Advance Care Planning Conversations: Measuring Registered Nurses' Self-Efficacy Before and After an Educational Intervention (QI701)

•Describe advance care planning from the perspective of the registered nurse.•Articulate changes in registered nurse advance care planning self-efficacy following evidence-based training. Advance care planning (ACP) improves patient outcomes at the end-of-life. Effective ACP requires specialized knowledge and communication skills lacking in traditional nursing education and by nurses practicing in our local community. Substantial gaps in the literature exist in understanding nurses’ ACP self-efficacy and the effects of innovative teaching approaches on this outcome. The purpose of this quality improvement project was to evaluate changes in registered nurses’ (RNs) ACP self-efficacy after participating in a multimodal evidence-based educational program designed to improve ACP conversations. This project was a comparative study using a non-experimental Before-After design with an equivalent control group. Participants completed a demographic survey and the Advance Care Planning Self-Efficacy (ACP-SE) scale before and after a program combining lecture, video-taped demonstration using a simulated patient scenario, and role-play activities. Analyses were conducted using descriptive statistics and Wilcoxon Signed Rank test. Bivariate correlations between a global single-item measure of ACP-SE and the mean score of the items on the ACP-SE scale were examined using Spearman Rho correlation coefficient to assess the validity of the ACP-SE scale, originally developed for physicians, in this sample of RNs (N=45). Findings demonstrated a statistically significant improvement in ACP-SE scores following the program, z=-3.65, p<.000, with a medium effect size (r=.39). The median score on the ACP-SE scale increased from pre-activity (Md=65) to post-activity (Md=74). There were strong, positive significant correlations between the global single-item and mean score of ACP-SE pre-activity, rs=.73, and post-activity, rs=.78, supporting the validity of the ACP-SE scale in this sample of RNs. Findings demonstrated that a multimodal educational program improved nurses’ self-efficacy in conducting ACP. As nurses are uniquely positioned to facilitate ACP, additional research is needed to determine if increased ACP-SE improves patient and family outcomes and decreases healthcare costs.