Support workers' experiences of work stress in long-term care settings: a qualitative study

Reducing the Burdens of Paid Caregivers of Older Adults by Using Assistive Technology: A Scoping Review

BACKGROUND

Paid caregivers are needed to support older adults, but caregiver burden contributes to high turnover rates. Assistive technologies help perform activities of daily living (ADLs) and can reduce caregiver burden, but little is known about how they impact paid caregivers.

OBJECTIVE

This scoping review provides an overview of evidence on using assistive technology to reduce burdens on paid caregivers working with older adults.

DESIGN

The review was conducted from May to August 2022. The eligibility criteria included: (1) publication within 5 years in peer-reviewed journals, (2) investigation of assistive technology, (3) main participants include paid caregivers supporting older adults, and (4) describing impacts on caregiver burden. Searches were conducted in 6 databases, generating 702 articles. The charted data included (1) country of study, (2) participant care roles, (3) study design, (4) main outcomes, and (5) types of assistive technology. Numerical description and qualitative content analysis of themes were used.

RESULTS

Fifteen articles reporting on studies in 9 countries were retained for analysis. Studies used a variety of quantitative (8/15), qualitative (5/15), and mixed (2/15) methods. Technologies studied included grab bars and handrails, bidet seats, bed transfer devices, sensor and monitoring systems, social communication systems, and companion robots. Articles identified benefits for reducing stress and workload, while paid caregivers described both positive and negative impacts.

CONCLUSIONS

Literature describing the impact of assistive technology on paid caregivers who work with older adults is limited and uses varied methodologies. Additional research is needed to enable rigorous evaluation of specific technologies and impacts on worker turnover.

Building an evidence-based multi-level system of quality disability support for adults with acquired neurological disability

PURPOSE

People with acquired neurological disability have the right to quality disability support, yet there is still limited user insights shaping disability services. This research aimed to develop a comprehensive understanding of quality support for adults with acquired neurological disability based on lived experiences.

METHODS

Using a constructivist grounded theory approach, this project engaged 12 adults with acquired neurological disability, 12 support workers, and 10 close others in individual interviews. Each perspective was analysed independently and subsequently merged to construct a holistic model of quality support grounded in lived experience.

RESULTS

The model of quality support encompasses interconnected themes spanning dyadic relationships, support worker competency, team dynamics, provider practices, and sector-wide considerations. Key elements include recognising the individual's expertise in their support needs, nurturing effective support relationships, fostering a capable support team, and upholding sector accountability. Authentic choice and personal agency emerged as paramount factors in achieving quality support.

CONCLUSIONS

The findings align with disability rights and individualised funding principles, emphasising the centrality of people with lived experience in shaping support services. The research underscores the need to prioritise authentic choice and individual empowerment, offering valuable insights for both practice and policy development in the disability support sector.

Irritation, General and Pandemic-Related Demands, and the Importance of Workplace Health Promotion in Long-Term Care-Results From a Survey of Managers in Outpatient and Inpatient Long-Term Care Facilities in Germany

OBJECTIVE

This study examines the association between irritation and demands of long-term care managers during the COVID-19 pandemic, as well as the role of workplace health promotion (WHP).

METHODS

Findings were derived from an online survey investigating long-term care managers as part of the employees in the COVID-19 pandemic (N = 207). Data analyses were performed with linear regression and interaction analyses.

RESULTS

For managers in long-term care, there was found a significant positive association between pandemic-related and general demands and irritation. The irritation level was significantly lower among managers in facilities where WHP was offered whereas the association between irritation and demands did not significantly vary by WHP.

CONCLUSIONS

The presence of WHP was associated with lower average irritation levels among managers during the COVID-19 pandemic. Thus, the implementation of WHP can contribute to maintain the well-being of long-term care managers.

Gauging the stress of long-term care nursing assistants using ecological momentary assessment, wearable sensors and end of day reconstruction

BACKGROUND

Nursing assistants working in long-term care (LTC) often report that their job is stressful. To reduce their work stress, a better understanding of their stress profile is needed.

