Bereavement in certified nurse assistants: Quality of care and workforce issues

认证护士助理的丧亲之痛：护理质量和劳动力问题

• 批准号: 7896052
• 负责人: Kathrin Boerner
• 金额: $ 5.25万
• 依托单位: JEWISH HOME LIFECARE, MANHATTAN
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-05-15 至 2012-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7896052
• 关键词: Absenteeism; Address; Adult; Age; Attention; Bereavement; Caregivers; Caring; Cessation of life; Code; Data; Development; Discipline of Nursing; Doctor of Philosophy; Elderly; Elements; Employment; Event; Exhibits; Family; Family Caregiver; Family member; Feeling; Fostering; Funding; Goals; Grant; Grief reaction; Health Personnel; Healthcare Systems; Home Nursing Care; Individual; Intensive Care; Intervention; Interview; Investigation; Job Satisfaction; Knowledge; Left; Life; Link; Literature; Long-Term Care; Longevity; Longitudinal Studies; Measures; Methods; Mosses; Motivation; New York; Nurses; Nurses' Aides; Nursing Homes; Occupations; Outcome; Participant; Patients; Persons; Population; Preparation; Process; Psychology; Public Health; Quality of Care; Quality of life; Randomized Clinical Trials; Recruitment Activity; Reporting; Research; Ritual compulsion; Role; Site; Stress; Structure; Support Groups; Symptoms; Testing; Time; United States National Institutes of Health; Work; Workplace; base; caregiving; coping; cost; design; disability; experience; innovation; knowledge base; member; programs; public health relevance; response; satisfaction; standardize measure; stressor

DESCRIPTION (provided by applicant): The primary goal of this study is to examine how Certified Nurse Assistants (CNAs) respond and adapt to the death of nursing home residents. This information has important implications for CNAs' continued tenure and ability to provide high quality care. Issues of dying, grief, and loss are extremely pertinent in the nursing home context. However, long-term care facilities typically provide little support, structure, or ritual to help staff through this time (Moss & Moss, 2002). This lack of attention regarding an issue that is a normative aspect of work life for long-term care staff may contribute to the extremely high turnover rate in this population that is consistently reported. The cost of turnover in CNAs, the principal caregivers in nursing homes, is estimated at $4 billion per year in the US (National Commission on Nursing Workforce for Long-Term Care, 2005). Evidence from a few exploratory studies suggests that long-term care staff experience some degree of grief in response to resident loss (e.g., Wilson & Daley, 1998). Yet, none of these studies provide a systematic assessment of grief and grief processing, and they fail to link assessments to particular deaths. Second, most do not focus on CNAs, the front-line staff in nursing homes who have the closest contact with the residents, and therefore have a tremendous impact on residents' life quality (Yeatts & Cready, 2007). Finally, few studies link grief-related staff responses with important employment-related outcomes (e.g., staff turnover), as well as examine the individual and institutional factors that predict these outcomes. The proposed research seeks to fill this void. Specific aims are: 1. To examine grief symptoms and grief processing in CNAs after the death of a resident in their care, and the extent to which these experiences parallel the experience of bereaved family members documented in prior research; 2. To investigate the relationship between grief- related and employment-related outcomes (e.g., job retention, absenteeism, impact of loss on work); 3. To determine how CNA-, resident-, and institutional factors are linked to grief- and employment-related outcomes, and to identify which of these are the strongest predictors of these outcomes. Participants will be 120 CNAs who provide nursing home care to residents of one of the largest health care providers for elders in New York State. Data will be collected through in-person interviews. The study has a mixed methods design, with both open and structured interview parts, and qualitative and quantitative data coding and analyses. The proposed research will provide the empirical knowledge base to adequately identify staff who are in need of support after the death of a resident, and to design support interventions based on empirically identified modifiable factors (e.g., development of rituals; support groups) that can successfully address this need. Our long-term research goals are: 1) to seek funding for a larger, longitudinal study of grief among CNAs, and 2) to conduct a randomized clinical trial to test a support intervention for CNAs based on empirical findings and CNA identified needs and determine effects on employment satisfaction and retention, as well as ability to cope with bereavement and to bond with other residents. PUBLIC HEALTH RELEVANCE: High quality care in nursing homes is an important public health need. As the front-line staff in nursing homes, certified nursing aides (CNAs) have the closest contact with the residents and therefore have a tremendous impact on residents' life quality. Issues of dying, grief, and loss are a normative aspect of their work life that may contribute to the extremely high turnover rate in this population. Thus, a better understanding of how CNAs respond to the death of residents, and what kind of support they may need, has important implications for the delivery and quality of care provided in nursing homes.

描述（由申请人提供）：本研究的主要目标是检查认证护士助理（CNA）如何应对和适应养老院居民的死亡。这一信息对CNA的持续任期和提供高质量护理的能力具有重要意义。死亡，悲伤和损失的问题在养老院的背景下是非常相关的。然而，长期护理设施通常提供很少的支持，结构，或仪式，以帮助工作人员通过这段时间（莫斯和莫斯，2002年）。这种缺乏关注的问题，是一个规范方面的长期护理工作人员的工作生活可能会导致极高的更替率，在这一人群中，不断报告。在美国，护理之家的主要护理人员CNA的周转成本估计为每年40亿美元（国家长期护理护理劳动力委员会，2005年）。一些探索性研究的证据表明，长期护理人员在应对居民损失时会经历一定程度的悲伤（例如，Wilson & Daley，1998）。然而，这些研究都没有提供一个系统的评估悲伤和悲伤的处理，他们未能将评估与特定的死亡联系起来。第二，大多数人没有关注养老院的一线工作人员CNA，他们与居民接触最密切，因此对居民的生活质量有巨大的影响（Yeatts & Cready，2007）。最后，很少有研究将工作人员的悲伤反应与重要的就业相关结果联系起来（例如，工作人员更替率），并审查预测这些结果的个人和机构因素。拟议的研究旨在填补这一空白。具体目标是：1。研究悲伤症状和悲伤处理后，在CNA的居民在他们的照顾死亡，以及在何种程度上这些经验平行的经验，在以前的研究中记录的丧亲家庭成员; 2。调查悲伤相关和就业相关结果之间的关系（例如，工作保留、缺勤、损失对工作的影响）; 3.确定CNA、居民和机构因素如何与悲伤和就业相关结果联系起来，并确定其中哪些是这些结果的最强预测因素。参与者将是120名CNA，他们为纽约州最大的老年人医疗保健提供者之一的居民提供养老院护理。数据将通过面对面访谈收集。本研究采用开放式访谈和结构化访谈相结合的混合研究方法，采用定性和定量相结合的数据编码和分析方法。拟议的研究将提供经验知识基础，以充分确定居民死亡后需要支持的工作人员，并根据经验确定的可修改因素（例如，仪式的发展;支持团体），可以成功地解决这一需要。我们的长期研究目标是：1）为CNA中悲伤的更大，纵向研究寻求资金，2）进行随机临床试验，以测试CNA的支持干预基于实证研究结果和CNA确定的需求，并确定对就业满意度和保留的影响，以及科普丧亲之痛和与其他居民建立联系的能力。 公共卫生相关性：养老院的高质量护理是一项重要的公共卫生需求。护理助理员作为护理院的一线工作人员，与院友的接触最为密切，对院友的生活质量有着重要的影响。死亡，悲伤和损失的问题是他们工作生活中的一个规范方面，可能导致这一人群的极高流动率。因此，更好地了解CNA如何应对居民的死亡，以及他们可能需要什么样的支持，对养老院提供的护理服务和质量具有重要意义。