Factors Impacting Retention of Aged Care Workers: A Systematic Review

Person-focused interventions for fall risk assessment, fall prevention and fall injury prevention in long-term care facilities: a scoping review

OBJECTIVE

Falls are a significant concern in long-term care facilities (LTCFs) as fall-related injuries can result in functional impairment, disability and death. Older adults living in LTCFs are at greater risk for falls than those in the community. Using scoping review methodology, we aimed to synthesise evidence examining intervention effects of person-focused interventions for risk assessment and prevention in LTCFs in order to identify evidence-based practices in LTCFs.

METHODS

We included three databases (Ovid-Medline, CINAHL and EMBASE) to identify original research from 2007 to 2022 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guideline. From the initial search, we identified 988 articles. Following the removal of duplicates, title and abstract screening, and full-text review against inclusion/exclusion criteria, 20 studies remained for analysis. Then, we conducted a narrative synthesis to summarise the included studies.

RESULTS

Identified evidence-based interventions for fall prevention include (1) exercise programmes (eg, high-intensity functional exercise, aerobic exercise, short stick exercises, etc); (2) multifactorial programmes; and (3) other interventions (eg, lavender olfactory stimulation). Outcomes of included studies included the number of falls, fall rate, risk of falls and fear of falls before and after interventions.

CONCLUSION

Overall, most studies reported significant effects of person-focused interventions in LTCFs. Available evidence supports that well-designed person-focused interventions can reduce falls and fear of falls for individuals in LTCFs.

Why do aged care employees leave? Two explanations compared

PURPOSE

The aim of the study was to compare the explanatory power of the dissatisfaction-based account of aged care employee turnover against that of Lee and Mitchell's (1994) unfolding theory of turnover.

DESIGN/METHODOLOGY/APPROACH

Mixed method prospective cohort study with three waves of employee survey data and an exit interview drawn from employees of a large Australian not-for-profit aged care provider. Independent t tests and mediated logistic regression analyses were conducted. Final sample: nStayers at Wave 3 = 138; nLeavers by Wave 3 = 42).

FINDINGS

The classic dissatisfaction-based theory accounts for 19% of actual leavers. The five unfolding theory exit pathways accounted for 73.8% of all leavers. Stayers had the same dissatisfaction as leavers. Shock-based turnover (40.5% of all leavers) was more common than dissatisfaction-based turnover (33.5%). An additional 11.9% of leavers resigned to retire from paid work.

RESEARCH LIMITATIONS/IMPLICATIONS

Dissatisfaction-based theory provided a relatively weak explanation of aged care turnover in this organisation. The unfolding theory provided a better and more nuanced account of employee leaving.

PRACTICAL IMPLICATIONS

Unfolding theory exit interviews will assist aged care employers to better identify organizationally specific exit patterns and assist in finding appropriate organizational solutions to employee turnover.

ORIGINALITY/VALUE

This paper provides the first direct comparison of two explanations of aged care employee turnover and provides guidance to better retention at a time of labour shortage.

The evaluation of health, disability and aged care-sector engagement with resources designed to support optimisation of the allied health assistant workforce: a qualitative study

BACKGROUND

Allied health assistants (AHAs) support allied health professionals (AHPs) to meet workforce demands in modern healthcare systems. In an Australian context historically, AHAs have been sub-optimally utilised. Prior research has identified that AHAs and AHPs working in health, disability and aged care sectors, and the Vocational Education and Training (VET) industry, may benefit from access to resources to support the optimisation of the AHA workforce. As a part of a Victorian department of health funded project, several resources were developed in line with workforce recommendations for use in each of the above sectors. Recommendations and resources covered the broad areas of pre-employment training, workforce planning and governance, consumer-centred therapy and supports, recruitment and induction and workplace training and development. This study aimed to evaluate the engagement with these newly designed resources to support optimisation of AHAs in the Victorian context.

METHODS

Semi-structured interviews were conducted to evaluate engagement with resources, from the perspective of AHAs, AHPs and allied health leaders (AHLs) in the health, aged care or disability sectors, and educators and managers of allied health assistance training. Thematic analysis was conducted using team-based framework analysis.

RESULTS

Thematic framework analysis of the interview data identified four themes; Why participants accessed the resources; How participants engaged with the resources; What (if any) changes in practice occurred as a result of engaging with the resources in a participant's local context, How did participants envision the resources being utilised for AHA workforce optimisation in the future. Responses were mapped to the AHA workforce career pathway at the career preparation, career development and career trajectory tiers.

CONCLUSIONS

Appetite for AHA workforce development and optimal utilisation is evident across Victoria, Australia. Readily accessible resources that inform AHA role and scope of practice, delegation practice, or improve the ability for an AHA to state their own development needs, were identified as useful by participants. The potential for these resources to assist in the optimal utilisation and development of AHA workforces across the career continuum differs according to the role, sector and geographical location of the resource user. Further study is needed to investigate the transferability of these resources to national and global contexts.

Discriminative and exploitive stereotypes: Artificial intelligence generated images of aged care nurses and the impacts on recruitment and retention

This article uses critical discourse analysis to investigate artificial intelligence (AI) generated images of aged care nurses and considers how perspectives and perceptions impact upon the recruitment and retention of nurses. The article demonstrates a recontextualization of aged care nursing, giving rise to hidden ideologies including harmful stereotypes which allow for discrimination and exploitation. It is argued that this may imply that nurses require fewer clinical skills in aged care, diminishing the value of working in this area. AI relies on existing data sets, and thus represent existing stereotypes and biases. The discourse analysis has highlighted key issues which may further impact upon nursing recruitment and retention, and advocates for stronger ethical consideration, including the use of experts in data validation, for the way that aged care services and nurses are depicted and thus valued.