopefully stabilize their condition. This is not always possible, and as many as 20% of patients admitted to critical care will die (Angus et al., 2004). High quality end-of-life and palliative care is fundamental for providing appropriate care for all patients in critical care since risk of death is substantial. High quality palliative and end-of-life care can be defined as a way of treating the patient and family members physical, spiritual, and psychosocial problems and aims to alleviate suffering (WHO 2022).

Problem and Purpose Statements: Death and treating patients at the end-of-life is an integral part of a nurse’s job in the hospital setting, especially in critical care where death can occur suddenly and to many of the critically ill patients there. Despite these facts, there is no standard curriculum about death and dying in nursing school (Hoang et al., 2022). Having knowledge of the dying process, what to expect, what interventions are most appropriate are essential in providing optimal care. Increasing training about end-of-life and palliative care among critical care nurses is a way to support the nurses, patients, and their families. The purpose of this project was to evaluate the efficacy of an educational intervention on palliative and end-of-life care for critical care nurses.

Methods: A pretest posttest methodology was used for this project with convenience sampling of the ICU and IMCU nurses in a smaller community hospital part of a larger system. A 2-week pretest period sampled the RNs confidence and knowledge of palliative and end of life care using the palliative care self-efficacy tool and the palliative care quiz for nurses (PCQN). There was a 3-week intervention phase when the 1-page educational tool was presented to participants at daily huddles, followed by the posttest phase lasting for another 2 weeks. The educational intervention was a guide for nurses caring for patients at end-of-life, and it focused on pharmacological interventions, assessments, and communication tips surrounding palliative and end-of-life care. The pretest and posttest phases utilized the same measurement tools to assess efficacy of the intervention.

Results/Outcomes: An unpaired t-test was run to analyze data. There were 18 participants in the pretest and 19 in the posttest groups. All participants in the posttest group received the educational intervention. Confidence surrounding palliative and end-of-life care was significantly higher after the educational intervention (M=41.84, SD=4.66) compared to the pretest group (M=35.67, SD=8.2), t(35)=2.84, p=0.0076. Palliative and end-of-life knowledge also significantly increased after the intervention (M=17.74, SD=3.09) compared to the pretest group (M=12.61, SD=3.48), t(35)=4.74, p=0.0001. These results show a statistically significant improvement in both self-efficacy and knowledge after implementation of the educational intervention.

Sustainability: Data was presented to managers on the unit and will be disseminated at shared leadership meetings for both the ICU and IMCU units. Currently meetings have not been occurring at a regular cadence due to factors influencing staffing and nurse availability. The 1-page educational handout has been distributed to all staff via email for reference and is displayed on the unit education board. Without a dedicated champion for this project, it may be hard to sustain.

Implications: The results from this project show how important continuing and focused education on palliative and end-of-life care is for all critical care nurses. This data could be used to inform creation or tailoring of palliative care specific orientation and continuing education for critical care nurses. These results highlight how there should be at minimum some sort of focused educational module given to nurses annually. This could be done with the other annual competencies that are required. Along with these more systems implications, this educational intervention increased confidence and knowledge of nurses caring for patients at the end-of-life which could potentially lead to better care for patients and their families.


Angus D., Barnato A., Linde-Zwirble W., Weissfeld L., Watson R., Rickert T., & Rubenfeld G. (2004). Robert Wood Johnson Foundation ICU end-of-life peer group. Use of intensive care at the end of life in the United States: an epidemiologic study. Critical Care Medicine, 32(3):638-43.

Hoang, C., Copnell, B., Lawrence, K., & Peddle, M. (2022). Undergraduate nursing education and death and end-of-life simulation: A scoping review. Clinical Simulation in Nursing, 70, 56-73. DOI:

World Health Organization (WHO). (2022). Palliative care.