PERT Program

Tip of the Month: March 2004


END-OF-LIFE RESOURCES FOR NURSING ASSISTANTS

There are many ways in which nursing assistants (NAs) contribute to excellence in end-of-life (EOL) care. It is widely accepted that nursing assistants provide up to 90% of hands-on care to residents in the nursing home setting.1 Nursing assistants also are responsible for observing and reporting EOL symptoms and responses to treatment. NAs provide emotional and physical comfort to residents and families, often for months or years. In addition, they provide care at the time of death. These are important roles that can contribute substantially to the well being of nursing home residents.

Despite these key roles, NAs frequently experience low wages, stressful workloads, and lack of respect or affirmation for a job well done.2,3 In addition, NAs often are inadequately prepared to respond to the complex responsibilities of caring for dying residents.3,4 It is no surprise that the rate of turnover of nursing assistants in nursing homes is 40–75%, with some states experiencing turnover as high as 117% annually.5 Frequent staff turnover results in less continuity and quality of care, and can negatively impact resident and family satisfaction.6

One way to deal with high staff turnover and job dissatisfaction is by addressing the learning needs of NAs. The Hospice and Palliative Nurses Association (HPNA) is committed to championing nursing assistants who provide EOL care in diverse settings, including the nursing home. Providing educational resources is one approach by which HPNA provides such support. Some of the educational products and opportunities available through HPNA are described below:


Clinical Review for the Hospice and Palliative Nursing Assistant

This workshop provides nurses an opportunity to increase their knowledge about the role of the NA at the end of life. Nurse participants, many of whom are staff development coordinators or educators, receive instruction about EOL care as it relates to the NA. They also are provided teaching materials to be used in their own in-services and educational offerings. Participants become HPNA-approved instructors and can teach this curriculum to nursing assistants in their facility, agency, or community. Some approved instructors apply their knowledge in preparing nursing assistants for the certification examination (information below). To find an approved instructor in your area, call the HPNA national office at (412) 787-9301 or look on their website at www.hpna.org.


Core Curriculum for the Hospice and Palliative Nursing Assistant
This recent (2003) publication is the first comprehensive presentation of the essential knowledge for nursing assistants involved in EOL care. Based on the Scope and Standard of Hospice and Palliative Nursing Assistant Practice, the Core Curriculum is authored by experts in hospice and palliative care, long-term care, and nursing assistant education. Chapters include all major aspects of practice:
  • Overview of hospice and palliative nursing assistant practice
  • Management of pain and other end-of-life symptoms
  • Ethical issues
  • Communication concerns
  • Cultural issues
  • Loss and bereavement
  • Spiritual care
  • Care of the patient and family when death is nearing
  • Personal and professional development
The text is written in an easy-to-follow outline format. This is a valuable resource for both the individual NA or as an addition to a work setting library.


Study Guide for the Hospice and Palliative Nursing Assistant

This new (2004) resource assists NAs to review the content of the Core Curriculum through the use of chapter-specific questions and answers, as well as case studies. Rationales are included, making it a rich learning tool. In addition, the Study Guide can be used as one source of preparation for the specialty certification exam.


Certification of the Hospice and Palliative Nursing Assistant

Specialty certification is available through HPNA’s sister organization, the National Board for Certification of Hospice and Palliative Nurses (NBCHPN). Certification is a process by which an NA can demonstrate an expert grasp of the principles and techniques of EOL care. In order to sit for the exam, NAs must have 2000 documented practice hours under the supervision of a registered nurse over the past two years. There is a fee for the exam, which is administered two times per year. Upon receiving a passing score, the NA is certified to begin using the credentials CHPNA or Certified Hospice and Palliative Nursing Assistant. For more information, see the NBCHPN website at www.nbchpn.org or follow the link from the HPNA homepage.


Nursing Assistant Teleconferences

On the fourth Wednesday of each month, HPNA sponsors a 30-minute teleconference devoted to EOL topics from a nursing assistant perspective. Up to 30 sites around the country can participate in any given teleconference, and there is no limit on the number of participants from each site. Topics to be presented in 2004 include: cultural considerations at EOL, alcoholism, advance directives, dealing with stress, and the bag bath. Previously presented topics are available to purchase on CD-ROM and all teleconferences include a written handout. This is a fun and reasonably priced opportunity to learn more about EOL issues as they relate to the NA.


HPNA is currently formulating a position statement on the value of the nursing assistant in end-of-life care. Another educational product in the pipeline is a computer-based, interactive teaching program on EOL care specifically for nursing assistants.

All of the aforementioned products and publications are available by calling the HPNA national office at (412) 787-9301 or by accessing their website at www.hpna.org.

Many NAs are deeply committed to their work, and strive to provide high-quality care. Nursing assistants that are educated and confident in their skills in caring for residents at the EOL experience higher job satisfaction. This in turn increases staff retention and improves quality of care and resident satisfaction.7 HPNA is pleased to offer these resources as one means to that end.



References

  1. Waxman HM, Carner EA, Berkenstock G. Job turnover and job satisfaction among nursing home aides. Gerontologist. 1984;24(5):503-509.
  2. Pennington K, Scott J, Magilvy K. The role of certified nursing assistants in nursing homes. Journal of Nursing Administration. 2003;33(11):578-584.
  3. Fitzpatrick PG. Turnover of certified nursing assistants: a major problem for long-term care facilities. Hospital Topics. 2002;80(2):21-25.
  4. Ersek M, Kraybill B, Hansberry J. Assessing the educational needs and concerns of nursing home staff regarding end-of-life care. Journal of Gerontological Nursing. 2000;26(10):16-26.
  5. Caudill M, Patrick M. Nursing assistant turnover in nursing homes and need satisfaction. Journal of Gerontological Nursing. 1989;15(6):24-30.
  6. Mesirow KM, Klopp A, Olson LL. Improving certified nurse aide retention. A long-term care management challenge. Journal of Nursing Administration. 1998;28(3):56-61.
  7. Ersek M, ed. Core Curriculum for the Hospice and Palliative Nursing Assistant. Dubuque, IA: Kendall-Hunt; 2003.