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Advance Care Planning in Rural Montana

Exploring the Nurse’s Role

Christensen, Kara L. DNP, FNP-C; Winters, Charlene A. PhD, RN; Colclough, Yoshiko PhD, RN; Oley, Erin DNP, FNP-C; Luparell, Susan PhD, CNS-BC, CNE

Journal of Hospice & Palliative Nursing: August 2019 - Volume 21 - Issue 4 - p 264–271
doi: 10.1097/NJH.0000000000000556
Feature Articles

It is recommended that advance care planning take place across the lifespan. Rural populations have a heightened risk for poor quality and high cost of end-of-life care. A doctoral project was completed to assess rural nurses’ knowledge, attitudes, and experiences with advance directives using the Knowledge, Attitudinal, and Experimental Surveys on Advance Directives. Descriptive statistics were used for analysis. Participants were nurses who practice in rural settings (N = 22). The average age was 46.4 years; all were white (n = 22), and the majority were baccalaureate prepared (n = 12). Practice settings were primarily in home care and hospice. Knowledge scores on advance directives were low (57%). Nurses felt confident in counseling and initiating discussions with patients and families. Less than one-half of the nurses reported they feel part of the advance care planning team. The majority reported advance directive resources and mentorship of younger nurses would be beneficial and indicated the need for additional education, training, knowledge, time, and support to better assist with advance care planning. Project results and recommendations were presented to the participating health care organization. Recommendations included workplace education, support, mentorship, resources, and education on cultural sensitivity using the rural nursing theory.

Kara L. Christensen, DNP, FNP-C, is captain and family nurse practitioner, US Air Force, JBSA-Lackland AFB, Texas.

Charlene A. Winters, PhD, RN, is professor, Montana State University College of Nursing, Bozeman.

Yoshiko Colclough, PhD, RN, is associate professor, Montana State University College of Nursing, Bozeman.

Erin Oley, DNP, FNP-C, is assistant clinical professor, Montana State University College of Nursing, Bozeman.

Susan Luparell, PhD, CNS-BC, CNE, is associate professor, Montana State University College of Nursing, Bozeman.

Address correspondence to Kara L. Christensen, DNP, FNP-C, 9930 Balboa Island, San Antonio, TX 78245 (

The authors have no conflicts of interest to disclose.

This study was supported by Helen Jacobson Lee Endowment for Rural Nursing Research.

The views expressed are those of the authors and do not reflect the official views or policy of the Department of Defense or its Components. The voluntary fully informed consent of the subjects used in this research was obtained as required by 32 CFR 219 and DODI 3216.02_AFI 40-402.

Online date: April 1, 2019

© 2019 by The Hospice and Palliative Nurses Association.