INTEGRATING RESEARCH ON BEREAVEMENT EXPERIENCE TO INFORM PALLIATIVE CARE IN LONG-TERM CARE DURING AND AFTER THE COVID-19 PANDEMIC

The older adult population in Canada is growing rapidly, resulting in an increased need for long-term care (LTC) services. The growing demand and limited supply of space in LTC has resulted in stricter admission requirements, creating a cohort of LTC residents with greater need for palliative and end-of-life care. Despite the frequency of resident deaths in this setting, research suggests that the care provided for family caregivers and staff in coping with these losses is insufficient. The aim of the current research, conducted as a series of two studies, was to better understand the bereavement experiences of family caregivers and staff working in healthcare settings, including LTC. Chapter 1 to 5 provide a background literature review on topics relevant to the contexts of studies 1 and 2. The chapters review LTC in Canada, palliative care, grief theory, family caregiver bereavement in LTC, and the impact of COVID-19 public health policy, including policies restricting contact with LTC residents. Study 1 is presented in chapter 6. In Study 1, a qualitative approach was employed to understand the staff caregiving approaches that are most meaningful for family caregivers of relatives approaching the end-of-life in LTC, and how these were impacted by the COVID-19 pandemic. Transcripts of interviews with bereaved family caregivers were analyzed, utilizing a reflexive approach to thematic analysis. Results spoke to different forms of support that were valued by family caregivers, and how during COVID-19 pandemic, adaptations needed to be made as support was limited. In study 2, the grief that healthcare staff experienced during the COVID-19 pandemic was explored through the lens of the Job Demand-Resource (JD-R) model, which proposes that chronic job demands lead to burnout by depleting resources over time, and that job resources can buffer the negative effect of job demands. More recent research studies contributing to the expansion of this model have suggested that personal resources can also buffer the negative effect of job demands on burnout. Chapters 7 to 9 provide important information related to the context of study 2, including the impact of grief and bereavement on long-term care employees, burnout, and models of burnout development. Study 2 is presented in chapter 10. In Study 2, a cross-sectional survey design was used to examine personal and job resources (e.g., coping strategies, employee supports) that might moderate the hypothesized relationship between grief and burnout. Although the hypothesized relationship was confirmed, no moderators were identified. Exploratory mediation analysis revealed a significant relationship between grief and burnout that is partially accounted for by low levels of optimism. No other moderators or mediators were found to be significant. Together, results from the two individual studies contribute to an understanding of the relevance of end-of-life care and bereavement support for LTC family caregivers as well as staff working in LTC and acute care settings. Specifically, Study 1 highlights areas to emphasize and improve when providing end-of-life care, while Study 2 highlights the significance of grief to burnout, and the explanatory role of optimism in this relationship. Such knowledge is important for informing interventions and research on how to support family caregivers and staff in coping with resident and patient deaths in the future. The final chapter, chapter 11, provides a general discussion of the information presented in the dissertation.

Name thesis:degree_name

Doctor of Philosophy (Ph.D.)

Level thesis:degree_level

Doctoral

Discipline thesis:degree_discipline

Clinical

Grantor

University of Saskatchewan

Year dc:date.issued

2026

Author dc:creator

• Myge, Ivy

Advisor dc:contributor.advisor

• Hunter, Dr. Paulette

Committee members dc:contributor.committeemember

• Teucher, Dr. Ulrich
• McWilliams, Dr. Lachlan
• Thorpe, Dr. Lillian
• Kortes-Miller, Dr. Katherine
• Morrison , Dr. Todd

• Long-term care
• healthcare
• family caregivers
• healthcare staff
• bereavement
• grief
• burnout

Language dc:language.iso

en

Handle dc:identifier.uri

https://hdl.handle.net/10388/18170

OAI identifier oai:identifier

oai:harvest.usask.ca:10388/18170