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Harrington C, Mollot R, Braun RT, Williams D. United States' Nursing Home Finances: Spending, Profitability, and Capital Structure. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2024; 54:131-142. [PMID: 38115716 PMCID: PMC10955796 DOI: 10.1177/27551938231221509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/12/2023] [Accepted: 11/06/2023] [Indexed: 12/21/2023]
Abstract
Little is known about nursing home (NH) financial status in the United States even though most NH care is publicly funded. To address this gap, this descriptive study used 2019 Medicare cost reports to examine NH revenues, expenditures, net income, related-party expenses, expense categories, and capital structure. After a cleaning process for all free-standing NHs, a study population of 11,752 NHs was examined. NHs had total net revenues of US$126 billion and a profit of US$730 million (0.58%) in 2019. When US$6.4 billion in disallowed costs and US$3.9 billion in non-cash depreciation expenses were excluded, the profit margin was 8.84 percent. About 77 percent of NHs reported US$11 billion in payments to related-party organizations (9.54% of net revenues). Overall spending for direct care was 66 percent of net revenues, including 27 percent on nursing, in contrast to 34 percent spent on administration, capital, other, and profits. Finally, NHs had long-term debts that outweighed their total available financing. The study shows the value of analyzing cost reports. It indicates the need to ensure greater accuracy and completeness of cost reports, financial transparency, and accountability for government funding, with implications for policy changes to improve rate setting and spending limits.
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Affiliation(s)
- Charlene Harrington
- Department of Social & Behavioral Sciences, University of California, San Francisco, CA, USA
| | | | | | - Dunc Williams
- Department of Health Care Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
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Yarycky L, Castillo LIR, Gagnon MM, Hadjistavropoulos T. Initiatives Targeting Health Care Professionals: A Systematic Review of Knowledge Translation Pain Assessment and Management Studies Focusing on Older Adults. Clin J Pain 2024; 40:230-242. [PMID: 38193260 DOI: 10.1097/ajp.0000000000001190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/21/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVES Pain is often undertreated in older adult populations due to factors, such as insufficient continuing education and health care resources. Initiatives to increase knowledge about pain assessment and management are crucial for the incorporation of research evidence into practice. Knowledge translation (KT) studies on pain management for older adults and relevant knowledge users have been conducted; however, the wide variety of KT program formats and outcomes underscores a need to evaluate and systematically report on the relevant literature. MATERIALS AND METHODS Using a systematic review methodology, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsycInfo, and Web of Science databases were searched from inception to June 2023. Pain-related KT programs targeted towards older adults, their informal caregivers, and health care professionals were examined. Initiatives focusing on health care professionals are the focus of this review. Initiatives focusing on older adults are reported in a companion article. RESULTS From an initial 21,669 search results, 172 studies met our inclusion criteria. These studies varied widely in focus and delivery format but the majority were associated with significant risk of bias. In this report, we are focusing on 124 studies targeting health care professionals; 48 studies involving initiatives targeting older adults are reported in a companion article. Moreover, most programs were classified as knowledge mobilization studies without an implementation component. Across all studies, knowledge user satisfaction with the initiative and the suitability of the material presented were most commonly assessed. Patient outcomes, however, were underemphasized in the literature. CONCLUSION Patient and clinical outcomes must be a focus of future research to fully conceptualize the success of KT programs for older adult individuals. Without implementation plans, disseminated knowledge does not tend to translate effectively into practice.
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Affiliation(s)
- Laney Yarycky
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina
| | - Louise I R Castillo
- Department of Psychology and Centre on Aging and Health, University of Regina, Regina
| | - Michelle M Gagnon
- Department of Psychology and Health Studies, University of Saskatchewan, Saskatoon, SK, Canada
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3
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Wang J, Yang Z, Li Y, Ma R, Zhang L, Du Y, Dou H. Status and influencing factors of elder neglect by geriatric nursing assistants in Chinese nursing homes: a cross-sectional survey. Front Med (Lausanne) 2023; 10:1273289. [PMID: 37954552 PMCID: PMC10634532 DOI: 10.3389/fmed.2023.1273289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/09/2023] [Indexed: 11/14/2023] Open
Abstract
Background In nursing homes, elder neglect has come to the forefront. Currently, few studies have examined the impact of personal and organizational factors of geriatric nursing assistants on elder neglect. From the perspective of geriatric nursing assistants, this study aims to explore the current situation and influencing factors of elder neglect in Chinese nursing homes. Methods A convenience sampling method was used to recruit 412 geriatric nursing assistants from 50 nursing homes in China. Participants were surveyed using a demographic questionnaire, the Elder Neglect Scale for Geriatric Nursing Assistants, the General Self-Efficacy Scale (GSES), and the Proactive Personality Scale (PPS). Spearman correlation analysis and multiple linear regression were used to analyze the factors influencing elder neglect. Results Geriatric nursing assistants scored a median of 74 out of 85 on the Elder Neglect Scale. Multiple linear regression analyses showed that the main personal factors influencing geriatric nursing assistants' elder neglect were general self-efficacy (β = 0.312), proactive personality (β = 0.180), and advanced qualification (β = 0.084), while the main organizational factors included monthly salary ≤ 1,900 RMB (β = -0.256), no regular training after induction (β = -0.253), and the number of days off per month (3-4 days off β = 0.192, ≥ 5 days off β = 0.101). Conclusion Although geriatric nursing assistants are at low levels of elder neglect, it remains a cause for concern. Among the personal factors, geriatric nursing assistants who possessed proactive personalities, high self-efficacy and advanced qualifications, exhibited low levels of elder neglect. Among the organizational factors, those who possessed a high number of days off per month portrayed low levels of elder neglect. Conversely, those who received low monthly salaries and no regular training after induction portrayed high levels of elder neglect. To reduce the risk of elder neglect, nursing homes should give due consideration to candidates' self-efficacy and proactive personality traits when recruiting, and focus on fostering these personality traits in their employees during their work. In addition, strengthening regular training for geriatric nursing assistants, optimizing the salary structure, and arranging rest days in a reasonable manner are also necessary measures.
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Affiliation(s)
- Jing Wang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhihua Yang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ya Li
- Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
| | - Ruijuan Ma
- School of Media and Communications, Urumqi Vocational University, Urumqi, China
| | - Liping Zhang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yage Du
- School of Nursing, Peking University, Beijing, China
| | - Haoying Dou
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Backman A, Lindkvist M, Lövheim H, Sjögren K, Edvardsson D. Exploring the impact of nursing home managers' leadership on staff job satisfaction, health and intention to leave in nursing homes. J Clin Nurs 2023; 32:7227-7237. [PMID: 37283193 DOI: 10.1111/jocn.16781] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/03/2023] [Accepted: 05/23/2023] [Indexed: 06/08/2023]
Abstract
AIMS AND OBJECTIVES To explore the impact of nursing home leadership and staffing characteristics on staff job satisfaction, health and intention to leave. BACKGROUND The number of older people has outpaced growth in the nursing home workforce worldwide. Identifying predictors with the potential to positively impact staff job satisfaction, health and intentions to leave are important. Leadership of the nursing home manager can be one such predictor. DESIGN Cross-sectional design. METHODS A sample of 2985 direct care staff in 190 nursing homes in 43 randomly selected municipalities in Sweden completed surveys on leadership, job satisfaction, self-rated health and intention to leave (response rate 52%). Descriptive statistics and Generalised Estimating Equations were conducted. The STROBE reporting checklist was applied. RESULTS Nursing home managers' leadership was positively related to job satisfaction, self-rated health and low intention to leave. Lower staff educational levels were related to poorer health and lower job satisfaction. CONCLUSIONS Nursing home leadership plays a significant role in the job satisfaction, self-reported health and intention to leave of direct care staff. Low education levels among staff seem to negatively influence staff health and job satisfaction, suggesting that educational initiatives for less-educated staff could be beneficial for improving staff health and job satisfaction. RELEVANCE TO CLINICAL PRACTICE Managers seeking to improve staff job satisfaction can consider how they support, coach and provide feedback. Recognising staff achievement at work can contribute to high job satisfaction. One important implication for managers is to offer continuing education to staff with lower or no education, given the large amount of uneducated direct care workers in aged care and the impact this may have on staff job satisfaction and health. NO PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution was required to outcome measures in this study. Direct care staff and managers contributed with data.
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Affiliation(s)
| | - Marie Lindkvist
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine in Umeå, Umeå, Sweden
| | - Karin Sjögren
- Department of Nursing, Umeå University, Umeå, Sweden
| | - David Edvardsson
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
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Miller VJ, Maziarz L, Wagner J, Bell J, Burek M. Nursing assistant turnover in nursing homes: A scoping review of the literature. Geriatr Nurs 2023; 51:360-368. [PMID: 37104907 DOI: 10.1016/j.gerinurse.2023.03.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Nurse aide turnover in long-term care is projected to increase in the coming years. Guided by a social ecological framework, this scoping review systematically searched for peer-reviewed journal articles on nursing assistant or nurse aide turnover in nursing homes. METHODS Using the PICO and PRISMA guidelines, 8 university-based library databases via EBSCOhost were searched to source peer-reviewed journal articles published between 2002 and 2022 on nurse aide turnover in nursing homes. RESULTS The initial article search revealed 997 articles. After a three-stage article screening and removal process, a final sample of 43 articles (N = 43) remained. Guided by levels of influence, nurse aide turnover is found to be influenced by intrapersonal, interpersonal, institutional, community, and public policy level factors. CONCLUSION Findings highlight the need for further research with nursing facility administrators and nurse aides to evaluate the complex interactions within long-term care nursing homes.
