Skip to main content Accessibility help
×
×
Home

End of Life in Residential Care from the Perspective of Care Aides*

  • Shelly Waskiewich, Laura M. Funk (a1) and Kelli I. Stajduhar (a2)

Abstract

We explored contextual features shaping end-of-life (EOL) care in residential care facilities by drawing on the perspectives of 11 resident care aides (RCAs) in one Western Canadian urban centre. RCAs characterized EOL care as “providing comfort”, including physical and emotional comfort. Concerns with time and workload challenges dominated accounts and generated guilt, sadness, and frustration. RCAs tried to “find the time” by taking it from themselves or other residents, and by relying on the commitment of co-workers and on families. Findings emphasize the importance of the RCA role (particularly in emotional comfort), yet call for attention to interpretations of what is involved in this work, and to definitions of scopes of practice and training requirements. Findings reiterate the importance, among Canadian RCAs, of appropriate workloads to facilitate quality EOL care, and raise concerns about how time constraints shape EOL care practice and the meanings infusing this practice.

Nous avons examiné les caractéristiques contextuelles qui façonnent les soins de fin de vie (SFV) dans les établissements de soins pour bénéficiaires, en s’appuyant sur les perspectives de 11 aidants résidents (AR) dans un centre urbain canadien de l’Ouest. ARs décrivent les soins de fin de vie comme “offrant un confort,” y compris le bien-être physique et émotionnel. Les inquiétudes au sujet des défis posés par le temps et la charge de travail ont dominé les comptes et ont généré la culpabilité, la tristesse et de la frustration. ARs ont essayé de “trouver le temps” en le prenant d’eux-mêmes ou les autres résidents, et en s’appuyant sur l’engagement des collègues et sur les familles. Les résultats soulignent l’importance du rôle d’AR (en particulier en offrant un confort émotionnel), mais faire appel à l’attention à l’interprétation de ce qui est impliqué dans ce travail, et à la définition du portée de la pratique et de la formation. Les résultats également réitère l’importance, entre aidants résidents canadiens, des charges de travail adéquates pour faciliter les soins de fin de vie de qualité, et soulève des préoccupations au sujet des contraintes et comment elles forment la pratique de soins de fin de vie et les significations qui infusent une telle pratique.

Copyright

Corresponding author

Correspondence and requests for offprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Laura M. Funk, Ph.D. Department of Sociology University of Manitoba Isbister Building 307-183 Dafoe Road Winnipeg, Manitoba R3T 2N2 (Laura.Funk@ad.umanitoba.ca)

Footnotes

Hide All
*

We thank the RCAs who contributed their time, as well as Elizabeth Causton, who assisted with interviewing and review of this manuscript. The guidance of Heather Cook, Holly Tuokko, and André Smith is also acknowledged, as is the advice of John Bond. Shelly Waskiewich was supported by a University of Victoria Interdisciplinary Student Award; Kelli Stajduhar is supported by a New Investigator award from the Canadian Institutes of Health Research and a Scholar Award from the Michael Smith Foundation for Health Research.

