adult learners, curricula, death, direct care workers, elder care, geriatrics, nurse aides, palliative care, terminal care, workforce development



  1. Braun, Kathryn L. DrPH
  2. Zir, Ana MPH, RN


Increasingly more people are spending their final days of life in nursing homes. Unfortunately, research suggests that end-of-life care in nursing homes is frequently suboptimal and pain is not well managed. As much of the care in nursing homes is provided by unlicensed staff, particularly certified nursing assistants, who have limited preemployment education, it is vital to provide them with appropriate in-service training related to dying, death, and bereavement. This article describes the development and testing of an 8-hour curriculum for paraprofessional staff in nursing homes that features active-learning strategies. Participants demonstrated high scores on posttests of training content, and they significantly improved their scores on personal comfort with providing end-of-life care over the course of training. Staff turnover, time constraints, and lack of institutional commitment for training were major barriers to broader participation. The use of this active-learning in-service curriculum represents an effective way to provide end-of-life care training to paraprofessional nursing home staff.