advance directives, education, end-of-life, long-term care, nursing assistants



  1. Kunte, Vera DNP, APN-C, CNE
  2. Johansen, Mary L. PhD, NE-BC, RN
  3. Isenberg-Cohen, Shari DNP, APN-C


This project aimed to examine whether improvement in end-of-life knowledge of long-term care nursing staff, especially nursing assistants, increases the rate of long-term care residents with advance directives and decreases the rate of their hospital transfers.


Nurses and nursing assistants in long-term care facilities are inadequately prepared to provide quality end-of-life (EOL) care. Few studies focus on improving EOL education of nursing assistants who are closest to the residents, providing most of their care. Eleven nurses and 18 nursing assistants from 1 urban and 1 suburban long-term care facilities received education based on the End-of-Life Nursing Education Consortium Geriatric curriculum separately and together. Pre-education and posteducation, knowledge of nursing staff was assessed and records of 139 residents were examined for advance directives and hospital transfers.


Posteducation, EOL knowledge of nursing assistants showed greater improvement than that of nurses; all nursing staff rated their knowledge higher. Documentation of resident EOL preferences improved minimally, but the rate of transfers to the hospitals was dramatically reduced.


Nursing staff education on EOL care reduces the number of long-term care residents' hospital transfers leading to improved quality of EOL care. Nursing assistants benefit from combined education sessions with the nurses.