Date of Award


Document Type


Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Kristen Slabaugh


Background: Over 35% of all deaths in the United States occur in the acute care hospital setting, and 75% of end-of-life (EOL) patients require palliative care. Registered nurses (RNs) with strong palliative care self-efficacy (PCSE) promote positive death experiences for patients and families by minimizing patient suffering and maintaining clinical and ethical standards. Employers can enhance RNs’ PCSE through educational interventions and resources.

Problem: Inpatient acute care hospital RNs lack PCSE because acute care is traditionally curative, and RNs receive limited EOL care education.

Methods: A quality improvement project was conducted. Participants were a convenience sample of RNs working on a medical-surgical (M-S) unit at rural hospital in Southern Pennsylvania. Participants’ baseline PCSE levels were obtained using the Palliative Care Self-Efficacy (PCSE) Scale. Postintervention, PCSE Scale scores were repeated.

Intervention: After a one-time education session, participants used the Comfort, Airway, Restlessness and delirium, Emotional and spiritual support, and Self-care (CARES) Tool, an evidence-based tangible EOL reference resource, when providing EOL care to patients under the services of palliative care or hospice during a 9-week implementation period.

Results: The difference between participants’ pre- and postintervention PCSE Scale scores had a moderate effect size (d = 0.6) but was not statistically significant (p = .164). However, when participants who did not care for EOL patients during implementation were withheld from analysis, the increase in PCSE Scale scores from pre- to postintervention was statistically significant (p = .029) with a large effect size (d = 1.5).

Conclusion: Clinically significant findings support the CARES Tool being an effective intervention to increases RN PCSE.