Document Type

DNP Project


School of Nursing

Date of Degree

Spring 2020


Doctor of Nursing Practice (DNP)

Primary Advisor

Richard Ricciardi, PhD, CRNP, FAANP, FAAN; Mary-Michael Brown, DNP, RN


Background: Advance Care Planning (ACP) at this primary care practice was minimal and lacked a consistent process to document existing advance directives (AD) or educate patients about ADs.

Objectives: The purpose of this QI project was to improve ACP engagement, documentation of existing ADs and educate patients about Five Wishes.

Methodology: Adults, at each office encounter, were asked three kiosk questions: Do you have an AD, know what ADs are and want to discuss ACP? The responses were uploaded to the EHR to become an evidence backed, visual reminder. Affirmation of existing ADs were descriptively documented. ACP engagement was analyzed by chi square comparing responses to the questions and provider engagement in ACP. All patients were invited to a Five Wishes seminar and given the same questionnaire with pre and post testing conducted via a paired t-test.

Results: The 1037 participants were mostly, employed, white, married with a mean age of 52. After 12 weeks, 90 ACP discussions took place compared to 6 discussions prior to implementation (p

Conclusion: Engagement in ACP improved by both asking about interest and creating EHR reminders. The kiosk-initiated process makes this project sustainable. Asking every patient normalizes ACP. Five Wishes does not meet legal requirements for an AD in every state and future policy should focus on full legalization.

Open Access


Included in

Nursing Commons



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