Friday, April 24, 2015

Certified Nursing Assistant (CNA): End-of-Life Care in Long-Term Care (Research, Video 1:51)

As a hospice volunteer working directly with patients, I had many opportunities to observe and communicate with certified nursing assistant (CNA) staff members. They provided most of residents’ daily care and were often first responders in meeting residents’ needs that required immediate attention. Many exhibited dedication and genuine concern for residents, in spite of their own expressed problems on the job such as low pay and high staff turnover resulting in increased workloads.

The success or failure of quality in the lives of residents always depends on the context in which it is given. That context includes everything and everybody involved. Because of their active roles in residents’ lives and the frequency of death in long-term care facilities, the importance of excellence in preparation of CNAs should be mandatory. What are the characteristics of the residents, CNAs, and the care context associated with preparedness for residents’ deaths?

Research on the CNA preparedness role included in-person interviews with 140 CNAs about their experiences regarding residents' deaths. These experiences included characteristics such as care preferences, status perceptions of residents, and the caregiving context with emotional and informational preparedness. These were the results:

1)    CNAs who reported that residents were "aware of dying" or "in pain" expressed higher levels of both emotional and informational preparedness.
2)    CNAs who endorsed an end-of-life care preference of wanting all possible treatments regardless of chances for recovery were likely to report lower emotional preparedness.
3)    More senior CNAs, both in regard to age and tenure, reported higher preparedness levels.
4)    Greater support from coworkers and hospice involvement were associated with higher levels of both facets of preparedness, the latter in particular when hospice care was viewed positively by the CNAs.

This research concludes that more information about the status of residents and more exchange opportunities within the care team around end-of-life care-related challenges may help CNAs feel more prepared for residents' deaths and strengthen their ability to provide good end-of-life care. Creating this kind of context requires ongoing commitment, implementation, and monitoring.

In this video, a CNA explains her passion for hospice care and her role on the interdisciplinary team.

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.


  1. Ronee Henson, Hospice volunteerApril 26, 2015

    CNA's give their best to their patients!!! They are wonderfully loving people!!!
    Hospices need them desperately.

  2. Thanks for commenting Ronee. I noticed that the regular CNAs were able to bond much more with residents. Staff shortages were frustrating for CNAs and residents. They were glad to have a hospice volunteer like me to help with feeding hospice patients assigned to the volunteer. Ongoing education is needed for those absent or not hired when inservices are given.

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