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

描述(由申请人提供)：这项研究的主要目标是检查注册护士助理(CNA)如何应对和适应疗养院居民的死亡。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影响。在养老院的背景下，死亡、悲伤和失去的问题是非常相关的。然而，长期护理机构通常很少提供支持、结构或仪式来帮助工作人员度过这段时间(Moss&Moss，2002)。对长期护理工作人员工作生活的一个规范性方面的问题缺乏重视，这可能是这一群体中不断报告的极高更替率的原因。在美国，疗养院的主要照顾者CNA的流动资金估计为每年40亿美元(全国护理劳动力长期护理委员会，2005年)。来自一些探索性研究的证据表明，长期护理人员因居民损失而经历一定程度的悲痛(例如，Wilson&Daley，1998)。然而，这些研究都没有提供对悲伤和悲伤过程的系统评估，也没有将评估与特定的死亡联系起来。其次，大多数人没有关注护理机构，这是养老院中与居民接触最密切的一线工作人员，因此对居民的生活质量有巨大影响(Yeatts&Cady，2007)。最后，很少有研究将与悲痛有关的工作人员反应与与就业有关的重要结果(例如，工作人员流失率)联系起来，以及审查预测这些结果的个人和机构因素。这项拟议的研究试图填补这一空白。具体目标是：1.检查在其照料的居民死亡后的CNA中的悲痛症状和悲伤处理，以及这些经历在多大程度上与先前研究中记录的失去亲人的家庭成员的经历相似；2.调查与悲痛相关的结果和与就业相关的结果之间的关系(例如，保住工作、缺勤、失去工作的影响)；3.确定CNA、居民和机构因素如何与与悲痛和与就业相关的结果相联系，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。数据将通过面对面的访谈收集。本研究采用混合方法设计，包括开放式访谈和结构化访谈部分，以及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助的工作人员，并根据经验确定的可改变因素(例如，制定仪式；支助小组)设计支助干预措施，以成功满足这一需要。我们的长期研究目标是：1)寻求资金用于一项更大规模的关于中国居民悲痛的纵向研究；以及2)进行一项随机临床试验，根据经验结果和中央通讯社确定的需求，测试对中国居民的支持干预，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。注册护理员作为养老院的一线工作人员，与居民接触最密切，对居民的生活质量有着巨大的影响。死亡、悲伤和失去是他们工作生活中一个正常的方面，这可能是导致这一人群极高的离职率的原因之一。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。

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.