Introduction (Problem Statement/Significance) –please see previous papers from this site having to do with this research/quality improvement project—Problem- lack of knowledge of nurses regarding palliative care– significance patient suffering, shifting in between hospitals and nursing homes Purpose/ PICO Clinical Questions/Objectives–Among long term care nurses is the use of a palliative assessment tools better than using no tools at all, in improving knowledge and comfort in assessing and referring for palliative care– also define what a PICO question is Definition of Terms– explain what palliative care is, define what a palliative care trigger assessment tool is Conceptual Underpinning and Theoretical Framework of the Project– Palliative care framework Methodology– quality improvement project using PDSA model PLAN AS FOLLOWS Study design– comparative before and after setting- long term care center in miami sample -15 registered nurses in long term care center instruments- questioner which assess nurses knowledge before implementation of quality improvement project– implement palliative care trigger tool exp PALLA 10 data collection— data analysis– human subjects protection– DO– implementation of the plan STUDY– analysis ACT- eventual evaluation of the QI project and results Results– describe the sample (registered nurses in long term care) Discussion—why is this quality improvement project important Implications for Advanced Practice Nursing– better patient outcomes Conclusions Summary of the literature (Evidence related to the clinical question)