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Abstract
Statement of the Problem: Grief suffered by staff in long-term care (LTC) facilities is a public health issue. Multiple studies show that the death of a family member can have an impact upon mortality, morbidity, and healthcare expenditures among the bereaved. In the long-term care setting, qualitative and quantitative studies show that (1) staff and residents develop a familial relationship, and (2) staff suffer a variety of grief symptoms when residents die. There is a need to address the bereavement needs of the LTC workforce, particularly in light of shortages in the healthcare workforce. These shortages are particularly severe among nurses and certified nursing assistants (CNAs) within the LTC setting.Purpose of the Study: To document the grief experiences of LTC staff and benefits of end of life planning.
Methods: The first manuscript provides a systematic review of the literature on long-term care staff grief using the PRISMA methodology. It includes quantitative, qualitative, and mixed methods studies. The second manuscript contains a qualitative content analysis (QCA) of seventeen interviews with 28 LTC staff and hospice chaplains that work with them. Those interviews were analyzed for grief symptoms, cumulative loss, and added stressors within the LTC setting. The final manuscript adopts a novel mixed methods approach through the use of QCA and legal analysis. The QCA analyzes the same seventeen interviews for discussions of end of life planning. The legal analysis involves cases brought by family members of deceased for the pain and suffering that they suffered as a result of the hospital’s failure to follow the end of life wishes of their loved ones, and it includes detailed descriptions of the legally compensable pain that they suffered.
Results: LTC staff suffer extensive grief symptoms due to the death of their residents. This pain is often exacerbated by cumulative losses, stressful interactions with family members, and failures in end of life planning. The Physician Orders for Life-Sustaining Treatment (POLST) is an effective tool to promote end of life planning.
Conclusion: LTC facilities should develop provide bereavement resources for staff and promote end of life planning through use of the POLST.