Burnout After Patient Death: Challenges for Direct Care Workers

Abstract

Context Direct care workers in long-term care can develop close relationships with their patients and subsequently experience significant grief after patient death (Boerner et al., 2015). Consequences of this experience for employment outcomes have received little attention. Objectives To (1) investigate staff, institutional, patient, and grief factors as predictors of burnout dimensions among direct care workers who had experienced recent patient death, (2) determine which specific aspects of these factors are of particular importance, and (3) establish grief as an independent predictor of burnout dimensions. Methods Participants were 140 certified nursing assistants and 80 homecare workers having recently experienced patient death. Data collection involved comprehensive semi-structured in-person interviews. Standardized assessments and structured questions addressed staff, patient, and institutional characteristics, grief symptoms and grief avoidance, as well as burnout dimensions (depersonalization, emotional exhaustion, and personal accomplishment). Results Hierarchical regressions revealed that grief factors accounted for unique variance in depersonalization, over and above staff, patient, and institutional factors. Supervisor support and caregiving benefits were consistently associated with higher levels on burnout dimensions. In contrast, coworker support was associated with a higher likelihood of depersonalization and emotional exhaustion. Conclusion Findings suggest that grief over patient death plays an overlooked role in direct care worker burnout. High supervisor support and caregiving benefits may have protective effects with respect to burnout, whereas high coworker support may constitute a reflection of burnout.

Home Care Workers’ Experiences of Client Death and Disenfranchised Grief

“…In this article, we confirm and build upon the existing research demonstrating that client death can have negative effects on the lives of home care workers (Boerner et al, 2015; Boerner et al, 2017; Delp et al, 2010) and that several types of support are needed to reduce these effects (Boerner et al, 2016; Gleason, Boerner, & Barooah, 2016). In examining aides’ grief strategies, we found some that were similar to those of nurses working with end-of-life clients (e.g., seeking emotional connection and attempting to set boundaries) and others that were largely distinct—specifically, the general lack of employer support in the postloss period and the need to rely primarily on one’s own personal strength to cope with grief.…”

“…The authors also learned that agency policies rarely allow aides to stay in contact with clients’ families after a death and that few aides felt they could seek support from their supervisors (Boerner, Gleason, & Barooah, 2016; van Riesenbeck, Boerner, Barooah, & Burack, 2015). The grief and lack of support following a client’s death are thus critical problems that likely reduce job satisfaction, increase burnout and turnover, and compromise home care workers’ health and the care they provide (Boerner, Gleason, & Jopp, 2017).…”

Burnout and Resilience After a Decade in Palliative Care: What Survivors Have to Teach Us. A Qualitative Study of Palliative Care Clinicians With More Than 10 Years of Experience

“…24 Having supportive supervisors and team leaders who exhibited the qualities of transformational leadership like genuineness and compassion also led to less burnout. 25,26 We found that the exposure to stress in the form of Personal and professional struggles was often necessary to build resilience. Cavanaugh et al 27 described these as challenge stressors as opportunities for growth and development.…”

Producing ‘Top Tips’ for Care Home Staff During the COVID-19 Pandemic in England: Rapid Reviews Inform Evidence-Based Practice but Reveal Major Gaps

“…What evidence exists suggests there is a need to prepare staff via better education about bereavement (Österlind et al, 2011) and a need to have bereavement support mechanisms in place (Carton & Hupcey, 2014;Boerner et al, 2015). Some evidence suggests that grief over residents' deaths play an overlooked role in direct care worker burnout (Boerner et al, 2017). Key recommendations for support include peer debriefing and support (Chen et al, 2019;Vis et al, 2016).…”