Date of Award

Spring 2024

Document Type

Dissertation

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

Committee Chairperson

Jacqueline Owens, DNP, CRNP, FNP-BC

Committee Member

Cheryl Schlamb DNP, CRNP

Abstract

Patients appropriate for Home-Based Palliative Care services are fragile with increased risk for mortality and hospital readmissions. Utilization of Home-Based Palliative Care skilled nursing services have been proven to decrease these risks and improve quality of life. Information deficits negatively impact nurse clinical decision making during the admission process, potentially misguiding the nurse resulting in a non-admission to service. This project focused on the impact of both nurse education and clinical information sharing at admission. Pre and post data was compared to examine the impact of these interventions on non-admissions rates for the reasons of “no skilled need” or “not homebound” statuses. A nested nurse survey was utilized to investigate nursing knowledge, skill, and comfort level related to Home-Based Palliative Care admissions. The After Visit Summary was identified as the tool to improve clinical information sharing. The average conversion rate of referrals to admissions increased from 69% to 77% during the project period. Pre and follow up nurse survey data were compared using an independent t-test, showing statistically significant improvement in nursing skill and a trend toward significant improvement in comfort level. The After Visit Summary was not consistently shared, implying nurse education was nearly entirely responsible for reducing non admissions to Home-Based Palliative Care for the reasons of “no skilled need” and “not home bound” from 16.7% in the comparison period to 0% during the intervention period.

Keywords: Home-Based Palliative Care, Palliative Care at Home, Home Health Nursing, Palliative Care Nursing, Home Health Admission

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