Document Type
DNP Project
Publication Date
2026
Degree Name
Doctor of Nursing Practice
Faculty Advisor
Dr. Constance Glenn, DNP, APRN, FNP-BC, CNE
Practice Mentor
Dr. Amisha Parekh De Campos, PhD, MPH, RN, CHPN
Abstract
Background
Palliative and hospice teams provide patient-centered end-of-life care that reduces symptom burden, supports psychosocial and spiritual needs, and improves quality of life for patients and caregivers. Despite these benefits, systemic inequities contribute to the underutilization of palliative care, hospice services, and advance care planning among marginalized populations—particularly the populations of Black, Indigenous, and people of color. These barriers include limited access to care, economic challenges, mistrust of the healthcare system, unmet cultural or spiritual needs, and clinician-related factors such as bias or time constraints for end-of-life discussions. As the aging population becomes more diverse, culturally competent care is increasingly essential to reduce health disparities, promote informed decision-making, and ensure equitable, respectful end of life care for patients and their families.
Project Goals
- Increase Comfort Care Unit clinicians and Hospice Home Care clinicians and staffs’ awareness of the importance of delivering culturally competent care to minority and Black patients.
- Increase Comfort Care Unit clinicians, Hospice Home Care clinicians and staffs’ awareness of personal cultural knowledge.
- Promote increased patient and staff participation in end-of-life comfort care by expanding awareness of the unique approaches to individual culturally competent end of life care.
Methods
The educational seminar and associated surveys were conducted between August 26, 2025, and November 6, 2025. Participants first completed the Cultural Competency Awareness Self-Assessment (North Carolina Department of Health and Human Services [NCDHHS], 2024), to establish a baseline measure of staff awareness and personal cultural knowledge. The educational seminar was delivered in a single session to the Hospice Home Care group and in multiple sessions to the Comfort Care Unit to accommodate staff schedules. Immediately following the seminar, participants completed the Initial Post Seminar Survey. A Follow-Up Post Seminar Survey was then administered at least six weeks later to evaluate sustained impact.
Results
A total of eighteen Hospice Home Care clinicians and twenty-eight Comfort Care Unit clinicians completed the Cultural Competency Awareness Self-Assessment, which included 11 LIKERT-scale questions with possible scores ranging from 11 to 44. The average score was 36.57, with a range of 24 to 44 and a mode of 35. All forty-six clinicians who completed the pre-survey and attended the seminar also completed the Initial Post Seminar Survey. This survey consisted of nine LIKERT-scale questions, with possible score range of 9 to 36, and one open-ended question. The average score was 30.78, with scores ranging from 18 to 36 and a mode of 36. Twenty-two participants provided qualitative feedback, emphasizing a desire for continued education and more accessible resources for patients and caregivers. At the six-week follow-up, fifteen of the original eighteen Hospice Home Care clinicians and twenty-five of the original twenty-eight Comfort Care Unit clinicians completed the Follow-Up Post Seminar Survey. The average score was 31.68, with a score range of 19 to 36 and a mode of 33. Seven participants provided additional qualitative feedback which reflected similar sentiments of the Initial Post Seminar Survey.
Conclusion
Outcome measures for 90% of staff to complete the Cultural Competency Awareness Self-Assessment (NCDHHS, 2024), educational seminar and Initial Post Seminar Survey were not achieved due to clinician or staff being out on Family and Medical Leave or declined to participate. Eighty percent of Comfort Care unit and Home Hospice staff participated in the project. There was an 87% participation retention rate for the Follow-Up Post Seminar Survey. Results from the Follow-Up Post Seminar survey, Appendix N Table N1.2, showed that each question had 80% or higher responses for ‘fairly often’ or ‘always’. This evidence helps to support that participants reflected increase to: awareness of baseline skills and knowledge of their cultural awareness; awareness of areas to expand approaches to provide culturally competent care; understanding that cultural competency is an ongoing process of intellectual curiosity, intentional learning and critical thinking; awareness of end of life health care disparities, and awareness of the unique needs of vulnerable and black, indigenous, or people or color patients at end of life. Qualitative responses support the need for ongoing culturally competent care learning, improved resources for patients and caregivers including health education, and support to address time constraints when discussing or providing end of life care.
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0 International License.
Recommended Citation
Whitt, M.M.H. (2026). Improving culturally competent care in palliative and hospice care: A quality improvement project [Unpublished DNP project]. Sacred Heart University.