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Affiliation(s)
- Vivian J Miller
- College of Health and Human Services, Bowling Green State University, 223 Health and Human Services Bldg, Bowling Green, OH 43403, USA.
| | - Lauren Maziarz
- College of Health and Human Services, Bowling Green State University, 223 Health and Human Services Bldg, Bowling Green, OH 43403, USA
| | - Jennifer Wagner
- College of Health and Human Services, Bowling Green State University, 223 Health and Human Services Bldg, Bowling Green, OH 43403, USA
| | - Julia Bell
- College of Health and Human Services, Bowling Green State University, 223 Health and Human Services Bldg, Bowling Green, OH 43403, USA
| | - Melissa Burek
- College of Health and Human Services, Bowling Green State University, 223 Health and Human Services Bldg, Bowling Green, OH 43403, USA
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Gleason HP, Miller EA, Boerner K. Focusing on the Positive: Home Health Aides' Desire for Autonomy and Control. J Appl Gerontol 2023; 42:728-736. [PMID: 36523133 DOI: 10.1177/07334648221145177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Home Health Aides (HHAs) are one of the fastest growing workforces in the country, yet the industry struggles to recruit and retain workers. This study explored HHAs' experiences with the level of control, autonomy, and decision-making authority in their work. Six focus groups with 37 HHAs were conducted in Massachusetts. Findings showed that HHAs viewed control as a positive job characteristic, which attracted them to and led them to remain in the position. Positive benefits included having control over client selection, location, hours, and the ability to determine their day-to-day tasks and schedules. The study results highlight the value that HHAs place on autonomy and control and the potential benefit that these job qualities have for greater recruitment and retention of these workers. Amplifying control by bolstering training and expanding scope of practice may entice new individuals to pursue a HHA career and help maintain those currently in the position.
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Affiliation(s)
- Hayley P Gleason
- 50252Colorado Department of Health Care Policy & Financing, Denver, CO, USA
| | - Edward Alan Miller
- Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy & Global Studies, 14708University of Massachusetts Boston, Boston, MA, USA.,Department of Health Services, Policy and Practice, and Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA
| | - Kathrin Boerner
- Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy & Global Studies, 14708University of Massachusetts Boston, Boston, MA, USA
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Bryant NS, Cimarolli VR, Falzarano F, Stone R. Organizational Factors Associated with Certified Nursing Assistants' Job Satisfaction during COVID-19. J Appl Gerontol 2023:7334648231155017. [PMID: 36748259 PMCID: PMC9908517 DOI: 10.1177/07334648231155017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Given the instability of the nursing home (NH) certified nursing assistant (CNA) workforce and the challenging demands during COVID-19, it is important to understand the organizational factors that are correlated with job satisfaction which is a major predictor of CNA turnover. The purpose of this study was to determine the associations between quality of supervisor relationships, organizational supports, COVID-19 work-related stressors, and job satisfaction among CNAs in NHs. The results indicate that CNAs who reported a more optimal relationship with their supervisors, felt appreciated for the job they do and worked in NHs with lower COVID-19 resident infection rates tended to report higher rates of job satisfaction. The COVID-19 work-related stressors of increased workload demands and understaffing were associated with lower rates of job satisfaction. The study has practical implications for employers regarding how to support CNAs to improve job satisfaction especially during a crisis.
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Affiliation(s)
- Natasha S. Bryant
- LeadingAge, LTSS Center @UMass Boston, Washington, DC, USA,Natasha S. Bryant, LeadingAge LTSS Center @UMass Boston, 2519 Connecticut Avenue NW; Washington, DC 20008, USA.
| | | | - Francesca Falzarano
- Weill Cornell Medicine, Division of Geriatrics and Palliative Medicine, New York, NY, USA
| | - Robyn Stone
- LeadingAge, LTSS Center @UMass Boston, Washington, DC, USA
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8
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Kennedy KA, Mohr DC. Job Characteristics Associated With Intent to Quit Among Nursing Home Employees and Managers. THE GERONTOLOGIST 2023; 63:108-119. [PMID: 36190312 PMCID: PMC9872759 DOI: 10.1093/geront/gnac134] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES High turnover and recruitment challenges of nursing home employees and managers are an ongoing concern. This study's objective was to examine intent to quit among all staff and assess the roles of job characteristics and job satisfaction. Employees and managers within one nursing home chain working in direct patient care or nursing were compared. RESEARCH DESIGN AND METHODS Data came from the Work, Family, Health Network 18-month follow-up survey in 2012 (total = 1,000, managers = 101, employees = 899). A cumulative logit model controlling for demographics was estimated for intent to quit. Herzberg's Two-Factor Theory of Work Motivation guided the study. RESULTS Employees scored significantly lower on family-supportive supervisor behaviors (FSSBs), schedule control, and decision authority than managers. Employees and managers did not differ on job satisfaction, intent to quit, or job demands. Satisfied workers had an 83% decrease in the odds of reporting an intent to quit compared to workers who were neutral or disagreed (odds ratio [OR] = 0.17, p < .0001). Decision authority (OR = 3.49) and schedule control (OR = 5.18) were independently related to greater odds of reporting an intent to quit. In contrast, FSSBs (OR = 0.69), safety compliance (OR = 0.71), and the combination of high decision authority with high schedule control (OR = 0.72) were related to lower odds of reporting an intent to quit. DISCUSSION AND IMPLICATIONS Among nursing home staff, lower intent to quit may be achieved through improving job satisfaction, the quality of supervision, safety culture, and job enrichment through more schedule control and decision-making power.
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Affiliation(s)
- Katherine A Kennedy
- Center for Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - David C Mohr
- VA Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
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9
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Let's Rename Nursing Assistants What They Are: Professional Caregivers. J Am Med Dir Assoc 2022; 23:1755-1756. [DOI: 10.1016/j.jamda.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022]
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10
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Young CC, Kesler S, Walker VG, Johnson A, Harrison TC. An Online Mindfulness-based Intervention for Certified Nursing Assistants in Long-term Care. J Holist Nurs 2022; 41:130-141. [PMID: 35712816 DOI: 10.1177/08980101221105709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Certified nursing assistants (CNAs) make up the largest segment of the long-term care (LTC) setting workforce, however, they are at high risk of job dissatisfaction and burnout. Evidence suggests that mindfulness-based interventions (MBIs) might be particularly relevant and useful for CNAs in reducing psychological distress, improving job satisfaction, and reducing burnout, but little research has investigated this possibility. A feasibility study of an online MBI for CNAs in LTC settings was therefore conducted. Methods: CNAs completed assessments at baseline and posttest. Paired t-tests assessed changes in mindfulness, psychological distress (i.e., depressive and anxiety symptoms, and stress), and professional quality of life. Results: Of the 19 CNAs who started the intervention, N = 13 (68%) completed it and provided postintervention data. Depressive symptoms were significantly decreased postintervention (F = 6.26, p = .036, d = .47). Conclusions: MBIs may have beneficial effects for CNAs in LTC settings. Further research with a larger CNA population will increase the power and relevance of these findings, ultimately contributing to the improvement of patient outcomes in LTC.
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11
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Hawes FM, Wang S. The Impact of Supervisor Support on the Job Satisfaction of Immigrant and Minority Long-Term Care Workers. J Appl Gerontol 2022; 41:2157-2166. [PMID: 35609234 DOI: 10.1177/07334648221104088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Previous research has demonstrated the effect of supervisor support on the job satisfaction of long-term care workers (LTCW); however, much less is known about how this effect differs among race/ethnicity or immigration groups. We examined how supervisor support mediates the associations between race/ethnicity, immigration status, and job satisfaction among nursing assistants (NAs). Data of 2749 NAs were extracted from the National Nursing Assistant Survey (2004). Findings indicated that NAs of non-Hispanic Black and other races and immigrant workers were more likely to be satisfied with their jobs compared to White and non-immigrant workers, and the associations were mediated by NAs' perceived supervisor support. Minority or immigrant LTCW may be more sensitive to supervisory support and more grateful if they received support from supervisors. Managers should be aware of these racial differences and by being supportive they may improve NAs job satisfaction and reduce turnover rates.
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Affiliation(s)
- Frances M Hawes
- Health Care Administration Department, 14747University of Wisconsin Eau Claire, Eau Claire, WI, USA
| | - Shuangshuang Wang
- School of Public Administration, 66555Southwest Jiaotong University, Chengdu, China.,Gerontology Institute, University of Massachusetts Boston, Boston, MA, USA
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12
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How is leadership experienced in joy-of-life-nursing-homes compared to ordinary nursing homes: a qualitative study. BMC Nurs 2022; 21:73. [PMID: 35351102 PMCID: PMC8966162 DOI: 10.1186/s12912-022-00850-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/21/2022] [Indexed: 12/01/2022] Open
Abstract
Background Nursing homes are under strong pressure to provide good care to the patients. In Norway, municipalities have applied the ‘Joy-of-Life-Nursing-Homes’ (JoLNH) strategy which is based on a health-promoting approach building on the older persons’ resources. Meanwhile job satisfaction is closely related to less intention to leave, less turnover and reduced sick leave. The knowledge about adjustable influences related with job satisfaction might help nursing home leaders to minimize turnover and preserve high quality of care. This study explores leadership in Norwegian nursing homes with and without implementation of JoLNH: How does leadership influence the work environment and how is leadership experienced in JoLNH compared to ordinary Nursing Homes? Method We used a qualitative approach and interviewed 19 health care personnel working in nursing homes in two Norwegian municipalities. The analysis was conducted following Kvale’s approach to qualitative analysis. Results The main categories after the data condensing were [1] the importance of leadership, and [2] the importance of leadership for the work environment in a municipality with (a) and without (b) an implementation of the JoLNH strategy. Conclusions The health care personnel in the municipality with an implementation of JoLNH emphasize that the leader’s influence may lead to increased motivation among the staff and better control of changes and implementation processes. Our findings may indicate that the employee from a JoLNH municipality experience a more trustful relationship to the leader.
