Paraprofessionals and caring practice: negotiating the use of self

Proud but Powerless: A Qualitative Study of Homecare Workers´ Work Experiences and Their Suggestions for How Care for Homebound Older Adults Can Be Improved

Many older adults with complex care needs live at home due to ageing-in-place policies. This study explored homecare workers' experiences and suggestions for improvements of care. Twelve semi-structured interviews were analyzed thematically, and revealed pride, capability, and satisfaction in their work, yet they feel undervalued and lack support. They advocate for integrated care models, recognition of their competence, flexible work approaches, and committed leadership. This would enhance patient care and address their own working conditions, addressing concerns from being relegated to the bottom of the hierarchy. They emphasize the need for comprehensive approaches, spanning from housekeeping to end-of-life palliative care.

The effect of the employee perceived training on job satisfaction: the mediating role of workplace stress

Purpose

This study aims to mediate the impact of workplace stress and job satisfaction on nurses’ perception of training. It sheds light on the links between job satisfaction, Certified Nursing Assistants’ perception of training and workplace stress in nursing homes.

Design/methodology/approach

A cross-sectional questionnaire was distributed in 12 different elderly home care centres in Northern Cyprus during September to October 2017. The sampling frame consists of 317 full-time Certified Nursing Assistants who completed measures of perception of training, job satisfaction and workplace stress. This paper used structural equation modelling to test a theoretical model and hypothesis.

Findings

The findings emphasize that Certified Nursing Assistants’ perception of training has a positive impact on their job satisfaction and negative impact on workplace stress while workplace stress mediates the relationship between their perception of training and job satisfaction. The results indicate that while the motivation for training and support for training have an effect on job satisfaction, access to training and benefits for training do not yield any significant impact on it and workplace stress plays a mediating role.

Originality/value

This study confirms that the CNAs’ perception of training and job stress affect the emergence of job satisfaction, and workplace stress mediated the relation between training and satisfaction posited by social exchange theory.

Correlates of perceived caring behaviour of formal caregivers in long-term care facilities: A cross-sectional survey

BACKGROUND

Researchers have identified several factors that correlate with the caring behaviours of formal caregivers in long-term care facilities (LTCFs). However, a limited range of socio-demographic factors has been discussed, and no studies have discussed the combined effects of the institutional characteristics of the LTCF and the personal characteristics (i.e. bio-psycho-socio-spiritual attributes) of the formal caregiver on the caring behaviour.

AIM

The aim of this study was to examine caring behaviours of formal caregivers for older residents of LTCFs and to explore factors that explain and predict the caring behaviours of them.

METHODS

A valid sample of 224 formal caregivers (nurses and nurse aids) employed at 56 LTCFs (21 nursing homes and 35 assisted living facilities) was analysed. Hierarchical regression analysis with two-tailed significance test was used to investigate whether the caring behaviours of the caregivers were independently associated with the characteristics of the caregivers or the institutions.

FINDINGS

Caring behaviours of the formal caregivers had significant positive associations with their job satisfaction (β = 0.152, p < 0.05) and with their perceived satisfaction of LTCF residents (β  = 0.214, p < 0.001).The organisational-level analysis revealed that caring behaviours had positive associations with accreditation level (β = 0.163, p < 0.01) and with nurse-aid staffing level (β = 0.126, p < 0.05). Additionally, the caring behaviour had positive associations with their attitude towards older adults (β  = 0.193, p < 0.01) and with their self-transcendence (β  = 0.184, p < 0.01). These two factors explained 42.2% of the variance in the caring behaviours of caregivers.

CONCLUSION AND IMPLICATIONS

Caring behaviours were related to both personal characteristics (attributes, mindset) and organisational characteristics. By clarifying factors in the caring behaviours of caregivers, this study provides information that LTCFs can use to develop strategies for managing their caregivers and that policymakers can use to establish and implement healthcare policies for older populations.

Factors related to perceived caring among older people residing in long-term care facilities: a cross-sectional study

BACKGROUND

Healthcare providers who exhibit caring behaviours promote quality of care. Theoretical and empirical models have promoted a three-dimensional paradigm of care perception. However, the perception of elderly residents in long-term care facilities related to caring has not been investigated.

