Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Nancy Magnuson, DSN, APRN, PCS, FNP-BC


Nancy Magnuson, DSN, APRN, PCS, FNP-BC

Tonya Haynes, DNP, RN

Jeff Davis, MS, FNP-BC, LNHA, CHC


Problem: Dementia is rapidly increasing as the people of the world mature and life expectancy increases. As the world ages and the prevalence of dementia increases, nursing home placement will and is the most sought place for care of this population. Dementia is under recognized as a terminal illness and palliative care is underutilized for nursing home residents with advanced symptoms of dementia.

Methods: This quality improvement (QI) initiative utilized a prospective, descriptive design. The Palliative Care Screening for the Elderly tool was administered to a purposive sample of persons living with dementia residing in the nursing home. Qualitative data was collected over 12 weeks. Data collected included age, sex, race, location, dementia diagnosis, decreased oral intake, weight loss, incontinence, decreased physical activity, new or worse pressure ulcer, fall, emergency room visits, and orders for palliative care.

Results: Following the implementation of the residents screened over the course of 12 weeks, (n = 52) were eligible for palliative care orders. Eleven residents were referred to palliative care, resulting in 21.3% of residents living with dementia receiving palliative services.

Implications for Practice: Standardized utilization of the Palliative Care Screening for the Elderly tool could further identify residents at risk for deconditioning and help to initiate interventions before a severe decline occurs. The early recognition of deterioration can positively affect quality of life and reduce suffering. Additionally, the early identification of CMS quality indicators can positively affect a nursing home star rating.