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State Tested Nursing Aides' Provision of End-of-Life Care in Nursing Homes: Implications for Quality Improvement

Nochomovitz, Emma MPH; Prince-Paul, Maryjo PhD, APRN, AHPCN, FPCN; Dolansky, Mary PhD, RN; Singer, Mendel E. PhD; DeGolia, Peter MD, CMD; Frank, Scott H. MD, MS

Journal of Hospice & Palliative Nursing: July-August 2010 - Volume 12 - Issue 4 - p 255-262
doi: 10.1097/NJH.0b013e3181dfd012
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An increasing prevalence in deaths occurring within nursing homes has led to a growing concern surrounding quality issues in end-of-life (EOL) nursing home care. In addition, prior research has failed to emphasize the importance of state tested nursing aides (STNAs) in providing this type of care. The purpose of this study was to examine quality issues in EOL nursing home care within the context of STNAs' comfort in providing this care. A convenience sample of 108 STNAs from four nursing homes in the Cleveland, Ohio area used PDAs to provide answers to an audio questionnaire. Questions included emergent themes from the literature pertaining to EOL care in nursing homes, as well as materials from a national education initiative to improve palliative care. Findings demonstrated lack of comfort in discussing death with nursing home residents and their families and insufficient knowledge surrounding EOL decisions and certain types of EOL care. Overall, the level of comfort providing EOL care was found to be associated with STNAs' perceived importance of EOL care, understanding of hospice, and spiritual well-being.

Author Affiliations: Emma Nochomovitz, MPH, is Research Analyst, National Quality Forum, Washington, DC and Case Western Reserve University, Cleveland, OH.

Maryjo Prince-Paul, PhD, APRN, AHPCN, FPCN, is Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH.

Mary Dolansky, PhD, RN, is Assistant Professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH.

Mendel E. Singer, PhD,is Associate Professor, Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH.

Peter DeGolia, MD, CMD, is Director, Center for Geriatric Medicine, University Hospitals Case Medical Center and Associate Professor, Family Medicine, Case Western Reserve University School of Medicine, Cleveland, OH.

Scott H. Frank, MD, MS, is Director, Master of Public Health Program, Department of Epidemiology and Biostatistics, Department of Family Medicine, Case Western Reserve University, Cleveland, OH.

Address correspondence to Emma Nochomovitz, MPH, National Quality Forum, 601 13th St NW, Suite 500 North Washington, DC 20005 (enochomo@yahoo.com).

© 2010 The Hospice and Palliative Nurses Association