In the presence of death and dying: death attitudes and compassion fatigue among certified nursing assistants in skilled care.

Objectives: Certified Nursing Assistants (CNAs) are responsible for 80-90% of direct-to-resident care in skilled nursing facilities (SNFs), and may develop close, family-like relationships with their residents. With SNFs becoming a common place of death for older adults, CNAs now find themselves engaging in end-of-life caregiving with limited training and institutional support for emotional outcomes. This study aimed to understand and evaluate the relations between bereavement, death exposure, and compassion fatigue among CNAs, hypothesizing that (a) experiential avoidance moderates the relation between death exposure and negative death attitudes and (b) death attitudes moderate the relation between death exposure and compassion fatigue.

Method: One hundred and ten CNAs across all shifts from four skilled nursing facilities in the southeastern United States participated in surveys and, potentially, focus groups.

Results: Results failed to find support for death exposure being related either to experiential avoidance or negative death attitudes. However, results supported the relation between negative death attitudes and compassion fatigue.

Conclusion: Implications highlight the need to develop interventions focusing on palliative skills-based training and emotional support of CNAs in their role as end-of-life caregivers. By reducing compassion fatigue, it may be possible to decrease job turnover and increase quality-of-care for residents.