Grief After Patient Death: Direct Care Staff in Nursing Homes and Homecare

• Kathrin Boerner, PhD^{1, 2, ,} ,
• Orah R. Burack, MA²,
• Daniela S. Jopp, PhD³,
• Steven E. Mock, PhD⁴

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Journal of Pain and Symptom Management

Available online 1 July 2014

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Abstract

Context.

Patient death is common in long-term care. Yet, little attention has been paid to how direct care staff members, who provide the bulk of daily long-term care, experience patient death and to what extent they are prepared for this experience.

Objectives

To

 1) determine how grief symptoms typically reported by bereaved family caregivers are experienced among direct care staff, 

2) explore how prepared staff members were for the death of their patients, and

 3) identify characteristics associated with their grief.

Methods

This was a cross-sectional study of direct care staff experiencing recent patient death. Participants were 140 certified nursing assistants and 80 homecare workers. Standardized assessments and structured questions addressed staff (e.g., preparedness for death), institutional (e.g., support availability), and patient/relational factors (e.g., relationship quality). Data analyses included bivariate group comparisons and hierarchical regression.

Results

Grief reactions of staff reflected many of the core grief symptoms reported by bereaved family caregivers in a large-scale caregiving study. Feelings of being “not at all prepared” for the death and struggling with “acceptance of death” were prevalent among staff. Grief was more intense when staff-patient relationships were closer, care was provided for longer, and staff felt emotionally unprepared for the death.

Conclusion

Grief symptoms like those experienced by family caregivers are common among direct care workers following patient death. Increasing preparedness for this experience via better training and support is likely to improve the occupational experience of direct care workers, and ultimately allow them to provide better palliative care in nursing homes and homecare.

Key Words

• Grief;
• bereavement;
• preparedness;
• patient death;
• caregiving;
• nursing assistants;
• homecare workers;
• direct care staff

Address correspondence to: Kathrin Boerner, PhD Jewish Home Lifecare, Research Institute on Aging, 120 West 106th Street, New York, NY 10025, USA.