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Dancis A. Do-Not-Hospitalize Orders in Assisted Living Facilities: Direct Care Workers' Perspectives. J Gerontol Nurs 2024; 50:11-15. [PMID: 38569104 DOI: 10.3928/00989134-20240311-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
PURPOSE To gather sufficient qualitative data to create an intervention that would prevent direct care workers (DCWs) from sending residents with do-not-hospitalize (DNH) orders to the hospital. METHOD This was a qualitative study with eight participants that included a descriptive survey followed by semi-structured interviews. RESULTS DCWs were unfamiliar with DNH orders and their thinking on end-of-life care was binary (hospice or hospital) and protocol driven. However, supportive leaders were able to help DCWs problem-solve these complicated scenarios. Results were mixed on whether having a RN on site was helpful. CONCLUSION DCWs may benefit from having access to a nurse with palliative care experience when making decisions about residents with DNH orders. [Journal of Gerontological Nursing, 50(4), 11-15.].
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Booi L, Sixsmith J, Chaudhury H, O'connor D, Surr C, Young M, Sixsmith A. "I didn't know it was going to be like this.": unprepared for end-of-Life care, the experiences of care aides care in long-term care. BMC Palliat Care 2023; 22:132. [PMID: 37689687 PMCID: PMC10492357 DOI: 10.1186/s12904-023-01244-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/14/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Care aides provide up to 70-90% of the direct care for residents in long-term care (LTC) and thus hold great potential in improving residents' quality of life and end-of-life (EoL) care experiences. Although the scope and necessity of the care aide role is predicted to increase in the future, there is a lack of understanding around their perceptions and experiences of delivering EoL care in LTC settings. The aim of this study was to gain an understanding of the perspectives, experiences, and working conditions of care aides delivering end-of-life care in LTC in a rural setting, within a high-income country. METHODS Data were collected over ten months of fieldwork at one long-term care home in western Canada; semi-structured interviews (70 h) with 31 care aides; and observation (170 h). Data were analysed using Reflexive Thematic Analysis. RESULTS Two themes were identified: (i) the emotional toll that delivering this care takes on the care aids and; (ii) the need for healing and support among this workforce. Findings show that the vast majority of care aides reported feeling unprepared for the delivery of the complex care work required for good EoL care. Findings indicate that there are no adequate resources available for care aides' to support the mental and emotional aspects of their role in the delivery of EoL care in LTC. Participants shared unique stories of their own self-care traditions to support their grief, processing and emotional healing. CONCLUSIONS To facilitate the health and well-being of this essential workforce internationally, care aides need to have appropriate training and preparation for the complex care work required for good EoL care. It is essential that mechanisms in LTC become mandatory to support care aides' mental health and emotional well-being in this role. Implications for practice highlight the need for greater care and attention played on the part of the educational settings during their selection and acceptance process to train care aides to ensure they have previous experience and societal awareness of what care in LTC settings entails, especially regarding EoL experiences.
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Affiliation(s)
- Laura Booi
- Centre for Dementia Research, School of Health, Leeds Beckett University, Leeds Beckett University, CL521 Calverley Building, City Campus, Leeds, LS1 3HE, UK.