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13
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Yang A, Fu S, Liu L, Fan C, Jilili M. Act Tough and Soft: Video Monitoring, Hongbao Gifts, and the Job Satisfaction of Domestic Workers. Front Public Health 2022; 10:862162. [PMID: 35400073 PMCID: PMC8990934 DOI: 10.3389/fpubh.2022.862162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
There is a rapidly growing demand for domestic services among urban families in China. However, domestic work remains a low-status occupation with a high turnover rate. Focusing on the job satisfaction of domestic workers is useful to interpret this phenomenon. We investigate how the job satisfaction of domestic workers in China is affected by to two distinct labor control strategies used by their employers: the installation of video-monitoring devices in employers' homes (a “tough” control strategy), and the Chinese custom of giving monetary gifts, or “hongbao” (a “soft” control strategy). By analyzing data from surveys of domestic workers in four cities in China (N = 699), we find that video monitoring in employers' homes negatively impacts domestic workers' job satisfaction, and that hongbao gifts from employers significantly promote domestic workers' job satisfaction. The analysis of the causal mechanism based on a structural equation model suggests that video monitoring can increase the discrimination that domestic workers perceive, which in turn reduces their job satisfaction. In particular, we find that domestic workers' perception of discrimination completely mediates the effect of video monitoring on their job satisfaction. However, we also find that hongbao gifts significantly reduce domestic workers' perceptions of discrimination, and thus promote their job satisfaction; that is, the relationship between hongbao gifts and job satisfaction is partially mediated by discrimination. Our study provides a more comprehensive understanding of Chinese employers' labor control strategies and their effects on the job satisfaction of domestic workers.
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Affiliation(s)
- Anuo Yang
- School of Social and Behavioral Sciences, Nanjing University, Nanjing, China
| | - Shuangle Fu
- School of Social and Behavioral Sciences, Nanjing University, Nanjing, China
| | - Linping Liu
- School of Public Administration, Hangzhou Normal University, Hangzhou, China
- *Correspondence: Linping Liu
| | - Changyu Fan
- School of Sociology, Central China Normal University, Wuhan, China
| | - Maitixirepu Jilili
- School of Social and Behavioral Sciences, Nanjing University, Nanjing, China
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14
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Blanco‐Donoso LM, Moreno‐Jiménez J, Gallego‐Alberto L, Amutio A, Moreno‐Jiménez B, Garrosa E. Satisfied as professionals, but also exhausted and worried!!: The role of job demands, resources and emotional experiences of Spanish nursing home workers during the COVID-19 pandemic. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e148-e160. [PMID: 34013986 PMCID: PMC8239566 DOI: 10.1111/hsc.13422] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 05/07/2023]
Abstract
Nursing home workers have been exposed to great physical and mental burdens during the COVID-19 pandemic. Although this has generated high levels of exhaustion, it may also have contributed to feelings of professional satisfaction. The objective of this study was to explore the levels of satisfaction among nursing home workers during the COVID-19 pandemic, as well as the role of job demands, resources and emotional experiences in explaining their levels of satisfaction. This cross-sectional study was conducted in Spain between March and May 2020. Three hundred and thirty-five nursing home workers participated. A quantitative analysis was conducted, as was a content analysis of the responses to an open-ended question about the respondents' perceptions of job demands and resources during the crisis. The results showed that workers had very high levels of satisfaction. Social pressure from work, contact with death and suffering, and emotional exhaustion were negatively associated with satisfaction. Moreover, under conditions of extensive contact with suffering people and great fear of contagion, social support at work was shown to promote professional satisfaction. In conclusion, nursing home workers in Spain experienced high rates of satisfaction during the COVID-19 crisis despite the high job demands, lack of job resources, fear of contagion and exhaustion. The main practical implication of this study is the importance of ensuring optimal working conditions in the nursing home sector in order to guarantee professional satisfaction, prevent burnout, reduce turnover and promote post-crisis resilience.
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Affiliation(s)
| | | | | | - Alberto Amutio
- Social PsychologyFaculty of Labor Relations and Social WorkUniversity of the Basque Country (UPV/EHU)BilbaoSpain
- Facultad de Educación y Ciencias SocialesUniversidad Andres BelloSantiagoChile
| | | | - Eva Garrosa
- Faculty of PsychologyAutonomous University of MadridMadridSpain
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15
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Lin L, Liu X, McGilton KS, Yuan Y, Li H, Dong B, Xie C, Wang H, Li H, Tian L. Level of nurse supportive supervision and its influencing factors in long-term care facilities. Geriatr Nurs 2021; 42:1316-1322. [PMID: 34560526 DOI: 10.1016/j.gerinurse.2021.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022]
Abstract
Quality of care provided by personal support workers (PSWs) in long-term care facilities (LTCFs) is associated with the supportive supervisory performance of registered nurses (RNs). To determine the level of supportive supervision of RNs and its influencing factors in LTCFs in East China, a cross-sectional survey was conducted in 12 LTCFs using self-designed sociodemographic questionnaires and the Chinese version of the Supportive Supervisory Scale. A total of 643 PSWs supervised by 260 RNs were surveyed. The average supportive supervision score was 59.60 ± 7.53, representing a moderate level of supervisory support. Supportive supervision was found to be positively correlated with the PSW's years of working, the RN's education, position, number of years in nursing, having access to managerial training as well as the RN/PSW ratio in the unit (p < 0.05). These factors can be modified to potentially influence the supportive capacity of nurse supervisors in LTCFs.
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Affiliation(s)
- Lu Lin
- The First Affiliated Hospital of Soochow University, No. 188 Shizi Road, Suzhou 215006, People's Republic of China; School of Nursing, Medical College of Soochow University, No. 188 Shizi Street, Suzhou 215006, People's Republic of China
| | - Xiaoming Liu
- The First Affiliated Hospital of Soochow University, No. 188 Shizi Road, Suzhou 215006, People's Republic of China
| | - Katherine S McGilton
- Toronto Rehabilitation Institute-UHN, Toronto, ON, Canada; University of Toronto, ON, Canada
| | - Yang Yuan
- School of Nursing, Medical College of Soochow University, No. 188 Shizi Street, Suzhou 215006, People's Republic of China
| | - Haixia Li
- Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou 215006, People's Republic of China
| | - Bei Dong
- School of Nursing, Medical College of Soochow University, No. 188 Shizi Street, Suzhou 215006, People's Republic of China
| | - Congyan Xie
- School of Nursing, Medical College of Soochow University, No. 188 Shizi Street, Suzhou 215006, People's Republic of China
| | - Hong Wang
- Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou 215006, People's Republic of China
| | - Huiling Li
- School of Nursing, Medical College of Soochow University, No. 188 Shizi Street, Suzhou 215006, People's Republic of China.
| | - Li Tian
- The First Affiliated Hospital of Soochow University, No. 188 Shizi Road, Suzhou 215006, People's Republic of China; School of Nursing, Medical College of Soochow University, No. 188 Shizi Street, Suzhou 215006, People's Republic of China.
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16
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State Tested Nursing Assistants' Workplace Experiences That Threaten or Support Intent to Stay. Rehabil Nurs 2021; 45:323-331. [PMID: 33332793 DOI: 10.1097/rnj.0000000000000232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Over 1 million Americans utilize skilled nursing facilities (SNFs) annually. Within SNFs, State Tested Nursing Assistants (STNAs) are primary caregivers; however, low retention rates are notable and threaten patient care. DESIGN A phenomenological, qualitative study was conducted to explore intrinsic factors that influence STNAs' intent to stay in their positions. METHODS Ten STNAs employed at for-profit SNFs participated in semistructured face-to-face interviews. Data were analyzed to identify broad concepts and recurrent themes. FINDINGS Findings suggest that intrinsic factors supporting and threatening intent to stay included the fulfillment of basic psychological needs. Supporting themes included self-confidence, appreciation, positive relationships, and a willingness to go beyond required duties. Threatening themes included frustration, lack of support, and career advancement opportunities. CONCLUSIONS Findings provide an understanding of factors that influence STNAs' intent to stay. CLINICAL RELEVANCE The results may help guide the development of responsive strategies that improve quality and continuity of care in SNFs.
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17
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Gleason HP, Miller EA. Maximizing Home Health Aide Retention: The Impact of Control and Support on the Job. THE GERONTOLOGIST 2021; 61:517-529. [PMID: 33423049 DOI: 10.1093/geront/gnab003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES This study examined relationships between the level of control and support and home health aides (HHAs) job satisfaction and intent to leave the job. RESEARCH DESIGN AND METHODS Data derive from a survey of 512 HHAs in Massachusetts. Logistic regression using generalized estimating equations was employed for the analysis. Dependent variables included satisfaction and intent to leave the job as a home care aide generally and satisfaction and intent to leave the job at the aide's current agency. RESULTS The findings showed that greater control and support on the job were important predictors of positive work outcomes, controlling for job demands and other covariates. The odds of HHAs being satisfied with their job as a home care aide increased with the degree of control, whereas the odds of HHAs being satisfied with their job at their current agency increased with the extent of support. Control was negatively associated with HHAs' intent to leave the job as an aide; no relationship was found between control or support and HHAs' intent to leave their current agency. DISCUSSION AND IMPLICATIONS The results from this study illustrate the importance for HHAs of having control and autonomy in their work, as well as the benefit of support from supervisors and the home care agency, on satisfaction and intent to leave. Expanding HHA's ability to maintain control over their day-to-day work, as well as enhancing the supports available to them, is likely to benefit home care workers, clients, and agencies through increased retention.
