Nurse Educator M.S.

Year Approved


First Advisor

Sandau, Kristen


Background: Although research supports palliative care (PC) to improve symptoms and quality of life for patients with terminal illnesses, these services are underutilized. While 80% of people prefer to die at home, the majority still die in an acute care facility, sometimes receiving aggressive interventions that may increase suffering up until the very end of life. Earlier referral to PC or hospice care can improve symptom management and facilitate end-of-life (EOL) wishes. Purpose: The purpose of this critical review of literature was to identify barriers as well as evidenced-based interventions to promote earlier enrollment into hospice and PC among patients with a terminal illness. Conceptual Framework: Kotter’s 8-Step Change Theory was condensed into three phases to enhance simplicity for proposed interventions for change. Methods: Studies (n=18) were reviewed to identify barriers and interventions to promote earlier enrollment into hospice and PC. Results: Across the studies, a consistent barrier was inadequate education. Undergraduate nurses and practicing nurses did not feel they had been prepared to converse with patients and caregivers about the services of hospice and PC. Barriers and interventions were summarized into three tables: for nursing students, practicing nurses, and terminally ill patients and families. Implications: Suggested interventions centered on assuring curriculum includes specific components of EOL care for undergraduate nursing students and practicing nurses with an emphasis on interprofessional collaboration and communication. Further studies with higher level of evidence are needed to test interventions for earlier enrollment into hospice and PC. Additionally, post-death studies about caregivers’ experiences with hospice and PC are needed to identify additional barriers and interventions to earlier access and management related to progression of terminal illness. Conclusion: Inadequacies in preparation can be addressed through a variety of introductory and ongoing interventions such as classroom lectures, case studies, clinical and role playing experiences for undergraduate and practicing nurses.

Degree Name

M.S. Nurse Educator

Document Type

Masterʼs thesis

Included in

Nursing Commons