Date of Award

Fall 12-20-2020

Document Type

DNP Project

Project Team Faculty Member

Dr. Mary E. Zerlan DNP, CRNA, APN


perioperative advanced directives, perioperative do-not-resuscitate, perioperative dnr, perioperative consent, anesthesia consent, dnr under anesthesia


Technology and surgical techniques continue to improve, resulting in more clients with advanced directives presenting to the operative suite for surgery or procedures requiring anesthesia. Anesthesia providers are in a critical position to discuss with the surgical patient or surrogate any alteration or reconsideration to their advanced directive. Unfortunately, patients and anesthesia provider discussions at a North Texas hospital were limited due to a knowledge deficit, an outdated hospital policy rescinding all directives perioperatively, and an inadequate consenting mechanism. The perioperative advanced directives project involved updating the hospital policy to current national guidelines and developing a “DNR Under Anesthesia” consenting tool. The implementation process consisted of two separate presentations tailored to educate both nursing and anesthesia staff about the importance of maintaining patient autonomy and the right to self-determination perioperatively. The results demonstrated improvement in all areas of knowledge and comfort when dealing with the perioperative directives. With the project's success, education is now included in all perioperative staff's yearly competency modules, thus promoting sustainability. Most importantly, the patients now retain their rights to autonomy and self-determination in the perioperative arena.

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Literature Review_dwasher.docx (70 kB)
Literature Review

Theoretical Framework_dwasher.docx (20 kB)
Theoretical Framework

Project Methods_dwasher.docx (2938 kB)
Project Methods

Instruments : Evaluation Process_dwasher.docx (10089 kB)
Instruments & Evaluation Process

Final Reference List_dwasher.docx (23 kB)
Final Reference List

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Nursing Commons



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