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Affiliation(s)
- Hayley P Gleason
- Colorado Department of Health Care Policy & Financing, Denver, USA
| | - Edward Alan Miller
- Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston, USA.,Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
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18
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Törmä J, Pingel R, Cederholm T, Saletti A, Winblad U. Is it possible to influence ability, willingness and understanding among nursing home care staff to implement nutritional guidelines? A comparison of a facilitated and an educational strategy. Int J Older People Nurs 2021; 16:e12367. [PMID: 33624452 DOI: 10.1111/opn.12367] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 12/22/2020] [Accepted: 01/07/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Translating nutrition knowledge into care practice is challenging since multiple factors can affect the implementation process. This study examined the impact of two implementation strategies, that is external facilitation (EF) and educational outreach visits (EOVs), on the organisational context and individual factors when implementing nutritional guidelines in a nursing home (NH) setting. METHODS The EF strategy was a one-year, multifaceted (including support, guidance, a practice audit and feedback) intervention given to four NH units. The EOV strategy was a three-hour lecture about the nutritional guidelines given to four other NH units. Both strategies were directed at selected NH teams, consisting of a unit manager, a nurse and 5-10 care staff. A questionnaire was distributed, before and after the interventions, to evaluate the prerequisites for the staff to use the guidelines. Three conditions were used to examine the organisational context and the individual factors: the staff's ability and willingness to implement the nutritional guidelines and their understanding of them. Confirmatory factor analysis and structural equation models were used for the data analysis. RESULTS The results indicated that on average, there was a significant increase in the staff's ability to implement the nutritional guidelines in the EF group. The staff exposed to the EF strategy experienced better resources to implement the guidelines in terms of time, tools and support from leadership and a clearer assignment of responsibility regarding nutrition procedures. There was no change in staff's willingness and understanding of the guidelines in the EF group. On average, no significant changes were observed for the staff's ability, willingness or understanding in the EOV group. CONCLUSIONS A long-term, active and flexible implementation strategy (i.e. EF) affected the care staff's ability to implement the nutritional guidelines in an NH setting. No such impact was observed for the more passive, educational approach (i.e. EOV).
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Affiliation(s)
- Johanna Törmä
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Ronnie Pingel
- Department of Statistics, Uppsala University, Uppsala, Sweden
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Anja Saletti
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden
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19
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Travers JL, Caceres BA, Vlahov D, Zaidi H, Dill JS, Stone RI, Stone PW. Federal requirements for nursing homes to include certified nursing assistants in resident care planning and interdisciplinary teams: A policy analysis. Nurs Outlook 2021; 69:617-625. [PMID: 33593666 DOI: 10.1016/j.outlook.2021.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 12/22/2020] [Accepted: 01/10/2021] [Indexed: 11/27/2022]
Abstract
Starting in 2016, Centers for Medicare and Medicaid Services implemented the first phase of a 3-year multi-phase plan revising the manner in which nursing homes are regulated. In this revision, attention was placed on the importance of certified nursing assistants (CNAs) to resident care and the need to empower these frontline workers. Phase II mandates that CNAs be included as members of the nursing home interdisciplinary team that develops care plans for the resident that are person-centered and comprehensive and reviews and revises these care plans after each resident assessment. While these efforts are laudable, there are no direct guidelines for how to integrate CNAs in the interdisciplinary team. We recommend the inclusion of direct guidelines, in which this policy revision clarifies the expected contributions from CNAs, their responsibilities, their role as members of the interdisciplinary team, and the expected patterns of communication between CNAs and other members of the interdisciplinary team.
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Affiliation(s)
| | | | | | | | | | | | - Patricia W Stone
- Columbia University School of Nursing, Center for Health Policy, New York, NY
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20
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Person-Centered Long-Term Care: Perfect May Be the Enemy of Good. J Am Med Dir Assoc 2020; 21:1580-1581. [PMID: 33138942 DOI: 10.1016/j.jamda.2020.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 11/22/2022]
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21
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Vainieri M, Smaldone P, Rosa A, Carroll K. The role of collective labor contracts and individual characteristics on job satisfaction in Tuscan nursing homes. Health Care Manage Rev 2020; 44:224-234. [PMID: 28837500 PMCID: PMC6587616 DOI: 10.1097/hmr.0000000000000177] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: The role played by remuneration strategies in motivating health care professionals is one of the most studied factors. Some studies of nursing home (NH) services, while considering wages and labor market characteristics, do not explicitly account for the influence of the contract itself. Purpose: This study investigates the relationship between the labor contracts applied in 62 Tuscan NHs and NH aides’ job satisfaction with two aims: to investigate the impact of European contracts on employee satisfaction in health care services and to determine possible limitations of research not incorporating these contracts. Methodology: We apply a multilevel model to data gathered from a staff survey administered in 2014 to all employees of 62 NHs to analyze two levels: individual and NH. Labor contracts were introduced into the model as a variable of NH. Results: Findings show that the factors influencing nursing aides’ satisfaction occur at both the individual and NH levels. Organizational characteristics explain 16% of the variation. For individual characteristics, foreign and temporary workers emerge as more satisfied than others. For NH variables, results indicate that the labor contract with the worst conditions is not associated with lower workers’ satisfaction. Conclusion: Although working conditions play a relevant role in the job satisfaction of aides, labor contracts do not seem to affect it. Interestingly, aides of the NHs with the contract having the best conditions register a significantly lower level of satisfaction compared to the NHs with the worst contract conditions. This suggests that organizational factors such as culture, team work, and other characteristics, which were not explicitly considered in this study, may be more powerful sources of worker satisfaction than labor contracts. Practice Implications: Our analysis has value as a management tool to consider alternative sources as well as the labor contract for employee incentives.
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Affiliation(s)
- Milena Vainieri
- Milena Vainieri, PhD, is Associate Professor in Management, Health and Management Lab, Institute of Management, Sant'Anna School of Advanced Studies of Pisa, Italy. E-mail: . Pierluigi Smaldone, PhD, is freelance researcher, previous doctoral student at Health and Management Lab, Institute of Management, Sant'Anna School of Advanced Studies of Pisa. Antonella Rosa, MSc, is Researcher in Management, Health and Management Lab, Institute of Management, Sant'Anna School of Advanced Studies of Pisa. Kathleen Carroll, is Associate Dean, College of Arts, Humanities, and Social Sciences, and Associate Professor in Economics, Department of Economics, University of Maryland, Baltimore County
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22
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Haugan G, Kuven BM, Eide WM, Taasen SE, Rinnan E, Xi Wu V, Drageset J, André B. Nurse-patient interaction and self-transcendence: assets for a meaningful life in nursing home residents? BMC Geriatr 2020; 20:168. [PMID: 32381032 PMCID: PMC7203905 DOI: 10.1186/s12877-020-01555-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/13/2020] [Indexed: 12/12/2022] Open
Abstract
Background Due to the shift to an older population worldwide and an increased need for 24-h care, finding new and alternative approaches to increase wellbeing among nursing home (NH) residents is highly warranted. To guide clinical practice in boosting wellbeing among NH residents, knowledge about nurse-patient interaction (NPI), inter- (ST1) and intra-personal (ST2) self-transcendence and meaning-in-life (PIL) seems vital. This study tests six hypotheses of the relationships between NPI, ST1, ST2 and PIL among cognitively intact NH residents. Methods In a cross-sectional design, 188 (92% response rate) out of 204 long-term NH residents representing 27 NHs responded to NPI, ST, and the PIL scales. Inclusion criteria were: (1) municipality authority’s decision of long-term NH care; (2) residential time 3 months or longer; (3) informed consent competency recognized by responsible doctor and nurse; and (4) capable of being interviewed. The hypothesized relations between the latent constructs were tested through structural equation modeling (SEM) using Stata 15.1. Results The SEM-model yielded a good fit (χ2 = 146.824, p = 0.021, df = 114, χ2/df = 1.29 RMSEA = 0.040, p-close 0.811, CFI = 0.97, TLI = 0.96, and SRMR = 0.063), supporting five of the six hypothesized relationships between the constructs of NPI, ST1, ST2 and PIL. Conclusion NPI significantly relates to both ST1, ST2 and PIL in NH residents. ST revealed a fundamental influence on perceived PIL, while NPI demonstrated a significant indirect influence on PIL, mediated by ST.
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Affiliation(s)
- Gørill Haugan
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway. .,NORD University, Faculty of Nursing and Health Science, Levanger, Norway.
| | - Britt Moene Kuven
- Faculty of Health and Social Science, Western University of Applied Science, Bergen, Norway
| | - Wenche Mjanger Eide
- Faculty of Health and Social Science, Western University of Applied Science, Bergen, Norway
| | - Siv Eriksen Taasen
- Faculty of Health and Social Science, Western University of Applied Science, Bergen, Norway
| | - Eva Rinnan
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway.,Trondheim Municiaplity, Trondheim, Norway
| | - Vivien Xi Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, The National University of Singapore, Singapore, Singapore
| | - Jorunn Drageset
- Faculty of Health and Social Science, Western University of Applied Science, Bergen, Norway.,Department of Global Health and Primary Care, University of Bergen, Bergen, Norway
| | - Beate André
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
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23
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Berridge C, Lima J, Schwartz M, Bishop C, Miller SC. Leadership, Staff Empowerment, and the Retention of Nursing Assistants: Findings From a Survey of U.S. Nursing Homes. J Am Med Dir Assoc 2020; 21:1254-1259.e2. [PMID: 32192871 DOI: 10.1016/j.jamda.2020.01.109] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/04/2020] [Accepted: 01/27/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We examined the relationship between nursing assistant (NA) retention and a measure capturing nursing home leadership and staff empowerment. DESIGN Cross-sectional study using nationally representative survey data. SETTING AND PARTICIPANTS Data from the Nursing Home Culture Change 2016-2017 Survey with nursing home administrator respondents (N = 1386) were merged with facility-level indicators. METHODS The leadership and staff empowerment practice score is an index derived from responses to 23 survey items and categorized as low, medium, and high. Multinomial logistic regression weighted for sample design and to address culture-change selection bias identified factors associated with 4 categories of 1-year NA retention: 0% to 50%, 51% to 75%, 76% to 90%, and 91% to 100%. RESULTS In an adjusted model, greater leadership and staff empowerment levels were consistently associated with high (76%-90% and 91%-100%) relative to low (0%-50%) NA retention. Occupancy rate, chain status, licensed practical nurse and certified nursing assistant hours per day per resident, nursing home administrator turnover, and the presence of a union were also significantly associated with higher categories of retention (vs low retention). CONCLUSIONS AND IMPLICATIONS Modifiable leadership and staff empowerment practices are associated with NA retention. Associations are most significant when examining the highest practice scores and retention categories. Nursing homes seeking to improve NA retention might look to leadership and staff empowerment practice changes common to culture change.
