End-of-life care (EOLC) is an essential component of comprehensive healthcare and has been shown to improve the quality of life of patients and their families by preventing and relieving pain caused by physical, psychosocial, and spiritual complications. Many rural communities lack access to EOLC, specifically certified palliative and hospice services. The lack of this specialty in rural areas directly affects the experience of healthcare staff. The absence of education for rural healthcare staff and the importance of culturally sensitive care among indigenous people are key concepts in this study.

The purpose of this study was to measure the knowledge, confidence, and comfort level of staff in a rural setting on the Navajo Nation related to palliative and EOLC, including Navajo cultural beliefs about EOLC. A 2-day training—the End-of-Life Nursing Education Consortium (ELNEC) Core Course—was led by two certified ELNEC trainers and one traditional Navajo healer for healthcare providers in the rural area. The impacts the training had on participants were evaluated through a survey, and quantitative data were collected at three points in time and analyzed using the two-paired t-test. This study compared the mean scores from the survey and analyzed the data from Time 1 to Time 2 and from Time 1 to Time 3.



Document Type

Scholarly Project

Degree Name

Doctor of Nursing Practice (DNP)

Level of Degree


First Committee Member

Carol Capitano, PhD, RN, PMHCNS (Member)


Palliative, Education, Hospice, Rural, Navajo, ELNEC

Included in

Other Nursing Commons