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

描述（由申请人提供）：本研究的主要目的是研究注册护士助理（CNAs）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、悲伤和失去的问题在养老院的环境中是非常相关的。然而，长期护理机构通常很少提供支持、结构或仪式来帮助员工度过这段时间（Moss & Moss, 2002）。缺乏对长期护理人员工作生活的规范方面的关注可能导致这一人群的极高流动率，这一直是报道的。在美国，作为养老院主要护理人员的CNAs每年的营业额估计为40亿美元（国家长期护理工作人员委员会，2005年）。一些探索性研究的证据表明，长期护理人员在面对住院医生的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对悲伤和悲伤处理的系统评估，也没有将评估与特定的死亡联系起来。其次，大多数研究都没有关注到与居民接触最密切的养老院一线工作人员CNAs，他们对居民的生活质量有着巨大的影响（Yeatts & Cready, 2007）。最后，很少有研究将与悲伤有关的工作人员反应与重要的与就业有关的结果（例如，工作人员离职）联系起来，并审查预测这些结果的个人和机构因素。拟议中的研究试图填补这一空白。具体目标是：1.；研究住院医师死亡后的悲伤症状和悲伤处理，以及这些经历与先前研究中记录的丧亲家庭成员的经历相似的程度；2. 调查与悲伤相关的结果与就业相关的结果之间的关系（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的结果相关联，并确定哪些因素是这些结果的最强预测因子。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的方式收集。本研究采用混合方法设计，包括开放式和结构化访谈部分，定性和定量数据编码和分析。拟议的研究将提供经验知识基础，以充分确定在居民死亡后需要支持的工作人员，并根据经验确定的可改变因素（例如，制定仪式；支持团体）设计能够成功满足这一需求的支助干预措施。我们的长期研究目标是：1)为一项更大规模的、针对CNA悲痛的纵向研究寻求资金支持；2)进行一项随机临床试验，基于经验发现和CNA确定的需求，测试对CNA的支持干预，并确定对就业满意度和保留率的影响，以及应对丧亲之痛和与其他住院医师联系的能力。

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.