Deceased

Footnotes

References

Hide All
Abbey, J., Froggatt, K.A., Parker, D., & Abbey, B. (2006). Palliative care in long-term care: A system in change. International Journal of Older People Nursing, 1(1), 5663.
Blasi, Z.V., Hurley, A.C., & Volicer, L. (2002). End-of-life care in dementia: A review of problems, prospects, and solutions in practice. Journal of the American Medical Directors Association, 3, 5765.
Brazil, K., Bedard, M., Krueger, P., Taniguchi, A., Kelley, M.L., McAiney, C., et al. . (2006). Barriers to providing palliative care in long-term care facilities. Canadian Family Physician, 52, 472473.
Brazil, K., McAiney, C., Caron-O’Brien, M., Kelley, M.L., O’Krafka, P., & Sturdy-Smith, C. (2004). Quality end-of-life care in long-term care facilities: Service providers’ perspective. Journal of Palliative Care, 20(2), 8592.
Brazil, K., & Vohra, J.U. (2005). Identifying educational needs in end-of-life care for staff and families of residents in care facilities. International Journal of Palliative Nursing, 11(9), 475480.
Chen, J.-H., Chan, D.-C., Kiely, D.L., Morris, J.N., & Mitchell, S.L. (2007). Terminal trajectories of functional decline in the long-term care setting. Journal of Gerontology, 62(5), 531536.
Ersek, M., Kraybill, B.M., & Hansberry, J. (1999). Investigating the educational needs of licensed nursing staff and certified nursing assistants in nursing homes regarding end-of-life care. American Journal of Hospice & Palliative Care, 16(4), 573582.
Ersek, M., & Wilson, S.A. (2003). The challenges and opportunities in providing end-of-life care in nursing homes. Journal of Palliative Medicine, 6(1), 4557.
Froggatt, K.A. (2001). Palliative care and nursing homes: Where next? Palliative Medicine, 15, 4248.
Goodridge, D., Bond, J.B., Cameron, C., & McKean, E. (2005). End-of-life care in a nursing home: A study of family, nurse and healthcare aide perspectives. International Journal of Palliative Nursing, 11(5), 226232.
Graham, J.E., Rockwood, K., Beattie, B.L., Eastwood, R., Gauthier, S., Tuokko, H., et al. . (1997). Prevalence and severity of cognitive impairment with and without dementia in an elderly population. Lancet, 349, 17931796.
Hall, P., Schroder, C., & Weaver, L. (2002). The last 48 hours of life in long-term care: A focused chart audit. Journal of the American Geriatrics Society, 50(3), 501506.
Hanson, L.C., Henderson, M., & Menon, M. (2002). As individual as death itself: A focus group study of terminal care in nursing homes. Journal of Palliative Medicine, 5(1), 117125.
Harris, D. (2007). Forget me not: Palliative care for people with dementia. Postgraduate Medical Journal, 83, 362366.
Kaasalainen, S., Brazil, K., Ploeg, J., & Martin, L.S. (2007). Nurses’ perceptions around providing palliative care for long-term care residents with dementia. Journal of Palliative Care, 23(3), 173180.
Kayser-Jones, J. (2002). The experience of dying: An ethnographic nursing home study. The Gerontologist, 42(3), 1119.
Kayser-Jones, J., Schell, E., Lyons, W., Kris, A.E., Chan, J., & Beard, R.L. (2003). Factors that influence end-of-life care in nursing homes: The physical environment inadequate staffing, and lack of supervision. The Gerontologist, 43(2), 7684.
Lunney, J.R., Lynn, J., Foley, D.L., Lipson, S., & Guralnik, J.M. (2003). Patterns of functional decline at the end of life. Journal of the American Medical Association, 289(18), 23872392.
Moss, M.S., Braunschweig, H., & Rubinstein, R.L. (2002). Terminal care for nursing home residents with dementia. Alzheimer’s Care Quarterly, 3(3), 233246.
Munn, J.C., Dobbs, D., Meier, A., Williams, C.S., Biola, H., & Zimmerman, S. (2008). The end-of-life experience in long-term care: Five themes identified from focus groups with residents, family members, and staff. The Gerontologist, 48(4), 485494.
Nochomovitz, E., Prince-Paul, M., Dolansky, M., Singer, M.E., DeGolia, P., & Frank, S.H. (2010). State tested nursing aides’ provision of end-of-life care in nursing homes. Journal of Hospice and Palliative Nursing, 12(4), 255262.
Quadagno, J., & Stahl, S.M. (2003). Challenges in nursing home care: A research agenda. The Gerontologist, 43(2), 46.
Raudonis, B.M., Kyba, F.C.N., & Kinsey, T.A. (2002). Long-term care nurses’ knowledge of end-of-life care. Geriatric Nursing, 23(6), 296301.
Rice, K.N., Coleman, E.A., Fish, R., Levy, C., & Kutner, J.S. (2004). Factors influencing models of end-of-life care in nursing homes: Results of a survey of nursing home administrators. Journal of Palliative Medicine, 7(5), 668675.
Temkin-Greener, H., Zheng, N., Norton, S.A., Quill, T., Ladwig, S., & Veazie, P. (2009). Measuring end-of-life care processes in nursing homes. The Gerontologist, 49(6), 803815.
Thorne, S., Kirkham, S.R., & MacDonald-Emes, J. (1997). Interpretive description: A noncategorical qualitative alternative for developing nursing knowledge. Research in Nursing & Health, 20, 169177.
Thorne, S., Reimer Kirkham, S., & O’Flynn Magee, K. (2004). The analytic challenge in interpretive description. International Journal of Qualitative Methods, 3(1), 121.
Travis, S.T., Bernard, M., Dixon, S., McAuley, W.J., Loving, G., & McClanahan, L. (2002). Obstacles to palliation and end-of-life care in a long-term care facility. The Gerontologist, 42(3), 342349.
Volicer, L. (2002). Commentary on “Terminal care for nursing home residents with dementia” by MS Moss et al. Alzheimer’s Care Quarterly, 3(3), 247251.
Watson, J., Hockley, J., & Dewar, B. (2006). Barriers to implementing an integrated care pathway for the last days of life in nursing homes. International Journal of Palliative Nursing, 12(5), 234240.
Wetle, T., Shield, R., Teno, J., Miller, S.C., & Welch, L. (2005). Family perspectives on end-of-life care experiences in nursing homes. The Gerontologist, 45(5), 642650.
Wilson, S.A., & Daley, B.J. (1998) Attachment/detachment: Forces influencing care of the dying in long-term care. Journal of Palliative Medicine, 1(1), 2134.
Wowchuk, S.M., McClement, S., & Bond, J. (2006). The challenge of providing palliative care in the nursing home part I: External factors. International Journal of Palliative Nursing, 12(6), 260267.
Zimmerman, S., Sloane, P.D., Hanson, L., Mitchell, M., & Shy, A. (2003). Staff perceptions of end-of-life care in long-term care. Journal of the American Medical Directors Association, 4(1), 2326.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Canadian Journal on Aging / La Revue canadienne du vieillissement
  • ISSN: 0714-9808
  • EISSN: 1710-1107
  • URL: /core/journals/canadian-journal-on-aging-la-revue-canadienne-du-vieillissement
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed