RÉSUMÉNous avons examiné les caractéristiques contextuelles qui façonnent les soins de fin de vie (SFV) dans les établissements de soins pour bénéficiaires, en s’appuyant sur les perspectives de 11 aidants résidents (AR) dans un centre urbain canadien de l’Ouest. ARs décrivent les soins de fin de vie comme “offrant un confort,” y compris le bien-être physique et émotionnel. Les inquiétudes au sujet des défis posés par le temps et la charge de travail ont dominé les comptes et ont généré la culpabilité, la tristesse et de la frustration. ARs ont essayé de “trouver le temps” en le prenant d’eux-mêmes ou les autres résidents, et en s’appuyant sur l’engagement des collègues et sur les familles. Les résultats soulignent l’importance du rôle d’AR (en particulier en offrant un confort émotionnel), mais faire appel à l’attention à l’interprétation de ce qui est impliqué dans ce travail, et à la définition du portée de la pratique et de la formation. Les résultats également réitère l’importance, entre aidants résidents canadiens, des charges de travail adéquates pour faciliter les soins de fin de vie de qualité, et soulève des préoccupations au sujet des contraintes et comment elles forment la pratique de soins de fin de vie et les significations qui infusent une telle pratique.

ABSTRACT. Managing grief and difficult emotions related to end of life (EOL) care is an oftenunder-recognized part of the work of resident care aides (RCAs). In this interpretive analysis we explore the shared and socially constructed ideas that eleven RCAs in one Canadian city employ to make sense of death and the provision of EOL care. RCAs spoke of personal challenges involved in witnessing death and experiencing loss, as well as helplessness and frustration when they could not provide quality EOL care. RCAs invoked "consoling refrains" to manage grief, including "such is life," "they are better off" and "they had a full life." To manage guilt and moral distress, RCAs reminded themselves "I did my best" and "I experience rewards." Though these ideas help RCAs, some may need to be reframed through coaching and mentorship, to prevent unintended negative effects on care or the reproduction of ageist beliefs more broadly.Author's Postprint Copy 3 Population demographics, technology and health care service delivery have been reshaping the nature of older populations in residential care facilities. More residents have chronic life-limiting conditions such as dementia, leading some to suggest that "long-term care facilities will become the hospices of the future" (Abbey, Froggatt, Parker, & Abbey, 2006: p.56). In Canadian residential care facilities, the most substantial portion of direct care is provided by resident care aides (RCAs). As a result of frequent and sustained contact with residents over time, RCAs frequently report developing close, family-like relationships with residents (Moss, Moss, Rubinstein, & Black, 2003;Wilson & Daley, 1998). Though this may help RCAs provide better quality end-of-life (EOL) care (and indeed, may sustain them in their work), it can also be a 'double-edged sword' entailing considerable grief and distress when a resident dies (Ersek & Wilson, 2003;McClement, Wowchuk & Klaasen, 2009).Staff members in residential care settings frequently lack opportunities to grieve resident deaths (Kaaslainen, Brazil, Ploeg & Martin, 2007;Moss et al., 2003) and many desire greater practical and/or emotional support after a death (Hanson, Henderson & Menon, 2002;Katz, Sidell & Komaromy, 2001;Katz, Sidell & Komaromy, 2000;Rickerson, Somers, Allen & Lewis, 2005). Bereavement support in these facilities is often non-existent or poorly resourced, due in part to resource constraints and an inability to recognize staff bereavement needs (Moss, Braunschwieg & Rubinstein, 2002;Katz, Sidell, & Komaromy, 2001). When deaths and relationships are unacknowledged, grief may be disenfranchised, which may have negative effects on personal growth, as documented in one study (Anderson & Gaugler, 2006).In addition to grief, RCAs providing EOL care deal with difficult emotions such as helplessness that can be involved when watching a resident suffer (Goodridge, Bond, Cameron & McKean, 2005;Palan Lopez, 2007). Additionally, RCAs may work in environments with inadequate staffing, lack of supervision, high turnover, lo...

Quality improvement is an essential feature of the ongoing development of palliative care programs. Little has been written, however, about using quality improvement as a strategy to introduce research concepts to staff and administrators for the purpose of enhancing research readiness in healthcare settings. This article describes such an endeavor. The authors discuss two quality improvement initiatives undertaken by a palliative care program in Canada. These two examples demonstrate how the quality improvement process acted as a catalyst to enhance research readiness.