Caring for Dying Patients in the Nursing Home: Voices From Frontline Nursing Home Staff.
Nursing homes are an important site for end-of-life care, yet little is known about the perspectives of the frontline staff who provide a majority of this care.



To describe, from the staff perspective, positive/negative experiences related to caring for dying residents.



Qualitative analysis using survey data from staff working in 52 Indiana nursing homes.



A total of 707 frontline staff who provide nursing, nurse aide, and social work services responded to open-ended prompts. Study data included responses to open-ended prompts asking participants to describe one positive experience and one negative experience caring for a dying patient. A thematic content analysis was conducted using the constant-comparative method. Respondents were largely female (93%), white (78%), 31-50 years (42%), and 53% had >5 years of nursing home work experience. Experiences were described from three perspectives: 1) first-hand experiences, 2) observed experiences of dying patients, and 3) observed experiences of family members. Selected themes for positive experiences include the following: creating close bonds; good patient care; involvement of hospice; being prepared; and good communication. Selected themes for negative experiences consisted of the following: challenging aspects of care; unacknowledged death; feeling helpless; uncertainty; absent family; painful emotions; and family discord.



Findings reveal the richness and many complexities of providing end-of-life care in nursing homes and have implications for improving staff knowledge, coordination of care with hospice, and social support for patients.
University of Maryland, Baltimore, Maryland, USA. Electronic address: jcagle@ssw.umaryland.edu.
John G
JG
Cagle
Indiana University Center for Aging Research, Indianapolis, Indiana, USA; Regenstrief Institute, Inc., Indianapolis, Indiana, USA.
Kathleen T
KT
Unroe
University of Maryland, Baltimore, Maryland, USA.
Morgan
M
Bunting
Indiana University Center for Aging Research, Indianapolis, Indiana, USA; Regenstrief Institute, Inc., Indianapolis, Indiana, USA.
Brittany L
BL
Bernard
Brown University School of Public Health, Providence, Rhode Island, USA.
Susan C
SC
Miller
D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D019538:Health Care Surveys; D017051:Hospice Care / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D009740:Nursing Staff; D012944:Social Support; D013727:Terminal Care / Q000523:psychology*
Long-term care; death; hospice; palliative care; person-centered care; quality of dying