| | - Judith Sixsmith
- School of Nursing and Health Sciences, University of Dundee, 11 Airlie Pl, Dundee, DD1 4HJ, UK
| | - Habib Chaudhury
- Department of Gerontology, Simon Fraser University, Suite #2800, Harbour Centre, 515 W Hastings Street, Vancouver, BC, V6B 5K3, Canada
| | - Deborah O'connor
- School of Social Work, Centre for Research on Personhood in Dementia (CRPD), University of British Columbia, Jack Bell Building, 2080 West Mall, Co-Director, Vancouver, BC, V6T 1Z2, Canada
| | - Claire Surr
- Centre for Dementia Research, School of Health, Leeds Beckett University, Leeds Beckett University, CL521 Calverley Building, City Campus, Leeds, LS1 3HE, UK
| | - Melanie Young
- Kiwanis Village, Vancouver Island Health Authority, British Columbia, Canada
| | - Andrew Sixsmith
- Department of Gerontology, Simon Fraser University, Suite #2800, Harbour Centre, 515 W Hastings Street, Vancouver, British Columbia, V6B 5K3, Canada
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Ådland AK, Gripsrud BH, Lavik MH, Ramvi E. "They Stay With You": Nursing Home Staff's Emotional Experiences of Being in a Close Relationship With a Resident in Long-Term Care who Died. J Holist Nurs 2021; 40:108-122. [PMID: 34048319 PMCID: PMC9121525 DOI: 10.1177/08980101211017766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Aim: To explore and develop understanding of nursing home staff's emotional
experiences of being in a close relationship with a resident in long-term care who later
died. Design: Ethnographic fieldwork. Methods: As part of
fieldwork, narrative interviews were conducted with nursing home staff
(n = 6) in two nursing homes in Norway and analyzed using interpretative
phenomenological analysis. Findings: Through data analysis, we identified
three superordinate themes: (1) wanting to be something good for the resident and their
families, (2) striving to make sense of the resident's death, and (3) struggling to
balance being personal and professional. Implications for holistic nursing and
conclusion: Nursing home staff experience tensions between ideals of distanced
professionalism and the emotional experience of proximity, evidenced by personal
commitment and mutual recognition in relationships with “special residents” in long-term
care. To support holistic practice, awareness is needed of the emotional impact of
relationships on health professionals. Suppressing feelings puts staff at risk of moral
distress, compassion fatigue, and burnout, as well as higher turnover and absenteeism.
Managers should facilitate discussions on professionals’ ideals of relationship-based
practice, including processing of, and reflection on, emotional experiences in long-term
care. Rituals to mark a resident's death can provide further emotional containment.
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Affiliation(s)
| | | | - Marta H Lavik
- The Research Group for Nursing- and Healthcare Science, 60496Stavanger University Hospital.,87446VID Specialized University.,Stellenbosch University.,56627University of Stavanger
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Cronin U, McCarthy J, Cornally N. The Role, Education, and Experience of Health Care Assistants in End-of-Life Care in Long-Term Care: A Scoping Review. J Gerontol Nurs 2020; 46:21-29. [PMID: 31895958 DOI: 10.3928/00989134-20191022-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/09/2019] [Indexed: 11/20/2022]
Abstract
The changing age profile of the human population globally means that the requirement for residential long-term care (LTC) for older adults is escalating, with an associated increase in deaths in these facilities. Health care assistants (HCAs), whose main role is provision of direct care to residents, comprise the largest staff cohort in residential care for older adults. The purpose of this scoping review was to explore three key areas related to HCAs: their role and responsibilities, end-of-life (EOL) education, and their views and experiences of caring for residents at EOL. The literature search included five databases and 32 studies were ultimately reviewed. Key issues were as follows: HCAs feel marginalized and undervalued, they need and desire EOL education, and resident deaths impact negatively on them. The changing care needs for older adults with complex comorbidities at EOL in LTC will place an increased onus on HCAs' skills, knowledge, and personal and professional development. [Journal of Gerontological Nursing, 46(1), 21-29.].
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Karacsony S, Chang E, Johnson A, Good A, Edenborough M. Assessing nursing assistants' competency in palliative care: An evaluation tool. Nurse Educ Pract 2018; 33:70-76. [PMID: 30248577 DOI: 10.1016/j.nepr.2018.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 09/04/2018] [Accepted: 09/07/2018] [Indexed: 11/30/2022]
Abstract
Nursing assistants are the largest aged care workforce providing direct care to older people in residential aged care facilities (RACF) in Australia and internationally. A palliative approach is a large component of this direct care that necessitates nursing assistants possess requisite knowledge, skills and attitudes. While training needs have been identified to enhance their practices, preservice education is variable, educational interventions have been adhoc and professional development found to be inadequate to the demands of the workplace. In addition, evaluation of nursing assistants' knowledge, skills and attitudes has lacked an instrument specifically tailored to nursing assistants' level of education and role responsibilities when providing a palliative approach. This paper reports on Phase 3 of a research study to develop such an instrument capable of assessing nursing assistants' knowledge of, skills in, and attitudes within a palliative approach. This phase assesses the usability and performance capabilities of the new instrument on a purposive sample of nursing assistants in two RACFs using the survey method. Results showed that the instrument was able to discriminate between groups of nursing assistants based on experience in role. Usability results indicated that the instrument is user friendly and time efficient.
