Date of Award


Document Type


Degree Name

Master of Science (MS)




One of the functions of nurses is to assist individuals to achieve a peaceful death. In order to fulfill this role, patient end-of-life wishes must be communicated to family members and health care providers. Since passage of the Patient Self-Determination Act (PSDA) in 1990, advance directives have served as the legal vehicle and communication tool for bringing about an understanding of these wishes, should the patient be unable to competently speak for him/herself. Unfortunately, although the majority of Americans favor the provisions that living wills and health care powers of attorney contain, only a small fraction actually complete advance directives. As one of the largest and most accessible members of the health care team, nurses are in an ideal position to serve as advocates and educators for the facilitation of informed decision-making for patients making choices about end-of-life care. However, a nurse’s ability to advocate is greatly affected by a number of essential concepts, such as perception, time, interaction, role, power, status, comfort level, and decision-making.

This was an exploratory descriptive study of nurses registered in and currently working within the state of North Dakota. The purpose of this study was to explore the current perceptions and experiences of North Dakota registered nurses with discussing advance directives with patients and assisting with their implementation.

A self-reported questionnaire was mailed to a random sample of 600 registered nurses in the state of North Dakota who met the study criteria. The questionnaire elicited participant perceptions and experiences related to advance directives, with a focus on knowledge and comfort levels with discussing advance directives, agreement with the concept of patient autonomy, and barriers to advance directive discussions encountered in practice. Data were analyzed using descriptive and inferential statistics.

More than half of all participants demonstrated actual as well as perceived knowledge on questions relating to the PSDA and possession of sufficient information to discuss advance directives with patients. However, the majority indicated that they would benefit from further education on the topic. Likewise, a little more than half of the participants indicated that they were comfortable with discussing advance directives with patients, and agreed that it was indeed a nursing responsibility to do so. However, social work was predominantly ranked number one over the patient’s nurse as the person they would contact if a patient asked for advance directive information. Almost all participants agreed with the concept of patient autonomy in making end-of-life care decisions, yet completion rates of advance directives for themselves reflected the low national averages. Finally, the majority of participants reported encountering multiple barriers to discussing advance directives in their practice, with time constraints ranked number one by a large margin.