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Affiliation(s)
- Clara Berridge
- University of Washington School of Social Work, Seattle, WA.
| | - Julie Lima
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, RI
| | - Margot Schwartz
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, RI
| | - Christine Bishop
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA
| | - Susan C Miller
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, RI
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24
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Qualitative analyses of nursing home residents' quality of life from multiple stakeholders' perspectives. Qual Life Res 2020; 29:1229-1238. [PMID: 31898111 DOI: 10.1007/s11136-019-02395-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Quality of life has been defined in various ways by nursing home stakeholders over the years. As such, analyzing the levels of agreement or disagreement among these stakeholders to ascertain if staff and leadership align with resident-identified factors for "good" quality of life has become important to include in the literature. This study sought to identify contributory factors to resident quality of life, as well as analyze areas of commonality in qualitative responses. METHODS Semi-structured interviews were conducted at 46 Midwestern nursing homes, with residents (n = 138), nursing assistants (n = 138), social workers (n = 46), activities directors (n = 46), and administrators (n = 46), on whether each stakeholder felt residents had a good quality of life and the factors contributing to resident quality of life. RESULTS Overall, the majority of residents perceived their quality of life as "good," though differences were noted in their main contributing factors when compared to staff members' and management's perspectives. Findings also demonstrated that nursing assistants most closely aligned with resident perspectives. CONCLUSIONS Given the implications of resident satisfaction with quality of life on multiple facets of a nursing home (e.g., survey process, financial reimbursement), it remains ever critical for management to engage residents and to truly listen to resident perspectives to enhance and ensure an optimal quality of life.
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25
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McGilton KS, Backman A, Boscart V, Chu C, Gea Sánchez M, Irwin C, Meyer J, Spilsbury K, Zheng N, Zúñiga F. Exploring a Common Data Element for International Research in Long-Term Care Homes: A Measure for Evaluating Nursing Supervisor Effectiveness. Gerontol Geriatr Med 2020; 6:2333721420979812. [PMID: 33426177 PMCID: PMC7758648 DOI: 10.1177/2333721420979812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 10/31/2020] [Accepted: 11/09/2020] [Indexed: 11/24/2022] Open
Abstract
The aim of this study is to recommend a common data element (CDE) to measure supervisory effectiveness of staff working in LTC homes that can be used in international research. Supervisory effectiveness can serve as a CDE in an effort to establish an international, person-centered LTC research infrastructure in accordance with the aims of the WE-THRIVE group (Worldwide Elements to Harmonize Research in Long Term Care Living Environments). A literature review was completed and then a panel of experts independently reviewed and prioritized appropriateness of the measures with mindfulness of their potential applications to international LTC settings. The selection of a recommended CDE measure was guided by the WE-THRIVE group's focus on capacity rather than deficits, the expected availability of internationally comparable data and the goal to provide a short, ecologically viable measurement, specifically for low- and middle-income countries. Two measures were considered as the CDE for supervisory effectiveness, Benjamin Rose Relationship Scale and the Supervisory Support Scale; however, given that the latter measure has been translated in Spanish and Chinese and has been tested with nursing assistants in both of these countries with good psychometric properties, our group recommends it as the CDE going forward.
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Affiliation(s)
- Katherine S. McGilton
- KITE – Toronto Rehabilitation Institute—UHN, Toronto, ON, Canada
- University of Toronto, ON, Canada
| | | | | | - Charlene Chu
- KITE – Toronto Rehabilitation Institute—UHN, Toronto, ON, Canada
- University of Toronto, ON, Canada
| | | | - Constance Irwin
- KITE – Toronto Rehabilitation Institute—UHN, Toronto, ON, Canada
| | | | | | - Nancy Zheng
- KITE – Toronto Rehabilitation Institute—UHN, Toronto, ON, Canada
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26
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Eaton J, Cloyes K, Paulsen B, Madden C, Ellington L. Certified nursing assistants as agents of creative caregiving in long‐term care. Int J Older People Nurs 2019; 15:e12280. [DOI: 10.1111/opn.12280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 08/31/2019] [Accepted: 09/08/2019] [Indexed: 11/28/2022]
Affiliation(s)
| | - Kristin Cloyes
- College of Nursing University of Utah Salt Lake City UT USA
| | - Brooke Paulsen
- College of Nursing University of Utah Salt Lake City UT USA
| | - Connie Madden
- College of Nursing University of Utah Salt Lake City UT USA
| | - Lee Ellington
- College of Nursing University of Utah Salt Lake City UT USA
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27
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Sturdevant D. Commentary on Bridging the Science-Practice Gap in Aging, Dementia, and Mental Health: Nursing Home Culture Change As an Exemplar. J Am Geriatr Soc 2019; 66 Suppl 1:S36-S39. [PMID: 29659000 DOI: 10.1111/jgs.15344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 02/03/2018] [Accepted: 02/07/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Diana Sturdevant
- Fran and Earl Ziegler College of Nursing, Health Sciences Center, University of Oklahoma, Oklahoma City, OK
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28
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White EM, Aiken LH, McHugh MD. Registered Nurse Burnout, Job Dissatisfaction, and Missed Care in Nursing Homes. J Am Geriatr Soc 2019; 67:2065-2071. [PMID: 31334567 DOI: 10.1111/jgs.16051] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/30/2019] [Accepted: 06/01/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine the relationship between registered nurse (RN) burnout, job dissatisfaction, and missed care in nursing homes. DESIGN Cross-sectional secondary analysis of linked data from the 2015 RN4CAST-US nurse survey and LTCfocus. SETTING A total of 540 Medicare- and Medicaid-certified nursing homes in California, Florida, New Jersey, and Pennsylvania. PARTICIPANTS A total of 687 direct care RNs. MEASUREMENTS Emotional Exhaustion subscale of the Maslach Burnout Inventory, job dissatisfaction, and missed care. RESULTS Across all RNs, 30% exhibited high levels of burnout, 31% were dissatisfied with their job, and 72% reported missing one or more necessary care tasks on their last shift due to lack of time or resources. One in five RNs reported frequently being unable to complete necessary patient care. Controlling for RN and nursing home characteristics, RNs with burnout were five times more likely to leave necessary care undone (odds ratio [OR] = 4.97; 95% confidence interval [CI] = 2.56-9.66) than RNs without burnout. RNs who were dissatisfied were 2.6 times more likely to leave necessary care undone (OR = 2.56; 95% CI = 1.68-3.91) than RNs who were satisfied. Tasks most often left undone were comforting/talking with patients, providing adequate patient surveillance, patient/family teaching, and care planning. CONCLUSION Missed nursing care due to inadequate time or resources is common in nursing homes and is associated with RN burnout and job dissatisfaction. Improved work environments with sufficient staff hold promise for improving care and nurse retention. J Am Geriatr Soc 67:2065-2071, 2019.
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Affiliation(s)
- Elizabeth M White
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Linda H Aiken
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Matthew D McHugh
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
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29
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Zysberg L, Band-Winterstein T, Doron I, Shulyaev K, Siegel EO, Kornas-Biela D, Zisberg A. The health care aide position in nursing homes: A comparative survey of nurses’ and aides’ perceptions. Int J Nurs Stud 2019; 94:98-106. [DOI: 10.1016/j.ijnurstu.2019.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 03/05/2019] [Accepted: 03/09/2019] [Indexed: 01/24/2023]
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30
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The Prevalence of Culture Change Practice in US Nursing Homes: Findings From a 2016/2017 Nationwide Survey. Med Care 2019; 56:985-993. [PMID: 30234764 DOI: 10.1097/mlr.0000000000000993] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Given the dynamic nursing home (NH) industry and evolving regulatory environment, depiction of contemporary NH culture-change (person/resident-centered) care practice is of interest. Thus, we aimed to portray the 2016/2017 prevalence of NH culture change-related processes and structures and to identify factors associated with greater practice prevalence. RESEARCH DESIGN AND METHODS We administered a nationwide survey to 2142 NH Administrators at NHs previously responding to a 2009/2010 survey. Seventy-four percent of administrators (1583) responded (with no detectable nonresponse bias) enabling us to generalize (weighted) findings to US NHs. From responses, we created index scores for practice domains of resident-centered care, staff empowerment, physical environment, leadership, and family and community engagement. Facility-level covariate data came from the survey and the Certification and Survey Provider Enhanced Reporting system. Ordered logistic regression identified the factors associated with higher index scores. RESULTS Eighty-eight percent of administrators reported some facility-level involvement in NH culture change, with higher reported involvement consistently associated with higher domain index scores. NHs performed the best (82.6/100 weighted points) on the standardized resident-centered care practices index, and had the lowest scores (54.8) on the family and community engagement index. Multivariable results indicate higher index scores in NHs with higher leadership scores and in states having Medicaid pay-for-performance with culture change-related quality measures. CONCLUSIONS The relatively higher resident-centered care scores (compared with other domain scores) suggest an emphasis on person-centered care in many US NHs. Findings also support pay-for-performance as a potential mechanism to incentivize preferred NH practice.
