Life In The Slower Lane

Here is the PICO analysis for the twelfth uploaded article:

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✅ PICO Analysis

Full Article Title:

Perceived needs for support among care home staff providing end of life care for people with dementia: a qualitative study

Type of Study:

Qualitative study using thematic analysis

Journal and Year:

International Journal of Geriatric Psychiatry (2017); 32:155–163

DOI: 10.1002/gps.4451

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P – Population

• Setting: Five care homes in Southern England, all registered for dementia care
• Participants:
  • 20 frontline care home staff (excluding nurses)
  • Mostly full-time workers; representative of broader UK care home demographics
• Resident Focus: People with dementia receiving end-of-life care 

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I – Intervention (or Exposure)

• Exposure Studied:
  • Staff experience of providing end-of-life care to residents with dementia
  • No structured clinical intervention; the study focused on perceived needs, coping mechanisms, and emotional impact on staff
• Themes Explored:
  • Emotional labour, communication challenges, lack of training, attachment to residents, and coping strategies
  • Specific attention to staff stress, burnout, and organisational culture 

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C – Comparison

• No direct comparison group (as typical in qualitative research)
• Internal contrasts were made between participants’ experiences, years of service, and training levels
• Some reflective comparison to expectations of care in other health settings or policy frameworks (e.g. “dying in place” policy) 

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O – Outcomes

1. Emotional and Psychological Impact on Staff:

• Staff experienced intense emotional strain from:
  • Witnessing frequent resident deaths
  • Being unable to relieve suffering
  • Feeling unacknowledged grief
  • Pressure to suppress emotional responses for professionalism 

2. Challenges in Communication and Care Delivery:

• Difficulty interpreting residents’ needs due to cognitive and communicative decline
• Managing aggressive or distressed behaviour without appropriate support or skills
• Tension between professional responsibilities and relational attachments 

3. Perceived Support Needs:

• Strong need for:
  • Dementia-specific end-of-life training (particularly on communication and emotional support)
  • Organisational cultures that legitimise grief and support open dialogue about death
  • Peer and managerial support to prevent isolation and burnout 

4. Coping Mechanisms:

• Peer support and camaraderie among staff
• Emotional detachment or suppression
• Personal self-care practices (e.g., exercise, prayer, reflection)
• Recognition that many lacked effective coping strategies 

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Outcome Classification

• Person-centred outcomes (indirect): Not directly measured, but staff distress could affect resident care quality
• Process outcomes: Identification of emotional labour, training gaps, and coping strategies
• System-level outcomes: Insights into structural barriers to workforce wellbeing (e.g., low pay, lack of role support)

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Summary Conclusion

This study highlights the psychological burden and unmet support needs of care home staff delivering end-of-life care to people with dementia. It suggests that without targeted dementia-specific training, acknowledgement of grief, and organisational support, staff are at risk of burnout and emotional distress. While emotional bonds with residents are often strong and meaningful, the culture in care homes often fails to accommodate grief or support staff wellbeing. Addressing these needs through relational, psychosocial, and organisational strategies could improve both staff and resident outcomes .

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