Life stories, death stories: connecting with the unique death narratives of care providers in residential aged care facilities in Australia

Background: Australia has the most institutionalised death in the world with around a third of people aged over 65 years being cared for in residential aged care (RAC) as they die. Assistants in Nursing (AIN), who represent around 70% the RAC workforce have the closest contact with those dying. AIN draw on personal experiences to create their own unique existential meanings of death, and these inform their reactions and behaviours towards dying residents in their care. Aims and objectives: This study examined how AIN prepare to work with people who are dying and how AIN own meaning-making of death impacts their preparedness and response to end of life care. Methods: Ten AIN across two residential aged care facilities in Australia participated in three interviews each, with each interview occurring approximately 4-8 weeks apart using a narrative analysis framework. Four Registered Nurses and 3 managers were interviewed to determine organisational narratives as a comparison with AIN personal narratives. Findings: AIN commence work with existing death narratives and these dynamic narratives evolve in complex and unique ways. Daily work sees AIN facing their own mortality, engaging in confronting aspects of death care, the death of loved residents, and peer and organisational narratives. Working in residential aged care can be challenging and confronting and AIN often feel unprepared for providing end of life care and post mortem care, leaving some AIN with experiences of trauma. Conclusion: Policies that acknowledge residential aged care as places of death and the important role played by AIN who provide the closest care with those dying will better equip facilities to train and support workers as they encounter death, particularly in the initial months of their roles. Supported workers may then be better placed to have a greater understanding of their reactions to death and the flow on effect this may have on the care they provide to people who are dying. Targeted training and support may also seek to address the level of attrition amongst aged care workers.