Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #114064

Sharon A. Denham, RN, DSN, Ann Rathbun, PhD, Mary A. Toborg, MPA, Michael G. Meyer, and Leslie Thornton, MA. Toborg Associates, Inc., 1129 Twentieth Street, N.W., Suite 108, Washington, DC 20036-3403, 202-776-0112, sdenham@toborg.net

Americans increasingly end their lives in institutions. As the cost of nursing escalates, facilities that care for the dying, particularly in rural America, more and more turn to less expensive and often undertrained, Certified Nurses' Aides (CNAs) to provide palliative care for the dying. Quality end-of-life care represents an urgent national priority. Rural America contains not just a disproportionate share of the nation's elderly but a higher age-adjusted rate of mortality at every stage of life. Given their relative isolation, rural CNAs have less access to training resources, and for this reason, we seek to develop a computer-based training (CBT) program to train rural CNAs in end-of-life care. Using focus groups and key informant interviews, we sought to define in a preliminary study the perceptions and attitudes of CNAs in rural communities about issues related to the terminally ill and care at the end-of-life. One special focus in the research was issues related to communication with the terminally ill and their family members. In November 2004, we conducted focus groups of rural CNAs in St. Mary's County, Maryland; Brown County, Texas; Carroll County, Kentucky; Jackson County, Ohio; Spencer County, Indiana; and Mills County, Texas. We also conducted structured telephone interviews of 20 key informants around the country. Findings from the focus groups included: CNAs believed their training is inadequate and that many of their skills result from on-the-job observation of other CNAs. CNAs share similar conceptual models to describe their responsibility to patients. Tensions occasionally mark their relationships with nurses in their facilities. CNAs indicate a high degree of commitment to the care of patients. Additionally, four major themes emerged from the expert interviews: The CNAs, patients, and patients' families develop bonds that lead to increased stress for CNAs when the patient dies. CNAs lack training to help patients and family members in grief management and do not know what to say to comfort them. Family members frequently conflict with the CNAs (due largely to their increased stress load) or involve CNAs in family conflicts. CNAs need to be involved in the care team.

Learning Objectives:

(
• Describe the contextual setting of care for terminally ill persons in rural communities. (
• Identify five concerns of Certified Nurses' Assistants (CNAs) in providing adequate care for the dying. (
• Identify four insights of key informants concerning the roles of CNAs in care for the dying.

Keywords: Death, Health Care Workers

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.