Award Date


Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Committee Member

Catherine Dingley

Second Committee Member

Lori Candela

Third Committee Member

Du Feng

Fourth Committee Member

Megan Pfitzinger Lippe

Fifth Committee Member

Jennifer Keene

Number of Pages



Introduction Approximately 40 million people are currently in need of palliative care (PC), and this number is predicted to increase due to the aging population and increasing longevity. Providing PC in the acute care setting leads to better quality and clinical outcomes, reduced inpatient hospital costs, and improved efficiency. Despite evidence indicating the benefits of PC, timely referrals and provision of PC in the acute care setting are lacking in part due to the complex interplay of factors that nurses must navigate, such as limited preparation, knowledge, and self-efficacy; nurse/provider attitudes; and patient/family and institutional barriers. A paucity of research exists that reflects a comprehensive approach, integrating the complexities of the clinical setting and encompassing the multidimensional factors. The purpose of this study was to examine the factors that influence the nature and frequency of self-reported PC practices of nurses in the acute care setting by using a comprehensive approach. Methods A descriptive, cross-sectional design, guided by Bandura’s Social Cognitive Theory as the theoretical framework, was used to examine the effects of nurses’ personal factors (palliative and EOL care knowledge, self-efficacy, palliative and EOL care education, attitudes toward care of the dying), and environmental factors (nurse-perceived patient/family barriers and institutional/unit factors) on nurses’ PC practices in the acute care setting. Registered nurses in Nevada (N = 325) completed an electronic survey containing items from a demographic questionnaire and six other measures (UNPCKS, CARES-PC, FATCOD, Institutional/unit factors subscale, Patient and family barriers subscale, and PCPS-E). Hierarchical multiple linear regression analysis was used to evaluate the degree to which each set of independent variables explained the variance in self-reported frequency of PC practices of acute care nurses while controlling for the others. Results Step one (demographics) explained 12.3% of the variance (F(7, 245) = 4.916, p < .001). Step two (personal factors) explained 19.4% (F(5, 240)= 13.678, p < .001). Step three (environmental factors) explained 0.4% [F(2, 238)= 9.053, p = .519]. The final regression model with demographics, personal factors, and environmental factors, accounted for 32.1% of the variance in the frequency of nurses’ self-reported PC practices, with personal factors contributing most significantly, and was significant [F(14, 238) = 8.050, p < .001]. Discussion While the practice context and environment, things external to the nurse, influence nurses’ PC practices to an extent, factors that are internal (personal factors, specifically attitudes and self-efficacy) are the most important predictors of behavior. This study advanced our knowledge regarding the factors that influence the self-reported PC practices of acute care nurses, and numerous implications for nursing practice, education, policy, and research were identified. The innovative aim of this study was to examine these factors simultaneously in a comprehensive model and determine the collective effects of nurses’ personal factors and environmental factors on the variance in the frequency of acute care nurses’ self-reported PC practices while controlling for demographic variables.


Acute Care Nursing; End of Life Care; Primary Palliative Care; Social Cognitive Theory



File Format


File Size

2000 KB

Degree Grantor

University of Nevada, Las Vegas




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Included in

Nursing Commons