Defense Date


Graduation Date

Summer 8-10-2019


One-year Embargo

Submission Type


Degree Name





School of Nursing

Committee Chair

Richard Zoucha

Committee Member

Joan Such Lockhart

Committee Member

Sandra J Mixer


end of life, advance directive, advance care planning, culture, cultural values and beliefs, ethnonursing, African American


Introduction: Advance directive completion rates among the general population are low. Studies report even lower completion rates among African Americans are impacted by demographic variables, cultural distinctives related to patient autonomy, mistrust of the healthcare system, low health literacy, strong spiritual beliefs, desire for aggressive interventions, importance of family-communal decision making, and presence of comorbidities. End of Life (EOL) advance care planning (ACP) promotes patient and family centered care. The purpose of this study was to identify culturally based meanings, expressions, and traditions of EOL ACP and decision making among African Americans, to better understand and provide culturally congruent nursing care to this population.

Methodology: Leininger’s Culture Care Theory and Ethnonursing Method guided the study. A convenience sample of 21 informants from the Midwestern U.S. were interviewed in community settings. Data analysis was guided using Leininger’s Phases of Ethnonursing Data Analysis for Qualitative Data.

Results: Data revealed three themes which impact EOL decision making: (a) Faith in God and belief in life after death (b) A strong matriarchal structure of African American families, and (c) Fear of talking about death and mistrust of the U.S. healthcare system.

Discussion: African American culture, beliefs, and traditions influence EOL ACP and practices, and must be considered in provision of culturally congruent care.



Additional Citations

Collins, J. W., Zoucha, R., Lockhart, J. S., & Mixer, S. J. (2018). Cultural aspects of end-of-life care planning for African Americans: An integrative review of literature. Journal of Transcultural Nursing, 29(6).