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Affiliation(s)
- Sara Karacsony
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Esther Chang
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Amanda Johnson
- School of Nursing, Midwifery and Paramedicine NSW/ACT, Australian Catholic University, PO Box 968, North Sydney, NSW 2059, Australia.
| | - Anthony Good
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia.
| | - Michel Edenborough
- School of Social Sciences and Psychology, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751, Australia.
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Mohlman WL, Dassel K, Supiano KP, Caserta M. End-of-Life Education and Discussions With Assisted Living Certified Nursing Assistants. J Gerontol Nurs 2018; 44:41-48. [DOI: 10.3928/00989134-20180327-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 03/05/2018] [Indexed: 01/15/2023]
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Meeker MA, Waldrop DP. Changing Focus: End-of-Life Care in a New York State Managed Long-Term Care Program. J Appl Gerontol 2017; 38:1371-1390. [PMID: 29165012 DOI: 10.1177/0733464817737620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In the United States, managed long-term care programs offer a noninstitutional approach to meeting the needs of increasing numbers of frail elders. Providing services that support both quality of life and quality of dying poses unique challenges. Using a qualitative descriptive design, we explored these challenges from the perspectives of care providers. Themes were identified using qualitative content analysis techniques applied to transcripts of 33 semistructured interviews. Professionals comprising an interdisciplinary care team and home health aide direct care providers described cues by which they identified movement into the end-of-life phase, their understandings of how care changed, and their concerns and recommendations for improvement. When the changing care needs could be met, a "good death" ensued, but that was not always possible. Managed long-term care programs are called upon to develop the capacity to integrate the phase of dying into the full story of each life for which they care.
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Affiliation(s)
- Mary Ann Meeker
- 1 University at Buffalo, the State University of New York, Buffalo, NY, USA
| | - Deborah P Waldrop
- 1 University at Buffalo, the State University of New York, Buffalo, NY, USA
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Boerner K, Gleason H, Jopp DS. Burnout After Patient Death: Challenges for Direct Care Workers. J Pain Symptom Manage 2017; 54:317-325. [PMID: 28797866 PMCID: PMC5610096 DOI: 10.1016/j.jpainsymman.2017.06.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 05/15/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
Abstract
CONTEXT Direct care workers in long-term care can develop close relationships with their patients and subsequently experience significant grief after patient death. Consequences of this experience for employment outcomes have received little attention. OBJECTIVES To investigate staff, institutional, patient, and grief factors as predictors of burnout dimensions among direct care workers who had experienced recent patient death; determine which specific aspects of these factors are of particular importance; and establish grief as an independent predictor of burnout dimensions. METHODS Participants were 140 certified nursing assistants and 80 homecare workers who recently experienced patient death. Data collection involved comprehensive semistructured in-person interviews. Standardized assessments and structured questions addressed staff, patient, and institutional characteristics, grief symptoms and grief avoidance, as well as burnout dimensions (depersonalization, emotional exhaustion, and personal accomplishment). RESULTS Hierarchical regressions revealed that grief factors accounted for unique variance in depersonalization, over and above staff, patient, and institutional factors. Supervisor support and caregiving benefits were consistently associated with higher levels on burnout dimensions. In contrast, coworker support was associated with a higher likelihood of depersonalization and emotional exhaustion. CONCLUSION Findings suggest that grief over patient death plays an overlooked role in direct care worker burnout. High supervisor support and caregiving benefits may have protective effects with respect to burnout, whereas high coworker support may constitute a reflection of burnout.
