title: "Sometimes I've gone home feeling that my voice hasn't been heard": a focus group study exploring the views and experiences of health care assistants when caring for dying residents.
abstract: BACKGROUND
  In most developed countries, Health Care Assistants comprise a significant, and growing, proportion of the residential aged care workforce. Despite the fact that they provide the majority of direct care for residents, little is known about a key care aspect of their work, namely their experience of caring for dying residents.
  
  
  METHODS
  Twenty-six Health Care Assistants working in aged residential care facilities in Auckland, New Zealand participated in six focus group discussions. Focus groups were designed to explore the experiences of Health Care Assistants caring for imminently dying residents in aged care facilities and to identify barriers and facilitators to their work in this area. The focus groups were digitally recorded, transcribed verbatim and analysed using a general inductive approach.
  
  
  RESULTS
  Participants confirmed that Health Care Assistants provide the majority of hands on care to dying residents and believed they had a valuable role to play at this time due to their unique 'familial' relationship with residents and families. However, it was apparent that a number of barriers existed to them maximising their contribution to supporting dying residents, most notably the lack of value placed on their knowledge and experience by other members of the multidisciplinary team. Whilst a need for additional palliative and end of life care education was identified, a preference was identified for hands on education delivered by peers, rather than the didactic education they currently receive.
  
  
  CONCLUSIONS
  Given ageing populations internationally coupled with a constrained health budget, the role of Health Care Assistants in most developed countries is likely to become even more significant in the short to medium term. This study makes a unique contribution to the international literature by identifying the barriers to caring for dying residents experienced by this valuable sector of the aged care workforce. These data have the potential to inform new, innovative, interventions to address the urgent need identified to improve palliative and end of life care management in aged care internationally.
authors.affiliation: Manukau Locality, Counties Manukau Health, Manukau, New Zealand.
authors.forename: Susan
authors.initials: S
authors.lastname: Fryer
authors.affiliation: North West London Clinical Research Network, London, England.
authors.forename: Gary
authors.initials: G
authors.lastname: Bellamy
authors.affiliation: School of Nursing, University of Auckland, Auckland, New Zealand.
authors.forename: Tessa
authors.initials: T
authors.lastname: Morgan
authors.affiliation: School of Nursing, University of Auckland, Auckland, New Zealand. m.gott@auckland.ac.nz.
authors.forename: Merryn
authors.identifier: http://orcid.org/0000-0003-4399-962X
authors.initials: M
authors.lastname: Gott
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D017028:Caregivers / Q000523:psychology; D002983:Clinical Competence / Q000592:standards; D017144:Focus Groups; D006282:Health Personnel / Q000523:psychology* / Q000592:standards; D006707:Homes for the Aged; D006801:Humans; D008875:Middle Aged; D009520:New Zealand; D009735:Nursing Homes; D010549:Personal Satisfaction; D011368:Professional-Family Relations; D013727:Terminal Care / Q000523:psychology*; D055815:Young Adult
keywords: Aged residential care; Care home; Dying; End of life; Health care assistant; Nursing home; Older people; Palliative; Residential aged care settings