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.
