Date Approved


Graduate Degree Type


Degree Name

Nursing (D.N.P.)

Degree Program

College of Nursing


Nurse expertise with end-of-life (EOL) conversation skills can facilitate the assessment of the patient’s sociocultural and spiritual beliefs about quality of life issues, yet nurse death anxiety may act as a barrier to needed conversations. Nurses are the most consistent healthcare provider at the inpatient bedside and as such they play an important role in EOL conversations.

The purpose of this practice dissertation project was to evaluate the impact of a nurse-facilitator led quality improvement initiative in one acute care hospital using the End of Life Nursing Education Consortium (ELNEC) communication Module 6. Specifically, nurse attitudes regarding death anxiety (using the Revised Death Anxiety Scale [DAS-R]) and communication apprehension (using the Communication Apprehension with Dying [CA-Dying] scale) were evaluated pre and post education. A multi-faceted evaluation approach was utilized, the Promoting Action on Research Implementation in Health Services (PARiHS) framework for assessment of organizational readiness for change, and the Donabedian Quality Model to evaluate efficacy of the ELNEC Module 6 education on nurse death anxiety and communication apprehension.

Preliminary evaluation of the ELNEC Module 6 intervention indicated that, controlling for the DAS-R pre-score, nurses with an ADN or Diploma degree had a significantly lower post-test death anxiety score than nurses with a BSN or MSN degree. Nurses who cared for more dying patients per year, controlling for the CA-Dying prescore, had a statistically significant lower CA-Dying score. Experiential learning and reflection are central to creating a culture of innovation, improvement and effectiveness.

The ELNEC curriculum promotes personal reflection about death. By embedding nurses skilled in advanced communication techniques at the frontline, a sustainable model for peer consultation and support regarding difficult conversations is possible. Providing effective palliative care across an organization is a complex endeavor. A doctorally prepared nurse can have an integral role in transforming EOL care.