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Mapira L, Kelly G, Geffen LN. A qualitative examination of policy and structural factors driving care workers' adverse experiences in long-term residential care facilities for the older adults in Cape Town. BMC Geriatr 2019; 19:97. [PMID: 30940078 PMCID: PMC6444580 DOI: 10.1186/s12877-019-1105-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/17/2019] [Indexed: 11/25/2022] Open
Abstract
Background There is lack of adequate training and policy support for employed care workers (CWs) employed in the South African (SA) older persons’ sector. Existing literature neglects the influence of training and policy support on CWs’ experiences in long-term care (LTC) for older adults in residential care facilities (RCFs). We investigated the ways in which CWs’ experiences are rooted in the lack of adequate training and policy support. Methods Qualitative data was collected through focus group (FG) interviews with 32 CWs employed in RCFs in the City of Cape Town. Data was also collected using semi-structured interviews with representatives of five RCFs for older adults and four training organisations providing CW training in the City of Cape Town, South Africa. Results Despite some positive caregiving experiences, CWs face role ambiguity and experience care work as a ‘career-less job’. They also face poor employment conditions, negative interpersonal relations at work, and role overload. They are not coping with the demands of LTC due to role overload, and lack of basic caregiving skills, coping skills and socio-emotional support. Their motivation to cope and provide quality care is hamstrung by their experiences of role ambiguity, poor employment conditions, negative interpersonal relations at work, and lack of career growth opportunities. Conclusions Findings suggest that CWs’ experiences derive from the policy and structural context of caregiving. Policy inadequacies and lack of structural support create conditions for adverse conditions which negatively impact on CWs motivation and ability to cope with the demands of LTC. Lack of policy implementation presents structural barriers to quality LTC in the older persons’ sector. Implementation of policies and systems for professionalising care work is long overdue.
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Affiliation(s)
- Leo Mapira
- The Samson Institute For Ageing Research, Highlands House, 234 Upper Buitenkant Street, Cape Town, Western Cape, 8001, South Africa. .,Department of Sociology, Faculty of Humanities, 4.35 Leslie Social Science Building, 12 University Avenue, Rondebosch, Cape Town, Western Cape, 7701, South Africa.
| | - Gabrielle Kelly
- The Samson Institute For Ageing Research, Highlands House, 234 Upper Buitenkant Street, Cape Town, Western Cape, 8001, South Africa
| | - Leon N Geffen
- The Samson Institute For Ageing Research, Highlands House, 234 Upper Buitenkant Street, Cape Town, Western Cape, 8001, South Africa.,Division of Geriatric Medicine and the Albertina & Walter Sisulu Institute of Ageing in Africa, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, L51 Old Main Building, Observatory, Cape Town, Western Cape, 7701, South Africa
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Bethell J, Chu CH, Wodchis WP, Walker K, Stewart SC, McGilton KS. Supportive Supervision and Staff Intent to Turn Over in Long-Term Care Homes. THE GERONTOLOGIST 2019; 58:953-959. [PMID: 28329826 DOI: 10.1093/geront/gnx008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Indexed: 01/14/2023] Open
Abstract
Background and Objectives To examine the association between supervisory support and intent to turn over among personal support workers (PSWs) employed in long-term care (LTC) homes in Ontario, Canada, by assessing whether the association is mediated by job satisfaction and the potential confounding effect of happiness. Research Design and Methods Cross-sectional survey data of 5,645 PSWs working within 398 LTC homes in Ontario, Canada, were obtained and analysed through a series of multilevel regression models. Results Overall, analyses support the assertion that the effect of supervisory support on intent to turn over is partially mediated by job satisfaction. However, happiness may act as an effect modifier rather than as a confounder. Discussion and Implications These results reinforce the importance of supportive supervision for PSWs working in LTC homes and highlight the multifaceted role of nurses in LTC, who traditionally provide the majority of PSW supervision. Nurses must be equipped with competencies and skills that reflect the complex organisational environments in which they work. However, these results must also be interpreted in context with the limitations of cross-sectional data; future research should incorporate prospective data collection and clarify the potential role of happiness.
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Affiliation(s)
- Jennifer Bethell
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Charlene H Chu
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Walter P Wodchis
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Kevin Walker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Steven C Stewart
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Katherine S McGilton
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada
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Escrig-Pinol A, Corazzini KN, Blodgett MB, Chu CH, McGilton KS. Supervisory relationships in long-term care facilities: A comparative case study of two facilities using complexity science. J Nurs Manag 2018; 27:311-319. [DOI: 10.1111/jonm.12681] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/20/2018] [Accepted: 06/10/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Astrid Escrig-Pinol
- Toronto Rehabilitation Institute, EnCOAR Team; University Health Network; Toronto ON Canada
- University of Toronto; Dalla Lana School of Public Health; Toronto ON Canada
| | | | - Meagan B. Blodgett
- Toronto Rehabilitation Institute, EnCOAR Team; University Health Network; Toronto ON Canada
| | - Charlene H. Chu
- Toronto Rehabilitation Institute, EnCOAR Team; University Health Network; Toronto ON Canada
| | - Katherine S. McGilton
- Toronto Rehabilitation Institute, EnCOAR Team; University Health Network; Toronto ON Canada
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Determinants of turnover among low wage earners in long term care: the role of manager-employee relationships. Geriatr Nurs 2018; 39:407-413. [DOI: 10.1016/j.gerinurse.2017.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 12/05/2017] [Accepted: 12/11/2017] [Indexed: 11/16/2022]
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Jordan KJ, Tsai PF, Heo S, Bai S, Dailey D, Beck CK, Butler LM, Greenwood RL. Pilot Testing a Coaching Intervention to Improve Certified Nursing Assistants' Dressing of Nursing Home Residents. Res Gerontol Nurs 2017; 10:267-276. [DOI: 10.3928/19404921-20171013-04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/11/2017] [Indexed: 11/20/2022]
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Boerner K, Gleason H, Jopp DS. Burnout After Patient Death: Challenges for Direct Care Workers. J Pain Symptom Manage 2017; 54:317-325. [PMID: 28797866 PMCID: PMC5610096 DOI: 10.1016/j.jpainsymman.2017.06.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 05/15/2017] [Accepted: 06/07/2017] [Indexed: 10/19/2022]
Abstract
CONTEXT Direct care workers in long-term care can develop close relationships with their patients and subsequently experience significant grief after patient death. Consequences of this experience for employment outcomes have received little attention. OBJECTIVES To investigate staff, institutional, patient, and grief factors as predictors of burnout dimensions among direct care workers who had experienced recent patient death; determine which specific aspects of these factors are of particular importance; and establish grief as an independent predictor of burnout dimensions. METHODS Participants were 140 certified nursing assistants and 80 homecare workers who recently experienced patient death. Data collection involved comprehensive semistructured in-person interviews. Standardized assessments and structured questions addressed staff, patient, and institutional characteristics, grief symptoms and grief avoidance, as well as burnout dimensions (depersonalization, emotional exhaustion, and personal accomplishment). RESULTS Hierarchical regressions revealed that grief factors accounted for unique variance in depersonalization, over and above staff, patient, and institutional factors. Supervisor support and caregiving benefits were consistently associated with higher levels on burnout dimensions. In contrast, coworker support was associated with a higher likelihood of depersonalization and emotional exhaustion. CONCLUSION Findings suggest that grief over patient death plays an overlooked role in direct care worker burnout. High supervisor support and caregiving benefits may have protective effects with respect to burnout, whereas high coworker support may constitute a reflection of burnout.
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Affiliation(s)
- Kathrin Boerner
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA.
| | - Hayley Gleason
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Daniela S Jopp
- Institute of Psychology, University of Lausanne, Lausanne, Switzerland
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Islam MS, Baker C, Huxley P, Russell IT, Dennis MS. The nature, characteristics and associations of care home staff stress and wellbeing: a national survey. BMC Nurs 2017; 16:22. [PMID: 28503094 PMCID: PMC5422906 DOI: 10.1186/s12912-017-0216-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 04/27/2017] [Indexed: 11/11/2022] Open
Abstract
Background The majority of residents in care homes in the United Kingdom are living with dementia or significant memory problems. Caring in this setting can be difficult and stressful for care staff who work long hours, have little opportunity for training, are poorly paid and yet subject to high expectation. This may affect their mental and physical wellbeing, cause high rates of staff turnover and absenteeism, and affect the quality of care they provide. The main objective of this survey was to explore the nature, characteristics and associations of stress in care home staff. Methods Staff working in a stratified random sample of care homes within Wales completed measures covering: general health and wellbeing (SF-12); stress (Work Stress Inventory); job content (Karasek Job Content); approach to, and experience of, working with people living with dementia (Approaches to Dementia Questionnaire; and Experience of Working with Dementia Patients); and Productivity and Health Status (SPS-6). Multiple linear regressions explored the effects of home and staff characteristics on carers. Results 212 staff from 72 care homes completed questionnaires. Staff from nursing homes experienced more work stress than those from residential homes (difference 0.30; 95% confidence interval (CI) from 0.10 to 0.51; P < 0.01), and were more likely to report that their health reduced their ability to work (difference -4.77; CI -7.80 to -1.73; P < 0.01). Psychological demands on nurses were higher than on other staff (difference = 1.57; CI 0.03 to 3.10; P < 0.05). A positive approach to dementia was more evident in those trained in dementia care (difference 8.54; CI 2.31 to 14.76; P < 0.01), and in staff working in local authority homes than in the private sector (difference 7.75; CI 2.56 to 12.94; P < 0.01). Conclusions Our study highlights the importance of dementia training in care homes, with a particular need in the private sector. An effective intervention to reduce stress in health and social care staff is required, especially in nursing and larger care homes, and for nursing staff. Trial registration ISRCTN registry: ISRCTN80487202. Registered 24 July 2013
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Affiliation(s)
| | - Christine Baker
- Swansea University Medical School, Swansea University, Wales, UK
| | - Peter Huxley
- Centre for Mental Health and Society, Bangor University, Bangor, Gwynedd, Wales UK
| | - Ian T Russell
- Swansea University Medical School, Swansea University, Wales, UK
| | - Michael S Dennis
- Swansea University Medical School, Swansea University, Wales, UK
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Gray JA, Lukyanova V. Examining Certified Nursing Assistants’ Perceptions of Work-Related Identity. Creat Nurs 2017; 23:112-120. [DOI: 10.1891/1078-4535.23.2.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: The purpose of this study was to examine certified nursing assistants’ (CNAs’) perceptions of their work identity within the context of their relationships with nursing facility residents and residents’ family members. Such information can help clarify CNAs’ roles and respond to their job needs. Although CNAs provide valuable care for residents, they often experience low status at work; it is important that they have opportunities to find value in their work.Methods: Eight focus groups were conducted with 45 CNAs from 4 nursing facilities. Thematic analysis and role theory were used to analyze the data.Results: Participants identified with the roles of connector, advocate, overloaded worker, and companion.Conclusions: CNAs expressed a lack of work-related control in the advocate and overloaded worker roles, and satisfaction in the companion role. Adequate organizational resources can help CNAs gain more satisfaction and effectiveness in their work.
