The Metaphor of “Family” in Staff Communication About Dying and Death

Objectives. Caregiving staff need to have a way to make sense out of the death and dying of nursing home residents. A range of cultural and institutional factors (e.g., disenfranchised grief; professional distance) thwart their expression of grief. This research examines the neglected area of staff's social construction of the meaning of their relationship with dying and deceased residents. Methods. As part of a multisite ethnographic study of bereavement in long-term care, we analyzed themes in audiotranscribed in-depth qualitative interviews with 26 hands-on caregiving staff members (over two thirds were nurse's aides) in two religiously and culturally diverse nursing homes. Results. A theme of family metaphor emerged as staff members spoke of family-like thoughts, feelings, and behaviors toward long-term residents. Staff members spontaneously told stories of deaths in their own families, and they described how the meanings of resident deaths and family deaths were interrelated. Discussion. The family metaphor provides cultural scripts that enable staff to overcome barriers to the expression of grief. The family metaphor structures the meaning for staff of death and bereavement, and it provides a bridge between their work and personal experience.