Caring for dying residents in aged residential care facilities: the experiences of health care assistants

Abstract

Background: International studies have highlighted the potential barriers to and facilitators of the provision of good end of life care for residents living in aged residential care (ARC) facilities. However, these have largely documented the perspectives of registered nurses and family caregivers and no studies have explored the views of Health Care Assistants (HCAs) who provide the majority of end of life care to residents. Aim: To explore the experiences of HCAs caring for imminently dying residents in ARC. Methods: Six focus group discussions were conducted with HCAs working at ARC facilities in one semi-rural region of Auckland. Facilities were eligible to participate if a death had occurred in the previous 12 months. Twenty six participants from six facilities took part. Focus groups were digitally recorded, transcribed verbatim and analysed using a general inductive approach. Results: Four distinct themes that influenced participants’ ability to care for the dying resident were identified. These included the themes Supportive Leadership, Team Recognition, Building Connections and Attributes of HCAs. Further analysis resulted in these four themes being organised into two conceptual domains: Organisation and Self. Implications for Practice: In order to maximise HCAs potential to care for dying residents it is recommended that: (1) communication skills workshops form an integral role for staff caring for residents and their families; (2) facilities recognise “expert” HCAs who can provide peer support to others unfamiliar with end of life care provision through a peer mentoring system; and (3) staff are given an opportunity to debrief following the death of a resident. Conclusion: This study describes the challenges faced by HCAs when caring for imminently dying residents. The findings offer a contribution to the limited evidence available in the international literature. Further research is required to build on these findings to identify strategies to enhance the care provided by HCAs to imminently dying residents and their families.