Understanding and Responding to Staff Grief: The Expanded Role of Social Work in the Nursing Home

Background & Purpose

Death is a common occurrence in the nursing home setting and social workers are often called upon to respond to the grief of fellow staff members. As such, it is critical for social workers to understand and effectively address the grief of nursing home staff. The purpose of the current study was to examine the effects of grief on well-being in one particular group, nursing assistants (NAs), and to propose a social work intervention that addresses grief in this population. The researchers explore both the positive and problematic effects of grief in NAs and discuss the development of a multi-component social work intervention designed to enfranchise grief in the nursing home setting.

Methods

In this cross-sectional study, a convenience sample of 380 (N = 380) NAs was recruited from 11 nursing homes located in a Midwestern metropolitan area. Participants were primarily middle-age (M = 39.6; SD = 11.4), African-American (65.5%) women (90.8%), with approximately 12 years of experience in the nursing profession (M = 12.4; SD = 9.0). Participants completed a self-administered survey that measured the following domains: distress from grief; growth from grief; personal and professional burnout; psychological and physical well-being; and job satisfaction. Stepwise linear regression models were generated to test these relationships.

Results

As hypothesized, NAs who experienced higher levels of distress from grief reported significantly higher levels of burnout (emotional exhaustion, ß = .10; p < .05; depersonalization, ß = .22; p < .001) and significantly lower levels of psychological well-being (ß = -.29; p < .001), and physical well-being (ß = -.11; p < .05). Conversely, NAs who experienced higher levels of growth from grief reported significantly lower levels of burnout (depersonalization, ß = -.13; p < .05) and significantly higher levels of psychological well-being (ß = .21; p < .001), physical well-being (ß = .19; p < .001), and job satisfaction (ß = .28; p < .001).

Conclusions & Implications

As indicated in these results, the grief that NAs experience in response to the deaths of nursing home residents can have a profound effect on their psychological, physical, and professional well-being. Lower levels of staff well-being may, in turn, negatively impact the quality of care that is provided to residents. As the primary providers of psychosocial services to both residents and staff, these findings have important implications for nursing home social workers. These professionals are ideally trained and situated to develop and implement structured grief interventions. Based upon Doka's theory of disenfranchised grief (2002), a multi-component social work intervention is proposed that recognizes the relationships between NAs and residents, acknowledges the loss when residents die, and includes NAs in the grieving process.