OBJECTIVE

We aimed to pilot test methods to identify and understand stressors that LTC nursing assistants experience.

METHODS

We asked each participant to provide wearable sensor/watch data, ecological momentary assessment (EMA) surveys and end of day review data over two eight-hour working shifts.

RESULTS

Eight nursing assistants participated. All participants worked in a common continuing care retirement community in Maryland, United States of America. Our stress assessment method revealed 83 stressful events that were classified under 10 categories. Most of the reported events were rated as having a mild to low-moderate intensity. The three most common causes of stress were work demands and pressure (28.35%), heavy workload and staffing (19.69%), and safety issues and COVID-19 concerns (17.32%). We also explored the difference between stress events and intensity among different shifts. Disrespect from residents (22.73%) was the most commonly reported stressor during day shifts. Feeling rushed was the most commonly reported stressor during the evening (22.47%) and the night (38.46%) shifts.

CONCLUSIONS

We found stress was commonly reported. Stress intensity conflicted with prior literature, and we explored possible explanations.

IMPLICATIONS FOR PRACTICE

We discuss potential implications for these findings, modification of our methods to increase feasibility, the utility of these data collection methods for future work and suggest next steps.

"Let the people you're supporting be how you learn": a grounded theory study on quality support from the perspective of disability support workers

PURPOSE

Quality disability support is fundamental to the lives of many adults with acquired neurological disability. However, little is known about the factors that influence the quality of paid support. This study is part of a larger project to develop a holistic understanding of quality support, grounded in the experience of people with acquired neurological disability, close others, and disability support workers. The current study focuses on the support worker perspective.

METHODS

Following constructivist grounded theory methodology, interviews were conducted with 12 support workers. Grounded theory analysis was followed to develop themes and subthemes and build a model of quality support.

RESULTS

Five key themes, with fifteen subthemes emerged to depict factors influencing the quality of support. The five themes are: being the right person for the role, delivering quality support in practice, working well together, maintaining and improving quality support, and considering the broader context. Findings emphasise the importance of the support worker recognising the person as an individual and respecting their autonomy.

CONCLUSIONS

Critical to quality support is centring the needs and preferences of people with disability, improving support worker working conditions and supporting people with disability and support workers to build effective, balanced working relationships.IMPLICATIONS FOR REHABILITATIONDelivering quality support in practice relies upon the support worker recognising, centring, and respecting the autonomy of the person with disability.To deliver quality support, support workers need to feel valued, be committed to the role and actively work to maintain and improve the quality of support provision.Quality support provision is facilitated by the support worker and the person with disability effectively balancing boundaries and friendship, and in turn building a quality working relationship.

Well-being of professional older adults' caregivers in Alberta's assisted living and long-term care facilities: a cross-sectional study

BACKGROUND

For the care need of older adults, long-term care (LTC) and assisted living (AL) facilities are expanding in Alberta, but little is known about the caregivers' well-being. The purpose of the study was to investigate the physical health conditions, mental and emotional health (MEH), health behaviour, stress levels, quality of life (QOL), and turnover and absenteeism (TAA) among professional caregivers in Alberta's LTC and AL facilities.

METHODS

This cross-sectional survey involved 933 conveniently selected caregivers working in Alberta's LTC and AL facilities. Standardised questions were selected from the Canadian Community Health Survey, Patient Health Questionnaire-9, and Short Form-36 QOL survey revalidated and administered to the participants. The new questionnaire was used to assess the caregivers' general health condition (GHC), physical health, health behaviour, stress level, QOL, and TAA. Data were analysed using descriptive statistics, Cronbach alpha, Pearson's correlation, one-way analysis of variance, and multiple linear regression.