OBJECTIVES

This study explored factors related to the elderly's perception of healthcare providers' caring in long-term care facilities.

METHODS

A cross-sectional survey was conducted among 461 elderly residents living in 57 long-term care facilities in southern Taiwan. A structured questionnaire included demographic information, facility characteristics and the 12-item Caring Scale for Institutionalized Elders. Hierarchical regression analysis was used to determine significant factors related to the elderly residents' caring perceptions.

FINDINGS

A hierarchical regression model showed 49.9% of the variance in elderly's perception of caring. Significant related factors included resident's age, number of comorbidities, need for caring, time spent being cared for, bed-to-nurse staffing ratios and accreditation status.

CONCLUSIONS

Improved Registered Nurse staffing ratios with a higher level of accreditation status yield better perceptions of caring among residential elderly. Those with comorbid diseases and fewer caring needs have a higher perception of healthcare provider caring.

IMPLICATIONS

The related factors of elderly's perceived caring provide long-term care managers and nursing staff with beneficial information to develop strategies that can manage residents with high expected-care needs. Policies to improve the accreditation standards of long-term care facilities are needed.

Caring for Residents of Eldercare Facilities: A Concept Analysis

PURPOSE

To report the results of an evolutionary concept analysis of caring in facilities that provide care for elders.

SOURCES

Cumulative indices for CINAHL, ERIC, Academic Search Complete, PsychINFO, Medline, and CEPTS.

RESULTS

Caring is an interactive process characterized by seeing, helping, and communicating, which are analogous to two wheels with one axle. Caring is preceded by individuality and followed by well-being.

CONCLUSION

The findings explicate the core components of caring in facilities that provide care for elders.

IMPLICATIONS

The metaphor of an axle and wheel can guide caregivers in delivering effective care as the demand for improved well-being of residents of eldercare facilities increases.

New roles and challenges within the healthcare workforce: a Heideggerian perspective

Purpose

– The purpose of this paper is to explore insights based on the phenomenology of Martin Heidegger, on the dynamic relationships between human experience and work roles.

Design/methodology/approach

– Drawing on the findings of a hermeneutic phenomenological study of nurse mentors, the topics of new roles and role challenges are explored, along with a consideration of their relevance to wider issues of workforce redesign. Heidegger’s philosophy of Dasein, in particular his concepts of inauthentic and authentic self, provided an interpretational lens. This paper applies these philosophical concepts to challenges associated with a changing workforce.

Findings

– Concepts elaborating human existence as proposed by Heidegger may offer analytic structures for understanding shifts in the lived experience of a changing workplace. In particular, the concepts could help managers to explore the implications of introducing novel work roles or extending roles. The understanding gained can also extend to situations where work practices may need to be challenged.

Originality/value

– As work roles and skill mix undergo rapid shifts, this paper offers an original way of understanding the experience of work roles.

From risky to safer home care: health care assistants striving to overcome a lack of training, supervision, and support

Patients receiving home care are becoming increasingly dependent upon competent caregivers’ 24-h availability due to their substantial care needs, often with advanced care and home care technology included. In Sweden, care is often carried out by municipality-employed paraprofessionals such as health care assistants (HC assistants) with limited or no health care training, performing advanced care without formal training or support. The aim of this study was to investigate the work experience of the HC assistants and to explore how they manage when delivering 24-h home care to patients with substantial care needs. Grounded theory methodology involving multiple data sources comprising interviews with HC assistants (n=19) and field observations in patients’ homes was used to collect data and constant comparative analysis was used for analysis. The initial analysis revealed a number of barriers, competence gap; trapped in the home setting; poor supervision and unconnected to the patient care system, describing the risks associated with the situations of HC assistants working in home care, thus affecting their working conditions as well as the patient care. The core process identified was the HC assistants’ strivings to combine safe home care with good working conditions by using compensatory processes. The four identified compensatory processes were: day-by-day learning; balancing relations with the patient; self-managing; and navigating the patient care system. By actively employing the compensatory processes, the HC assistants could be said to adopt an inclusive approach, by compensating for their own barriers as well as those of their colleagues’ and taking overall responsibility for their workplace. In conclusion, the importance of supporting HC assistants in relation to their needs for training, supervision,and support from health care professionals must be addressed when organising 24-h home care to patients with substantial care needs in the future.