Boerner Kathrin, Burack Orah R, Jopp Daniela S, Mock Steven E
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.
Jewish Home Lifecare, Research Institute on Aging, New York, New York, USA.
J Pain Symptom Manage. 2015 Feb;49(2):214-22. doi: 10.1016/j.jpainsymman.2014.05.023. Epub 2014 Jul 1.
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.
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.
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.
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.
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.
患者死亡在长期护理（LTC）中很常见。然而，对于提供大部分日常长期护理的直接护理人员如何经历患者死亡以及他们对这种经历的准备程度，却很少有人关注。
1）确定直接护理人员中通常由丧亲家庭护理人员报告的悲伤症状的体验情况；2）探讨工作人员对患者死亡的准备程度；3）确定与他们的悲伤相关的特征。
这是一项对经历过近期患者死亡的直接护理人员的横断面研究。参与者包括140名注册护理助理和80名家庭护理人员。标准化评估和结构化问题涉及工作人员（例如对死亡的准备情况）、机构（例如支持的可用性）以及患者/关系因素（例如关系质量）。数据分析包括双变量组比较和层次回归。
工作人员的悲伤反应反映了在一项大规模护理研究中丧亲家庭护理人员报告的许多核心悲伤症状。工作人员中普遍存在对死亡“完全没有准备”的感觉以及在“接受死亡”方面的挣扎。当工作人员与患者的关系更密切、护理时间更长且工作人员在情感上对死亡没有准备时，悲伤会更强烈。
患者死亡后，像家庭护理人员所经历的那种悲伤症状在直接护理人员中很常见。通过更好的培训和支持来提高对这种经历的准备程度，可能会改善直接护理人员的职业体验，并最终使他们能够在养老院和家庭护理中提供更好的姑息治疗。