RESULTS

Of 1385 surveys sent to 39 facilities, 933 valid responses were received (response rate = 67.4%). The majority of the caregivers were females (90.8%) who were ≥ 35 years (73.6%), worked between 20 to 40 h weekly (67.3%), and were satisfied with their GHC (68.1%). The Registered Nurses had better GHC (mean difference [MD] = 0.18, p = 0.004) and higher TAA than the Health Care Aides (MD = 0.24, p = 0.005). There were correlations between caregivers' TAA and each of MEH (r = 0.398), QOL (r = 0.308), and stress (r = 0.251); p < 0.001. The most significant predictors of TAA were the propensity to quit a workplace or the profession, illness, job stress, and work-related injury, F (5, 551) = 76.62, p < 0.001, adjusted R² = 0.998.

CONCLUSION

Reducing the caregivers' job stressors such as work overload, inflexible schedule, and poor remuneration, and improving their quality of life, health behaviour, and mental, emotional, and physical health conditions may increase their job satisfaction and reduce turnover and absenteeism.

Perceived strategies for reducing staff-turnover and improving well-being and retention among professional caregivers in Alberta's continuing-care facilities: A qualitative study

This qualitative study explored potential factors that lead to turnover and absenteeism and how to improve well-being and retention among professional older-adult-caregivers in Alberta's assisted living (AL) and long-term care (LTC) facilities. Four hundred and forty-seven participants aged 45-54 years were interviewed through a five-item, content-validated open-ended questionnaire. The questionnaire was self-administered in the English language and the soft copy of their responses was transferred into NVIVO version 12 software for coding. A thematic narrative analysis grounded in the "happy productive worker" theory was completed. The main themes were caregivers' perception of the factors affecting their well-being, absenteeism, and turnover, and caregivers' suggestions on ways to improve their well-being and retention. Participants reported that their professional well-being was suboptimal. They suggested that their employers should provide them with the needed social, psychological, and professional support, improve wages and hire more staff to ameliorate absenteeism and turnover rates.

Influence at work is a key factor for mental health – but what do contemporary employees in knowledge and relational work mean by “influence at work”?

Purpose

Common mental health problems are a substantial burden in many western countries. Studies have pointed out that work related factors can both increase and decrease the risk of developing mental health problems. Influence at work is a key factor relating the psychosocial work environment to employees mental health. However, little is known regarding how contemporary employees experience and understand influence at work. The purpose of this study is to explore this in depth.

Methods

We conducted semi-structured interviews with 59 employees in knowledge and relational work and analysed the data using principles from Interpretative Phenomenological Analysis (IPA).

Findings

TWe identified three themes each consisting of two interrelated parts, where the second part describes the consequences of the identified type of influence for employees: 1) work tasks and performance, 2) relations and belonging, 3) identity and becoming.

Conclusions

The interviewed employees had a multifaceted understanding of influence at work and that influence at work mattered to them in different but important ways. Our hope is that managers, employees and consultants will be inspired by the three themes when designing work tasks, organizations and interventions in order to increase the level of influence and thereby help enhance the mental well-being of employees.

The unmet needs of older adults living in nursing homes in Mainland China: a nation-wide observational study

BACKGROUND

The unmet needs of older adults in nursing homes could result in their poor health status physically and psychologically. The aim of this study was to understand the characteristics of unmet needs of older adults residing in nursing homes in China, and to probe into the contributing factors.

METHODS

In this cross-sectional design, the demographic and health status questionnaire, Modified Barthel Index, the Numerical Rating Scale for pain assessment, Geriatric Depression Scale, Camberwell Assessment of Need for the elderly were employed to survey older adults living in 38 nursing homes in 13 cities in China from July 2017 to June 2018 through a multi-stage, stratified sampling scheme. The Short Portable Mental Status Questionnaire was adopted to exclude participants with severe cognitive impairment. Aside from descriptive analysis, a raft of hierarchical logistic regression models were run by sequentially controlling for the independent variables at 5 levels (demographic characteristics, health status, pain, ADL, and depression), aiming to identify the influencing factors of the unmet needs of the residents.

