DNP Projects

Date of Award

7-28-2026

Document Type

Graduate Paper

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Dr. Georgia Hogenson

Second Advisor

Dr. Carrie Hoover

Subject Categories

Nursing

Abstract

Background:
Advance care planning (ACP) conversations are essential for ensuring that patient healthcare preferences are understood and respected; however, nurses often report limited confidence and self-efficacy when initiating these discussions. Educational interventions that emphasize communication skills may improve nurses' preparedness to engage in ACP conversations.

Methods:
A quality improvement project utilizing a pre-post intervention design was conducted on three adult inpatient medical units within a regional Midwestern hospital. Registered nurses participated in an educational intervention consisting of ACP education, role-playing case scenarios, guided discussion, and debriefing. A modified 22-item Advance Care Planning Self-Efficacy Questionnaire was administered before and after the intervention to assess changes in confidence, perceived facilitators, and perceived barriers related to ACP conversations. Descriptive statistics, paired samples t-tests, Wilcoxon signed-rank tests, and Cronbach’s alpha were used for data analysis. Intervention: The intervention incorporated structured role-playing exercises designed to simulate common ACP conversations encountered in clinical practice. Participants engaged in case-based scenarios focused on initiating ACP discussions, addressing patient hesitancy, and supporting advance directive completion. Educational content regarding ACP principles and advance directive documentation was also provided. Results: Twenty-nine nurses completed the pre-intervention survey, and 28 completed both pre- and post-intervention surveys. The questionnaire demonstrated good internal consistency at pretest (Cronbach’s α = .82) and excellent internal consistency at posttest (Cronbach’s α = .92). ACP total scores increased significantly from pretest (M = 116.23, SD = 8.73) to posttest (M = 124.41, SD = 6.01), t (27) = 7.63, p < .001. Findings were confirmed using a Wilcoxon signed-rank test (W = 0.00, p < .001). Participants reported increased confidence, preparedness, and perceived capability to conduct ACP conversations following the intervention.

Conclusions:
A structured educational intervention utilizing role-playing and guided discussion significantly improved nurses’ self-efficacy related to ACP conversations. Findings support the use of simulation-based communication training as an effective strategy to strengthen nursing confidence and preparedness for ACP discussions. Future initiatives should evaluate long-term sustainability, ACP documentation rates, and patient-level outcomes to further assess the impact of ACP education on clinical practice.

Keywords:
Advance care planning; self-efficacy; nursing education; communication training; role play; quality improvement; advance directives.

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