Problem Statement: Hospice nurses are responsible for managing patient exacerbated symptoms, although research has shown that symptom management at end of life is deficient. The symptom management protocol (SMP) utilized by a rural hospice organization is not sufficient, causing nurses to struggle with the management and documentation of exacerbated symptoms.

Purpose: The purpose of this DNP project was to determine if a revised SMP and related educational intervention will increase hospice nurse self-efficacy, and subsequent improvement in documentation, and follow-up care.

Methods: Self-efficacy of the nurses related to the SMP was measured using a Palliative Care Self-Efficacy Scale and retrospective medical record chart audits comparing three months pre- and post-implementation documentation of patient symptom management provided by hospice nurses.

Results: SMP implementation did demonstrate an increase in nurse self-efficacy related to symptom management over the three-month timeframe. Run Charts revealed an initial increase in nurse documentation of symptom management and follow-up; however, there was decline during the last month of the post-SMP implementation phase, indicating the necessity of ongoing protocol education.

Significance: Adequate symptom management by hospice nurses leads to improved patient outcomes and quality of life, and adequate documentation of exacerbated symptoms will ensure the hospice organization will meet regulatory standards.