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Updated: Dec 14, 2025
Setup and Execution of the Rapid Cycle Deliberate Practice Death Notification Curriculum
Published on: August 5, 2020
Original Research: Understanding Nursing Home Staff Attitudes Toward Death and Dying: A Survey
Nhat Bui1, Elizabeth Halifax, Daniel David
1Nhat Bui is an adult gerontology NP at the Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco (UCSF). Elizabeth Halifax is an assistant clinical professor in the UCSF School of Nursing. Daniel David is an assistant professor at the New York University Rory Meyers College of Nursing in New York City. Lauren Hunt is an assistant professor in the UCSF School of Nursing and at San Francisco Veterans Affairs Medical Center. Edyssa Uy is an NP at the City of Hope Comprehensive Cancer Center in Duarte, CA. Christine Ritchie is the Kenneth L. Minaker Chair in Geriatrics and director of research for the Division of Palliative Care and Geriatric Medicine at Massachusetts General Hospital in Boston. Caroline Stephens is an associate professor and the Helen Lowe Bamberger Colby Presidential Endowed Chair in Gerontological Nursing at the University of Utah College of Nursing in Salt Lake City. Support for this study included grants from the National Institute on Aging Paul B. Beeson Emerging Leaders Career Development Award (K76AG054862), the UCSF Pepper Center, and the National Institutes of Health (8 KL2 TR000143-08). Contact author: Nhat Bui, nhat.bui@ucsf.edu. The authors have disclosed no potential conflicts of interest, financial or otherwise.
Background:
Nearly 70% of nursing home residents are eligible for palliative care, yet few receive formal palliative care outside of hospice. Little is known about nursing home staff attitudes, knowledge, skills, and behaviors related to palliative care.
Methods:
We administered a modified survey measuring attitudes toward death to 146 nursing home staff members, including both clinical and nonclinical staff, from 14 nursing homes.
Results:
Nursing home staff generally reported feeling comfortable caring for the dying, but half believed the end of life is a time of great suffering. Pain control (63%), loneliness (52%), and depression (48%) were the most important issues identified with regard to these patients, and there was ambivalence about the use of strong pain medications and the utility of feeding tubes at the end of life. Top priorities identified for improving palliative care included greater family involvement (43%), education and training in pain control (50%) and in management of other symptoms (37%), and use of a palliative care team (35%) at their facility.
Conclusions:
Findings show there is a need for more palliative care training and education, which should be built on current staff knowledge, skills, and attitudes toward palliative care.
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