Hospice as Experienced by LTC Nurses and Their Perception of Resident Experiences.

OBJECTIVES: This study utilized qualitative methods to better understand long-term care (LTC) nursing staff's experience with hospice services and their perceptions of resident choice to utilize hospice services, as well as understand differences LTC nurses have experienced in regards to resident deaths. METHODS: Interpretative Phenomenological Analysis (IPA) was utilized to extract themes and subthemes from 10 interviews that occurred with LTC nursing staff. Content analysis was also utilized to extract one noteworthy concept, which was a comparison of two resident deaths, with and without the utilization of hospice services. RESULTS: Three main themes were extracted from the data: LTC nursing participant's positive view of hospice, their perception that residents view hospice very negatively, and why residents choose to utilize hospice services. Participants also identified aspects of a "bad" or "good" death, with clear relationships noted when using hospice services. CONCLUSIONS: Findings identified a difference between the LTC nursing staff's positive view of hospice and their belief that their residents view hospice services very negatively. According to these nurses' experiences, to most residents, hospice meant something rather negative and feared. CLINICAL IMPLICATIONS: An intervention providing information about hospice services for LTC resident population may increase the percentage of older adults who utilize hospice services.

Exploring Staff Clinical Knowledge and Practice with LGBT Residents in Long-Term Care: A Grounded Theory of Cultural Competency and Training Needs.

OBJECTIVES: Existing literature shows that LGBT residents are likely to face suboptimal care in LTC facilities due to prejudice and discriminatory policies. The aim of this project was to assess the LGBT cultural competency of staff working in LTC facilities, identify their current training needs, and develop a framework for understanding LGBT cultural competency among LTC staff and providers. METHODS: This grounded theory study comprised data from focus groups of interdisciplinary staff from three LTC facilities. RESULTS: Results suggested that LTC staff struggle with how to be sensitive to LGBT residents' needs. Tension appeared to exist between wanting to provide an equal standard of care to all LTC residents and fearing they would show "favoritism" or "special treatment," which might be viewed as unprofessional. Participants indicated training could help to address the ambivalence they experience about providing sensitive care to subpopulations of residents who face stigma and oppression. CONCLUSIONS: LTC staff stand to benefit from cultural competency training focused on LGBT residents. Training should be not only informational in nature, but also facilitate greater self-awareness and self-efficacy with respect to providing care to LGBT people.

The "We Care" program for long-term care: providing family members with support following the death of a loved one.

Although bereavement programs in hospice and palliative care settings are known to produce positive outcomes for family members after the death of a loved one, currently there is a clear lack of services offered through long-term care (LTC) facilities, where older adults often reside prior to their death. The purpose of the present article is to present an initial bereavement program called We Care that focused on providing additional support for family members who experience a death of a loved one while in a LTC facility. Goals for the program include: 1) providing ongoing contact with the family for 1 year, and 2) offering a bereavement group. The program's model is explained, with highlights of obstacles experienced and suggestions for future programs.

Staff perceptions of same-gender sexual contacts in long-term care facilities.

An ongoing fear in the gay and lesbian community is that long-term care (LTC) facilities may not be sensitive to their needs. In the present study, 218 LTC staff members responded to one of three vignettes in which resident sexual contact was observed, with only the gender of the characters changing, to create different gender pairings. Results suggested that staff rated male-male and female-female pairings more negatively than heterosexual intimacy. Knowledge about older adult sexuality made little difference in staff ratings. However, staff attitudes were directly related to ratings of negative reaction and level of acceptability of same-gender sexuality.

The underreporting gap in aggressive incidents from geriatric patients against certified nursing assistants.

Staff in the health care industry experience workplace aggression at a much higher rate than the general workforce. However, a large proportion of aggressive incidents go unreported, and the source of many of these incidents is patients. This study investigates aggressive incidents from patients against certified nursing assistants (CNAs; n = 76) in a sample of six geriatric care facilities. The results indicate that CNAs experienced a median of 26 aggressive incidents over the course of the 2-week study and that approximately 95% of these incidents were not reported to the facility. The present study also empirically examines reasons why nursing staff decide to report incidents. Finally, this study reveals that the experience of aggression from patients is related to subsequent organizational commitment, job satisfaction, and intent to leave the job.