Objective
Staff communication has been shown to influence overall nursing home (NH) performance.
However, no empirical studies have focused specifically on the impact of CNA communication
on end-of-life (EOL) care processes. This study examines the relationship between
CNA communication and nursing home performance in EOL care processes.
Design
Secondary data analysis of 2 NH surveys conducted in 2006–2007.
Setting
One hundred seven nursing homes in New York State.
Participants
Participants were 2636 CNAs and 107 directors of nursing (DON).
Measurements
The measures of EOL care processes—EOL assessment and care delivery (5-point Likert
scale scores)—were obtained from survey responses provided by 107 DONs. The measure
of CNA communication was derived from survey responses obtained from 2636 CNAs. Other
independent variables included staff education, hospice use intensity, staffing ratio,
staff-resident ethnic overlap index, facility religious affiliation, and ownership.
Methods
The reliability and validity of the measures of EOL care processes and CNA communication
were tested in the current study sample. Multivariate linear regression models with
probability weights were used. The analysis was conducted at the facility level.
Results
We found better CNA communication to be significantly associated with better EOL assessment
(P = .043) and care delivery (P = .098). Two potentially modifiable factors—staff education and hospice use intensity—were
associated with NHs' performance in EOL care processes. Facilities with greater ethnic
overlap between staff and residents demonstrated better EOL assessment (P = .051) and care delivery scores (P = .029).
Conclusion
Better CNA communication was associated with better performance in EOL care processes.
Our findings provide specific insights for NH leaders striving to improve EOL care
processes and ultimately the quality of care for dying residents.
Keywords
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Article info
Publication history
Published online: August 02, 2010
Footnotes
We gratefully acknowledge funding from the National Institute on Aging (grant R01 AG23077), National Institute of Nursing Research (grant R01 0727), and the Foundation for Healthy Living, NY.
Identification
Copyright
© 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