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Affiliation(s)
- Kathrin Boerner
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA.
| | - Hayley Gleason
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Daniela S Jopp
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
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Sawatzky R, Russell L, Friberg F, Carlsson EK, Pettersson M, Öhlén J. Longitudinal person-centered measurement: A psychometric evaluation of the Preparedness for Colorectal Cancer Surgery Questionnaire (PCSQ). PATIENT EDUCATION AND COUNSELING 2017; 100:827-835. [PMID: 27955903 DOI: 10.1016/j.pec.2016.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 10/28/2016] [Accepted: 11/14/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The Preparedness for Colorectal Cancer Surgery Questionnaire (PCSQ) was previously developed in Swedish to assess patients' knowledge seeking and sense making capabilities. Aiming to measure preparedness at different phases during the pre-surgery and recovery period, the objectives were to (a) evaluate psychometric properties of the longitudinal PCSQ, (b) establish measurement invariance over time, and (c) describe change in preparedness. METHODS Elective colorectal cancer surgery patients completed a questionnaire at five time points from pre-surgery until 6 months post-surgery (n=250). The longitudinal PCSQ consists of 23 items measuring four domains: Searching for and making use of information, Understanding and involvement in care, Making sense of recovery, Support and access to care. Psychometric analyses, including confirmatory factor analysis, were applied to evaluate internal consistency reliability and ascertain invariance over time of the measurement structure and parameters. RESULTS The psychometric analyses revealed good fit of the measurement models, high internal consistency reliability (≥.94), and support for configural, metric and scalar measurement invariance of the four PCSQ domains. Patients reported lower levels of preparedness after surgery than pre-surgery. CONCLUSION The adapted version of the PCSQ can be used for longitudinal analyses. PRACTICE IMPLICATIONS The measurement of preparedness is important for evaluating person-centred outcomes before and during recovery from colorectal cancer surgery.
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Affiliation(s)
- Richard Sawatzky
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada; Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, 588-1081 Burrard Street, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada.
| | - Lara Russell
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, 588-1081 Burrard Street, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada; School of Nursing, University of Victoria, P.O. Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada.
| | - Febe Friberg
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway.
| | - Eva K Carlsson
- University of Gothenburg Centre for Person-Centred Care, P.O. Box 457, SE-40539 Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, P.O. Box 457, SES-49539 Gothenburg, Sweden; Department of Colorectal Surgery, Sahlgrenska University Hospital/East, SE_41685 Gothenburg, Sweden.
| | - Monica Pettersson
- University of Gothenburg Centre for Person-Centred Care, P.O. Box 457, SE-40539 Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, P.O. Box 457, SES-49539 Gothenburg, Sweden; Department of Vascular Surgery, Sahlgrenska University Hospital, SE-41345 Gothenburg, Sweden.
| | - Joakim Öhlén
- University of Gothenburg Centre for Person-Centred Care, P.O. Box 457, SE-40539 Gothenburg, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, P.O. Box 457, SES-49539 Gothenburg, Sweden.
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Gray JA, Kim J. Direct care workers’ experiences of grief and needs for support. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 30:995-1006. [DOI: 10.1111/jar.12339] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Jennifer A. Gray
- School of Health StudiesPublic HealthNorthern Illinois University DeKalb IL USA
| | - Jinsook Kim
- School of Health StudiesPublic HealthNorthern Illinois University DeKalb IL USA
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11
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Development and validation of the preparedness for Colorectal Cancer Surgery Questionnaire: PCSQ-pre 24. Eur J Oncol Nurs 2016; 25:24-32. [DOI: 10.1016/j.ejon.2016.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/24/2016] [Accepted: 09/06/2016] [Indexed: 02/04/2023]
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