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Nowrouzi B, Giddens E, Gohar B, Schoenenberger S, Bautista MC, Casole J. The quality of work life of registered nurses in Canada and the United States: a comprehensive literature review. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2016; 22:341-358. [PMID: 27734769 DOI: 10.1080/10773525.2016.1241920] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Workplace environment is related to the physical and psychological well-being, and quality of work life (QWL) for nurses. OBJECTIVE The aim of this paper was to perform a comprehensive literature review on nurses' quality of work life to identify a comprehensive set of QWL predictors for nurses employed in the United States and Canada. METHODS Using publications from 2004-2014, contributing factors to American and Canadian nurses' QWL were analyzed. The review was structured using the Work Disability Prevention Framework. Sixty-six articles were selected for analysis. RESULTS Literature indicated that changes are required within the workplace and across the health care system to improve nurses' QWL. Areas for improvement to nurses' quality of work life included treatment of new nursing graduates, opportunities for continuing education, promotion of positive collegial relationships, stress-reduction programs, and increased financial compensation. CONCLUSIONS This review's findings support the importance of QWL as an indicator of nurses' broader work-related experiences. A shift in health care systems across Canada and the United States is warranted where health care delivery and services are improved in conjunction with the health of the nurses working in the system.
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Affiliation(s)
- Behdin Nowrouzi
- a Centre for Research in Occupational Safety and Health , Laurentian University , Sudbury , Canada.,e Department of Occupational Science and Occupational Therapy , Faculty of Medicine, University of Toronto , Ontario , Canada
| | - Emilia Giddens
- b Lawrence S. Bloomberg Faculty of Nursing , University of Toronto , Toronto , Canada
| | - Basem Gohar
- a Centre for Research in Occupational Safety and Health , Laurentian University , Sudbury , Canada
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McGilton KS, Chu CH, Shaw AC, Wong R, Ploeg J. Outcomes related to effective nurse supervision in long-term care homes: an integrative review. J Nurs Manag 2016; 24:1007-1026. [DOI: 10.1111/jonm.12419] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Katherine S. McGilton
- Department of Research; Toronto Rehabilitation Institute-UHN; Toronto Ontario Canada
- Lawrence S. Bloomberg Faculty of Nursing; University of Toronto; Toronto Ontario Canada
| | - Charlene H. Chu
- Department of Research; Toronto Rehabilitation Institute-UHN; Toronto Ontario Canada
| | | | - Rosalind Wong
- Toronto Western Research Institute; Toronto Ontario Canada
| | - Jenny Ploeg
- McMaster University; Hamilton Ontario Canada
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Chu CH, Ploeg J, Wong R, Blain J, McGilton KS. An Integrative Review of the Structures and Processes Related to Nurse Supervisory Performance in Long-Term Care. Worldviews Evid Based Nurs 2016; 13:411-419. [PMID: 27458714 DOI: 10.1111/wvn.12170] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Understanding the structures and processes related to the supervisor performance of regulated nurses (registered nurses [RN] and registered practical nurses [RPN]) is critical in order to discern how administrators of long-term care (LTC) homes can facilitate and better support nurses given their important contribution to nurse assistants' job satisfaction and resident outcomes. AIMS The aim of this integrative review is to identify the structures and processes related to supervisory performance of regulated nurses in LTC. METHODS An electronic search of six databases for studies published in English between 2000 and September 2015 was conducted by a librarian. The inclusion criteria were studies focused on RN or RPN supervisory performance in LTC, which included a structure or process related to supervisory performance of the nurse. Screening, quality assessment using the Mixed Methods Assessment Tool, and data extraction for the included studies were conducted independently by two reviewers. RESULTS A total of 22 studies were included in the review. Six nurse structures (e.g., nurses' "perceptions of their supervisory role and authority" as well as their "personal qualities"), and eight organizational structures (e.g., "organizational support (culture) for supervisory and management practices" and "staffing levels") were identified. Six processes of effective supervisory performance were identified, such as "being flexible, understanding, considerate listeners and encourage staff input" as well as "respect, value, recognize, acknowledge and motivate" nursing assistants they supervise. LINKING EVIDENCE TO ACTION The results highlight the nuanced and complex nature of nurses' supervisory performance and the multifaceted approach required to support effective nurse supervisors in LTC. Future research should examine how resident-related structures, as well as other moderators and mediators, may influence supervisory performance. Developing detailed models of effective supervision can inform future interventions targeting modifiable processes related to supervisory performance to thereby change practice and optimize supervisory performance in LTC.
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Affiliation(s)
- Charlene H Chu
- Research Associate 2, Toronto Rehabilitation Institute, University Health Network and Doctoral Graduate, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Jenny Ploeg
- Professor, School of Nursing and Scientific Director, Aging, Community and Health Research Unit, McMaster University, Hamilton, Ontario, Canada
| | - Rosalind Wong
- Research Coordinator, Division of Health Care and Outcomes Research and Arthritis Community Research and Evaluation Unit, Toronto Western Research Institute, Toronto, Ontario, Canada
| | - Julie Blain
- Research Assistant, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Katherine S McGilton
- Senior Scientist, Toronto Rehabilitation Institute, University Health Network and Associate Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Schwendimann R, Dhaini S, Ausserhofer D, Engberg S, Zúñiga F. Factors associated with high job satisfaction among care workers in Swiss nursing homes - a cross sectional survey study. BMC Nurs 2016; 15:37. [PMID: 27274334 PMCID: PMC4895903 DOI: 10.1186/s12912-016-0160-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/31/2016] [Indexed: 11/10/2022] Open
Abstract
Background While the relationship between nurses’ job satisfaction and their work in hospital environments is well known, it remains unclear, which factors are most influential in the nursing home setting. The purpose of this study was to describe job satisfaction among care workers in Swiss nursing homes and to examine its associations with work environment factors, work stressors, and health issues. Methods This cross-sectional study used data from a representative national sample of 162 Swiss nursing homes including 4,145 care workers from all educational levels (registered nurses, licensed practical nurses, nursing assistants and aides). Care worker-reported job satisfaction was measured with a single item. Explanatory variables were assessed with established scales, as e.g. the Practice Environment Scale – Nursing Work Index. Generalized Estimating Equation (GEE) models were used to examine factors related to job satisfaction. Results Overall, 36.2 % of respondents reported high satisfaction with their workplace, while another 50.4 % were rather satisfied. Factors significantly associated with high job satisfaction were supportive leadership (OR = 3.76), better teamwork and resident safety climate (OR = 2.60), a resonant nursing home administrator (OR = 2.30), adequate staffing resources (OR = 1.40), fewer workplace conflicts (OR = .61), less sense of depletion after work (OR = .88), and fewer physical health problems (OR = .91). Conclusions The quality of nursing home leadership–at both the unit supervisor and the executive administrator level–was strongly associated with care workers’ job satisfaction. Therefore, recruitment strategies addressing specific profiles for nursing home leaders are needed, followed by ongoing leadership training. Future studies should examine the effects of interventions designed to improve nursing home leadership and work environments on outcomes both for care staff and for residents.
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Affiliation(s)
- René Schwendimann
- Institute of Nursing Science, University of Basel, Bernoullistr. 28, Basel, 4056 Switzerland
| | - Suzanne Dhaini
- Institute of Nursing Science, University of Basel, Bernoullistr. 28, Basel, 4056 Switzerland
| | - Dietmar Ausserhofer
- Institute of Nursing Science, University of Basel, Bernoullistr. 28, Basel, 4056 Switzerland ; College of Health-Care Professions Claudiana, Lorenz-Böhlerstr. 13, Bozen, 39100 Italy
| | - Sandra Engberg
- Institute of Nursing Science, University of Basel, Bernoullistr. 28, Basel, 4056 Switzerland ; Pittsburgh University, School of Nursing, 350 Victoria Building, 3500 Victoria St, Pittsburgh, PA 15261 USA
| | - Franziska Zúñiga
- Institute of Nursing Science, University of Basel, Bernoullistr. 28, Basel, 4056 Switzerland
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Gray M, Shadden B, Henry J, Di Brezzo R, Ferguson A, Fort I. Meaning making in long-term care: what do certified nursing assistants think? Nurs Inq 2016; 23:244-52. [DOI: 10.1111/nin.12137] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Michelle Gray
- Office for Studies on Aging; University of Arkansas; Fayetteville AR USA
| | - Barbara Shadden
- Department of Rehabilitation, Human Resources and Communication Disorders; University of Arkansas; Fayetteville AR USA
| | - Jean Henry
- Department of Health, Human Performance, and Recreation; University of Arkansas; Fayetteville AR USA
| | - Ro Di Brezzo
- Exercise Science and Vice Provost of Faculty Development; University of Arkansas; Fayetteville AR USA
| | | | - Inza Fort
- Office for Studies on Aging; University of Arkansas; Fayetteville AR USA
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Brown PB, Hudak SL, Horn SD, Cohen LW, Reed DA, Zimmerman S. Workforce Characteristics, Perceptions, Stress, and Satisfaction among Staff in Green House and Other Nursing Homes. Health Serv Res 2015; 51 Suppl 1:418-32. [PMID: 26708511 DOI: 10.1111/1475-6773.12431] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To compare workforce characteristics and staff perceptions of safety, satisfaction, and stress between Green House (GH) and comparison nursing homes (CNHs). DATA SOURCES/STUDY SETTING Primary data on staff perceptions of safety, stress, and satisfaction from 13 GHs and 8 comparison NHs in 11 states; secondary data from human resources records on workforce characteristics, turnover, and staffing from 01/01/2011-06/30/2012. STUDY DESIGN Observational study. DATA COLLECTION METHODS Workforce data were from human resources offices; staff perceptions were from surveys. PRINCIPAL FINDINGS Few significant differences were found between GH and CNHs. Exceptions were GH direct caregivers were older, provided twice the normalized hours per week budgeted per resident than CNAs in CNHs or Legacy NHs, and trended toward lower turnover. CONCLUSIONS GH environment may promote staff longevity and does not negatively affect worker's stress, safety perceptions, or satisfaction. Larger studies are needed to confirm findings.
