Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2018


Doctor of Nursing Practice (DNP)

Primary Advisor

Beverly Lunsford, Ph.D., R.N., F.A.A.N.; Dale Lupu, Ph.D., RN, M.P.H


Background: Palliative care referrals are important in long-term care facilities because they are the first step in generating the services that the patient may need. This study looked at the phenomena of how Directors of Nursing in long-term care facilities that had access to palliative care services determined if a referral was needed.

Objectives: The purpose of this study was to gain a deeper understanding of the decision- making process used by Directors of Nursing for referrals. The study’s aims were to determine what factors prompt a referral in long-term care settings. The primary research question was: How do Directors of Nursing determine which long-term care patients should be referred for palliative care.

Methods: A telephone interview was conducted with seven Directors of Nursing. An interview protocol used a planned behavior theoretical framework and interviews were recorded and transcribed for analysis.

Results: Telephone interview transcripts were analyzed from Directors of Nursing from two skilled nursing facilities and five assisted living facilities. Monthly referrals varied from one to four, and interview responses were grouped in three categories: physical, cognitive, and administrative decisions. Responses were analyzed for content and saturation.

Conclusions: This study demonstrates a lack of understanding of palliative care services by Directors of Nursing in long-term care. Physical symptoms were often cited as a reason for referral, but there was no mention of the other domains noted in the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care (2013). Study findings support a need to integrate national guidelines for initiating palliative care for more patients who may benefit in long-term care facilities.

Open Access




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