title: Grief after patient death: direct care staff in nursing homes and homecare.
abstract: BACKGROUND
  Patient death is common in long-term care (LTC). Yet, little attention has been paid to how direct care staff members, who provide the bulk of daily LTC, experience patient death and to what extent they are prepared for this experience.
  
  
  OBJECTIVE
  To 1) determine how grief symptoms typically reported by bereaved family caregivers are experienced among direct care staff, 2) explore how prepared the 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 the staff. Grief was more intense when staff-patient relationships were closer, care was provided for longer, and staff felt emotionally unprepared for the death.
  
  
  CONCLUSIONS
  Grief symptoms like those experienced by family caregivers are common among direct care workers after 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.
authors.affiliation: Jewish Home Lifecare, Research Institute on Aging, New York, New York, USA; Brookdale Department of Geriatrics & Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA. Electronic address: kboerner@jewishhome.org.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Boerner
authors.affiliation: Jewish Home Lifecare, Research Institute on Aging, New York, New York, USA.
authors.forename: Orah R
authors.initials: OR
authors.lastname: Burack
authors.affiliation: Department of Psychology, Fordham University, Bronx, New York, USA.
authors.forename: Daniela S
authors.initials: DS
authors.lastname: Jopp
authors.affiliation: RBC Retirement Research Centre, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Mock
mesh_terms: D000328:Adult; D000368:Aged; D001601:Bereavement; D017028:Caregivers / Q000523:psychology; D003430:Cross-Sectional Studies; D003643:Death; D005190:Family / Q000523:psychology; D005260:Female; D006117:Grief; D006282:Health Personnel / Q000523:psychology*; D006699:Home Care Services; D006801:Humans; D008134:Long-Term Care / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D011368:Professional-Family Relations; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D055815:Young Adult
keywords: Grief; bereavement; caregiving; direct care staff; homecare workers; nursing assistants; patient death; preparedness