• John G Cagle, Kathleen T Unroe, Morgan Bunting, Brittany L Bernard, and Susan C Miller.
• University of Maryland, Baltimore, Maryland, USA. Electronic address: jcagle@ssw.umaryland.edu.
• J Pain Symptom Manage. 2017 Feb 1; 53 (2): 198-207.

ContextNursing homes are an important site for end-of-life care, yet little is known about the perspectives of the frontline staff who provide a majority of this care.ObjectiveTo describe, from the staff perspective, positive/negative experiences related to caring for dying residents.MethodsQualitative analysis using survey data from staff working in 52 Indiana nursing homes.ResultsA total of 707 frontline staff who provide nursing, nurse aide, and social work services responded to open-ended prompts. Study data included responses to open-ended prompts asking participants to describe one positive experience and one negative experience caring for a dying patient. A thematic content analysis was conducted using the constant-comparative method. Respondents were largely female (93%), white (78%), 31-50 years (42%), and 53% had >5 years of nursing home work experience. Experiences were described from three perspectives: 1) first-hand experiences, 2) observed experiences of dying patients, and 3) observed experiences of family members. Selected themes for positive experiences include the following: creating close bonds; good patient care; involvement of hospice; being prepared; and good communication. Selected themes for negative experiences consisted of the following: challenging aspects of care; unacknowledged death; feeling helpless; uncertainty; absent family; painful emotions; and family discord.ConclusionFindings reveal the richness and many complexities of providing end-of-life care in nursing homes and have implications for improving staff knowledge, coordination of care with hospice, and social support for patients.Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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