RESIDENT STAFF RELATIONSHIPS

Methods for evaluating resident/staff relationships in the nursing home

Methods for evaluating resident/staff relationships in the nursing home

Introduction

In this paper, we examine the variety of roles performed by formal and informal residents and staff in assisting persons who are dying in health care institutions or at home with hospice and home health care services. We explore the influence of the institutional setting on residents and staff and the roles of formal and informal residents and staff, including how these are influenced by social, cultural, and technological factors. Although residents and staff often derive professional and/or personal satisfaction from providing care to dying persons, they may experience stress themselves; therefore, we address how caregiver support in the form of resources and training can aid them in their efforts to provide compassionate and effective care.

Regardless of cause or setting, and depending on the nature and circumstances surrounding the death, a variety of residents and staff may be involved in helping with the dying process. The word caregiver is used to describe both those who provide help on a formal basis (e.g., professionals and trained volunteers) and those whose help is provided more informally (e.g., family members, friends, neighbors, and others who are not associated with health care organizations but who have personal connections to the patient and/or family). (We use the hospice definition of family:“All those in loving relationships with the person who is dying, the people who can be counted on for caring and support, regardless of blood or legal ties”; Lattanzi-Licht, Mahoney, and Miller 1998:29) By improving our understanding of the complexity of caregiving, we can enhance the care of the dying and better support those who provide that care.

In nursing homes, professional residents and staff face the challenge of maintaining cultural sensitivity and competence in their work with patients and families. We acknowledge that extensive variation exists among cultures in regard to the dying process, and we discuss this briefly, but other chapters in this handbook address the impact of culture on dying more directly. We discuss the more traditional caregiving model in health care institutions, which originates from a Western or Eurocentric tradition, because that is the reality most Americans experience.

Despite its intuitive appeal, thebeliefs of resident-centered care has not yet been widely embraced. Resistance arises from both the institutional scheme and the direct vehiclee provider. System grade obstacles include regulatory and restriction stresses and the worry of litigation if one deviates from taut conformation to uniform protocols, high employees turnover rates which make it difficult for staff to get to know and evolve relationships with inhabitants, anda lack of clear measures to direct the provision of more individualized, humanistic care (Rader, 1995, p. 6).

Discussion

At the grade of the direct care provider, the pervasive procedure of a “hospital model” (Rader, 1995, p. 3) and shortfalls in both abilities and motivation may drive the failure to completely adopt a philosophy of resident-centered care. For Certified Nursing Assistants (CNAs), for example, vocational training typically emphasizes physical ...