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Affiliation(s)
- Patrick B Brown
- International Severity Information Systems, Inc., Salt Lake City, UT
| | | | - Susan D Horn
- Department of Population Health Sciences, Health System Innovation and Research Program, University of Utah School of Medicine, Salt Lake City, UT
| | - Lauren W Cohen
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - David Allen Reed
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research, School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Perceptions and employment intentions among aged care nurses and nursing assistants from diverse cultural backgrounds: A qualitative interview study. J Aging Stud 2015; 35:111-22. [DOI: 10.1016/j.jaging.2015.08.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/20/2015] [Accepted: 08/20/2015] [Indexed: 11/24/2022]
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Knopp-Sihota JA, Niehaus L, Squires JE, Norton PG, Estabrooks CA. Factors associated with rushed and missed resident care in western Canadian nursing homes: a cross-sectional survey of health care aides. J Clin Nurs 2015; 24:2815-25. [PMID: 26177787 DOI: 10.1111/jocn.12887] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2015] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To describe the nature, frequency and factors associated with care that was rushed or missed by health care aides in western Canadian nursing homes. BACKGROUND The growing number of nursing home residents with dementia has created job strain for frontline health care providers, the majority of whom are health care aides. Due to the associated complexity of care, health care aides are challenged to complete more care tasks in less time. Rushed or missed resident care are associated with adverse resident outcomes (e.g. falls) and poorer quality of staff work life (e.g. burnout) making this an important quality of care concern. DESIGN Cross-sectional survey of health care aides (n = 583) working in a representative sample of nursing homes (30 urban, six rural) in western Canada. METHODS Data were collected in 2010 as part of the Translating Research in Elder Care study. We collected data on individual health care aides (demographic characteristics, job and vocational satisfaction, physical and mental health, burnout), unit level characteristics associated with organisational context, facility characteristics (location, size, owner/operator model), and the outcome variables of rushed and missed resident care. RESULTS Most health care aides (86%) reported being rushed. Due to lack of time, 75% left at least one care task missed during their previous shift. Tasks most frequently missed were talking with residents (52% of health care aides) and assisting with mobility (51%). Health care aides working on units with higher organisational context scores were less likely to report rushed and missed care. CONCLUSION Health care aides frequently report care that is rushed and tasks omitted due to lack of time. RELEVANCE TO CLINICAL PRACTICE Considering the resident population in nursing homes today--many with advanced dementia and all with complex care needs--health care aides having enough time to provide physical and psychosocial care of high quality is a critical concern.
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Affiliation(s)
- Jennifer A Knopp-Sihota
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB, Canada.,Faculty of Nursing, University of Alberta, Level 5, Edmonton Clinic Health Academy, Edmonton, AB, Canada
| | - Linda Niehaus
- Faculty of Nursing, University of Alberta, Level 5, Edmonton Clinic Health Academy, Edmonton, AB, Canada
| | - Janet E Squires
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Peter G Norton
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, University of Alberta, Level 5, Edmonton Clinic Health Academy, Edmonton, AB, Canada
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48
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Bassal C, Czellar J, Kaiser S, Dan-Glauser ES. Relationship Between Emotions, Emotion Regulation, and Well-Being of Professional Caregivers of People With Dementia. Res Aging 2015; 38:477-503. [DOI: 10.1177/0164027515591629] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
So far, limited research has been carried out to better understand the interplay between the emotions, the use of emotion regulation strategies, and the well-being of professional caregivers of People with Dementia (PwD). This pilot study ( N = 43 professional caregivers) aimed to (1) describe the type and frequency of emotions experienced at work; (2) analyze the associations between experienced emotions, emotion regulation strategies, and well-being; and (3) test whether the use of specific emotion regulation strategies moderates the relationship between experienced emotions and emotional exhaustion. In the challenging context of professionally caring for PwD, results suggest that (1) caregivers experience positive emotions more frequently than negative emotions; (2) caregivers using relatively inappropriate regulation strategies are more likely to experience negative emotions, less likely to experience positive emotions, and have poorer physical and mental health; and (3) expressive suppression significantly moderates the relationship between positive experienced emotions and emotional exhaustion.
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Affiliation(s)
- Catherine Bassal
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland
| | - Judith Czellar
- Unicentre, University of Lausanne, Lausanne, Switzerland
| | - Susanne Kaiser
- Department of Psychology, Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
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49
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Lundgren D, Ernsth-Bravell M, Kåreholt I. Leadership and the psychosocial work environment in old age care. Int J Older People Nurs 2015; 11:44-54. [PMID: 26073426 PMCID: PMC5033033 DOI: 10.1111/opn.12088] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 01/22/2015] [Indexed: 11/29/2022]
Abstract
Aims and objectives To study leadership factors and their associations with psychosocial work environmental among nursing assistants who are engaged in old age care and to analyse (i) differences in the assessment of leadership factors and the assessment of psychosocial work environmental in nursing homes and home help services and (ii) the association between the psychosocial work environment and factors that are related to leadership in nursing homes and home help services. Background Leadership factors are an important element of the psychosocial work environment in old age care. The physical distance between leaders and nursing assistants is larger in home help services than in nursing homes. Therefore, it is important to study leadership separately in nursing homes and home help services. Design Assessments from 844 nursing assistants in nursing homes and 288 in home help services (45 nursing homes and 21 home help service units) were analysed. Methods The data were analysed using linear regression. Age, gender, number of staff at the unit, number of years at the current working unit and educational level were controlled in Model 1. Summarised indexes that were based on all independent variables except the main independent variable were additionally controlled in Model 2. Results Psychosocial work environment was related to leadership factors, but stronger associations occurred more frequently in nursing homes than in home help services. Empowering leadership, support from superiors, the primacy of human resources and control over decisions were associated with higher assessments on all the variables that were related to the psychosocial work environment in both the nursing homes and home help services. Conclusions Organisational differences in conducting leadership in old age care must be considered. Some leadership characteristics are better prerequisites for creating and maintaining a positive psychosocial work environment for nursing assistants in nursing homes and home help services. Implications for practice Due to the differences in organisational settings, it is important to consider the differences in prerequisites in conducting leadership. To influence nursing assistants' performance and to increase quality in old age care in the long term, appropriate leadership is necessary.
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Affiliation(s)
- Dan Lundgren
- Institute of Gerontology, School of Health Sciences, Jönköping University, Jönköping, Sweden.,Department of Analysis and Strategy, Division of Social Services, Municipality of Jönköping, Jönköping, Sweden
| | - Marie Ernsth-Bravell
- Institute of Gerontology, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Ingemar Kåreholt
- Institute of Gerontology, School of Health Sciences, Jönköping University, Jönköping, Sweden.,Aging Research Center, Karolinska Institutet/Stockholm University, Stockholm, Sweden
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50
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Barooah A, Boerner K, van Riesenbeck I, Burack OR. Nursing home practices following resident death: the experience of Certified Nursing Assistants. Geriatr Nurs 2014; 36:120-5. [PMID: 25554351 DOI: 10.1016/j.gerinurse.2014.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 11/15/2014] [Accepted: 11/24/2014] [Indexed: 11/26/2022]
Abstract
This study examined certified nursing assistants' (CNAs) experiences of nursing home practices following resident death. Participants were 140 CNAs who had experienced recent resident death. In semi-structured, in-person interviews, CNAs were asked about their experiences with the removal of the resident's body, filling the bed with a new resident, and how they were notified about the death. The facilities' practice of filling the bed quickly was most often experienced as negative. Responses to body removal and staff notification varied, but negative experiences were reported by a substantial minority. Being notified prior to returning to work was associated with a more positive experience. Learning about the death by walking into a room to find the bed empty or already filled was the most negative experience. Study findings suggest that more mindful approaches to the transitions related to resident deaths would be valued by CNAs and could improve their work experience.
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Affiliation(s)
- Adrita Barooah
- Jewish Home Lifecare, Research Institute on Aging, 120 West 106th Street, New York, NY 10025, USA
| | - Kathrin Boerner
- University of Massachusetts Boston, Department of Gerontology, 100 Morrissey Boulevard, Boston, MA 02125, USA.
| | - Isabelle van Riesenbeck
- University of Osnabrück, FB 8/Institut für Psychologie Seminarstraße 20, 49074 Osnabrück, Germany
| | - Orah R Burack
- Jewish Home Lifecare, Research Institute on Aging, 120 West 106th Street, New York, NY 10025, USA
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