Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Diana Beckmann-Mendez


Despite advancements in health care, hospice registered nurses and medical professionals caring for patients at end of life lack the required knowledge effectively to care for this patient population. Educational gaps contribute to deficiencies. This process improvement project aimed to increase nurses’ and medical staff’s knowledge and recognition of delirium at end of life through the use of a delirium assessment tool and evidenced-based treatment guideline when managing symptoms. Project implementation occurred at a small hospice company with a patient census of 180, utilizing 2 teams of registered nurses, medical doctors, and a nurse practitioner. A 2-hour educational session had participants (n = 13) complete a pretest with an end of life hospice care focus. The same post-test was administered at project conclusion to re-assess learned knowledge. Chart reviews were conducted pre- and post-intervention. Nurses’ and medical team’s knowledge increased from a cumulative score of 75% to 100%, all new patients were screened for delirium with a 0% to 100% increase, patients with a change of status were screened for delirium with a 0% to 100% increase, and 46% of patients were found to have delirium and treated according to the treatment guideline, thus the latter objective of 100% participation was unmet. Research should continue on improving nurses’ and medical staff’s knowledge of evidence-based end of life care by focusing on knowledge deficits, improving delivery methods, and assessing the potential increase in positive patient outcomes of symptom recognition and management at end of life.