Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2024


Doctor of Nursing Practice (DNP)

Primary Advisor

Dr. Cynthia Allen


Problem: Lack of a standardized assessment tool (SAT) in the acute care setting that correlates pharmacological interventions with assessment findings negatively impact patients who have transitioned to “End-of-life” (EOL) level of care. Bedside nurses are left to interpret their own subjective assessment findings and implement interventions they feel appropriate, leading to a variance in the treatment provided to patients. It has been identified there is an issue in the current practice at one acute care organization in which medication indications are not specific as to which type and dosage of medication to administer to the EOL patient. EOL patient care is also not a topic of annual education for bedside nurses, leading to the possibility of a deficit in the knowledge of caring for this patient population.

Purpose: This quality improvement (QI) project would implement a validated SAT, the Respiratory Distress Observation Scale (RDOS), and correlate existing pharmacological interventions to provide bedside nurses with a validated tool for reference based upon their objective assessment findings, to clearly guide them as to which specific medication to administer. Together, the implementation of the RDOS and education provided on caring for the EOL patient, bedside nurses’ confidence may increase in caring for the EOL patient population and administering appropriate pharmacological interventions.

Methods: A pre- and post-study design will compare the level of confidence and knowledge of bedside nurses in managing dyspnea and caring for the EOL patients within one acute care facility. The post survey will assess if the RDOS increases bedside nurses’ confidence in administering pharmacological interventions to the EOL patient population. A convenience sample of bedside nurses and providers who are currently employed at one acute care facility within the Intensive Care Unit, Progressive Care Unit, and Medical Unit will be recruited to complete surveys. A paired sample t-test will be used to compare pre- and post-survey responses.

Implications for Practice: Implementing the RDOS for managing dyspnea in EOL patients and providing education on caring for the EOL patient population may increase the level of confidence of bedside nurses in caring for this population.

Open Access




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