Student Theses, Dissertations and Capstones

Document Type


Degree Name

Doctor of Philosophy (PhD) in Nursing Education

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All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.


College of Nursing

First Advisor

Cynthia Fletcher

Publication Date / Copyright Date



Nova Southeastern University


Background: Advance directives allow patients to put in writing the type of health care they want if they are unable to make decisions due to their medical condition. Purpose: The purpose of this study was to determine if there were differences in senior nursing students’ knowledge, attitudes, and confidence based on when the information is positioned in the curriculum. Theoretical: Social cognitive learning theory and Zimmerman’s self-regulation model provided the theoretical framework. Methods: This study reflected a non-experimental, exploratory design, with a convenience sample of senior nursing students from 2 different nursing programs in central Illinois. One program offers advance directive education in the first year and the other program offers the information in the second year. A total of 131 students participated in the study that used subscales of the Knowledge, Attitudinal, Experiential Survey on Advance Directives. Results: The group that received the information the second year rated themselves as having more confidence with advance directives. However, both groups scored low in the area of knowledge of advance directives, the Patient Self-Determination Act, and Illinois law. Students who reported higher knowledge levels had higher attitudes about end-of-life care. There was no difference in attitudes between the two groups. Conclusion: The results of this study highlight the need to review nursing curricula specifically relating to end-of-life care content and its placement in the curriculum.




Health and environmental sciences, Advance directives, Attitudes, Confidence, End of life care, Knowledge, Nursing students



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Nursing Commons