Date of Award

Fall 12-2018

Degree Name

Doctor of Nursing Practice (DNP)


Leadership and Advanced Nursing Practice

Committee Chair

Dr. Bonnie Harbaugh

Committee Chair Department


Committee Member 2

Dr. Juanita Graham

Committee Member 2 Department


Committee Member 3

Dr. Marcus Gaut

Committee Member 3 Department




The Patient Self-Determination Act of December 1991 directs healthcare facilities to inform patients regarding their right to make decisions about their healthcare, their right to refuse care, and their right to designate a healthcare surrogate. Culturally diverse populations often do not complete advance directives as often as other populations. The purpose of this project was to determine if an educational intervention, using a culturally appropriate video and written materials, improves understanding about advance directives among a Choctaw Native American population. The project used feedback from tribal members to evaluate the effectiveness of this educational intervention and modify it so that it can be used in Tribal healthcare and community settings to improve understanding of advance directives. The theory for this project, Leininger’s Culture Care Diversity, and Universality Theory allows providers to use culturally focused clinical educational interventions to promote respect and decision-making in cultural populations (Leininger & McFarland, 2006).

The advance directive educational video and written materials were prepared with the Tribal healthcare employees and video department. Eight Choctaw tribal members evaluated the video and educational materials. None of the participants had advance directives, and 75% of them said they had never been told about advance directives. Choctaw tribal members expressed favorable responses to using a video to discuss advance directives. The Choctaw tribal members did emphasize the importance of making the materials and video in their Choctaw language. The healthcare outcomes and education should be further examined when this information is presented using Choctaw Tribal language by partnering with Choctaw Tribal language experts.