RESULTS

The effective sample size involved 2063 older adults (63.4% female versus 36.6% male), with a response rate of 98.5%. The median and inter-quartile range of the total needs and unmet needs of the sample was 3(1, 4) and 0(0, 1) respectively, with 122 older participants having more than 3 unmet needs (high unmet need category) versus 1922 older ones having ≤ 3 unmet needs (low unmet need category). The unmet needs of older adults in nursing homes mainly fell into social domains. Gender, religion, educational background, marital status, living condition before admission, room type, incomes, staffing, number of diseases, pain, Barthel Index, and depression were contributive to unmet needs of older adults in long-term care facilities in the final model that was adjusted for all levels of variables (all p < 0.05).

CONCLUSION

Understanding the influencing factors of the unmet needs of older adults in long term care provides clues for healthcare professionals to offer better care for this population. System-level support to nursing homes and training of staff are highlighted. Plus, taking measures to beef up social connections for the older adults to meet their social needs was suggested.

Occupational stress and health risk of employees working in the garments sector of Bangladesh: An empirical study

The present study was conducted with a view to examining the impact of occupational stress on employees' health risk. A total number of 350 garment employees (114 supervisors and 236 workers) were selected from 25 readymade garment factories of Dhaka, Narayanganj, and Gazipur industrial areas of Bangladesh on a random sampling basis. Occupational stress was estimated using an ERIs modified questionnaire; when self-reported health problems, work related information and socio-demographic information were obtained using face-to-face interviews using a pre-formed questionnaire. The survey was conducted for 2 years from January 2020 to December 2021 in Dhaka, Narayanganj and Gazipur districts where most of the garment industries in Bangladesh are located. All data were processed by using Statistical Package for Social Sciences (SPSS) and Decision Analyst Stats, Version 2.0. For analyzing data, suitable statistical tools such as two-way ANOVA, z-test, chi-square test, Pearson's product-moment correlation, stepwise multiple regressions, and descriptive statistics were used. The results of the present study reveal that the occupational stress had a significant positive influence on health risk. The findings also reveal that both the male and female employees perceived garment job highly stressful and risky for their health causes many dies and sickness, but it was higher among the female employees than their counterparts. Study suggests that due to major illness and diseases garments' employees are lacks of sound health that have to consider remedying for reducing occupational stress and health risk.

Healthcare support workers' lived experiences and adaptation strategies within the care sector during the COVID-19 pandemic. A meta-ethnography review

Support workers are an "invisible" part of the health sector often working during pandemics to support clients. This meta-ethnography screened 167 articles out of 211 results identifying 4 qualitative studies that explored the support worker's experiences during the COVID-19 pandemic. "Redundancy approach" was used to map non-essential criteria and the analysis was informed by the interpretative meta-ethnography method. Eight key themes identified from studies in UK and USA. The themes identified are: (1) job role; (2) marginalized profession; (3) impact of work; (4) concerns surrounding PPE; (5) transportation challenges; (6) level of support and guidance; (7) a higher calling and self sacrifice; (8) adaptation strategies. Adaptation strategies include purchasing their own masks, to policy and agency adaptation, cleaning, talk walks, meetings with colleagues or within the company. The adaptation strategies aim at tackling emotional distress and raise the level of appreciation that society or organizations show to the support workers.

Organizational Support Experiences of Care Home and Home Care Staff in Sweden, Italy, Germany and the United Kingdom during the COVID-19 Pandemic

The COVID-19 pandemic has affected care workers all over the globe, as older and more vulnerable people face a high risk of developing severe symptoms and dying from the virus infection. The aim of this study was to compare staff experiences of stress and anxiety as well as internal and external organizational support in Sweden, Italy, Germany, and the United Kingdom (UK) in order to determine how care staff were affected by the pandemic. A 29-item online questionnaire was used to collect data from care staff respondents: management (n = 136), nurses (n = 132), nursing assistants (n = 195), and other healthcare staff working in these organizations (n = 132). Stress and anxiety levels were highest in the UK and Germany, with Swedish staff showing the least stress. Internal and external support only partially explain the outcomes. Striking discrepancies between different staff groups' assessment of organizational support as well as a lack of staff voice in the UK and Germany could be key factors in understanding staff's stress levels during the pandemic. Structural, political, cultural, and economic factors play a significant role, not only factors within the care organization or in the immediate context.