Caring Self-Efficacy of Personal Care Attendants From English-Speaking and Non-English-Speaking Countries Working in Australian Residential Aged Care Settings

Objectives: This study compared the caring self-efficacy between personal care attendants (PCAs) from English-speaking and non-English-speaking countries, controlling for potential sociodemographic and work-related covariates. PCAs' perceptions of their caring self-efficacy were further explored. Methods: An independent samples t-test was used to determine the mean difference in the caring self-efficacy score between the two groups. A multivariate analysis was conducted to adjust for covariates. Thematic analysis was conducted on open-ended responses. Results: The results showed that caring self-efficacy was significantly influenced by whether participants primarily spoke English at home rather than where they were born. Younger age and everyday discrimination experiences were negatively associated with caring self-efficacy. Both groups perceived that inadequate resources and experiencing bullying and discrimination reduced their caring self-efficacy. Discussion: Access to organisational resources and training opportunities and addressing workplace bullying and discrimination against PCAs, particularly younger PCAs and those from non-English-speaking backgrounds, could improve their caring self-efficacy.

Staff well-being in UK children's hospices: a national survey

OBJECTIVES

Poor psychological well-being among healthcare workers can have numerous negative impacts, but evidence about levels of burnout in children's hospice care staff is limited. This study aimed to determine the prevalence of burnout and to explore the association between staff characteristics and support mechanisms with burnout among children's hospice care staff in the UK.

METHODS

Two national online surveys collecting data on hospice care staff psychological well-being and hospice organisational characteristics. All children's hospices in the UK were invited.Thirty-one hospices (out of 52) responded to the hospice survey and 583 staff responded to the staff survey. Data collection took place between May and December 2020 and measures included the Copenhagen Burnout Inventory, Work Engagement and the Health and Safety Executive Management Standards Indicator Tool.

RESULTS

Burnout prevalence was 11% and mean burnout score was 32.5 (SD: 13.1). Burnout levels were independent of working arrangements (eg, working from home or at the hospice) during the COVID-19 pandemic. Hospices performed well in most management standards, but poorly on the 'Control' domain. The average Work Engagement score for staff was 7.5 (SD: 1.5).

CONCLUSIONS

Burnout levels for staff in children's hospices in the UK were lower than in other healthcare settings, with this comparing to 17.3% among palliative care staff generally. Overall, hospices performed well in management standards and there was no indication of urgent action needed. Work Engagement in our sample was higher compared with other National Health Service workers during the COVID-19 pandemic.

Job satisfaction and regulation in the aged care sector: staff perspectives

BACKGROUND

The quality of care provided in residential aged care facilities is largely dependent on the job satisfaction of employees and the organisational framework and systems that they provide care in. This study aimed to explore aged care staff perceptions of job satisfaction, regulation of the sector and the Royal Commission into Aged Care Quality and Safety.

METHODS

A cross-sectional survey conducted in 2019-early 2020 with staff employed in various roles at residential aged care services in Australia. The study specific survey collected views and experiences about working in the aged care sector as well as information about their role.

RESULTS

A total of 167 aged care staff completed the survey of which 71% worked in a direct care role. Most participants indicated they thought they were doing a worthwhile and important job (98%), were proud to work in the sector (94%) and found the job personally rewarding (94%). However, participants also reported feeling emotionally drained by the work (37%) and fatigued by having to face a day of work (30%). 72% of participants felt the Royal Commission would lead to improvements in the care provided to residents.

CONCLUSION

Aged care staff have an overall positive feeling towards their work. Additional support including increasing skills to deliver high-quality care, creating a supportive work environment to reduce job stressors and changes to the way the sector is regulated, are likely to lead to improved care.

Why do workers leave geriatric care, and do they come back? A timing of events study

BACKGROUND

In many industrialized countries, demographic change is accompanied by increasing demand for geriatric care workers, which in turn intensifies the need to retain them or to attract them back after leaving. Although much is known about the intention of workers to leave, little is known about how many of them actually do leave and return to geriatric care at a later stage in a comprehensive framework.

OBJECTIVE

To examine and explain how many workers withdraw from geriatric care, take up other occupations, and return to geriatric care at a later stage in their careers, and the reasons behind this.

DESIGN

This study used administrative daily data that cover all workers in Germany who started working in geriatric care in the period 1996 to 2018 and observed their employment biographies for a maximum of 26 years.

METHODS

Kaplan-Meier survival analysis and parametric regression survival-time analysis were used to estimate the survival rates and to estimate individual, workplace and regional determinants of leaving and returning to geriatric care.

RESULTS

Workers in geriatric care were more likely to leave the profession than other workers, two thirds withdrew within five years of first taking up work in geriatric care. If they remained in employment, they generally chose an occupation related to geriatric care. Half of the leavers returned to geriatric care again within eight years. Individual and workplace-related factors, such as age and remuneration, are statistically significant predictors of leaving and returning.

CONCLUSIONS

The findings emphasize how important it is for organizations to keep in touch with geriatric care workers leaving their job, since a substantial share of them returns again.

Factors and Challenges in Increasing the Utilization Rate of a New Long-term Care Service (Kantaki) in a Superaging Society: Cross-sectional Study

BACKGROUND

Japan is a superaging society unparalleled in the world. Elderly people who need medical care do not receive adequate support in the community. As a new service to address this issue, a small-scale multifunctional in-home care nursing service called Kantaki was created in 2012. Kantaki, in collaboration with a primary physician, operates 24 hours a day and provides various nursing services (home visits, home care, day care, and overnight stays) to older people living in the community. The Japanese Nursing Association is working hard to promote this system; however, its low utilization rate is an issue.

OBJECTIVE

This study aimed to determine factors influencing the utilization rate of Kantaki facilities.

METHODS

This was a cross-sectional study. A questionnaire on the operation of Kantaki was sent to all administrators of Kantaki facilities operating in Japan from October 1 to December 31, 2020. A multiple regression analysis was used to determine factors associated with a high utilization rate.

RESULTS

Responses from 154 of the 593 facilities were analyzed. The average utilization rate for all valid responding facilities was 79.4%. The average number of actual users and the break-even point were almost equal, resulting in little surplus profit from facility operations. A multiple regression analysis showed that factors that had a significant impact on the utilization rate included the break-even point, a surplus of users relative to the break-even point (ie, the margin of revenues), the number of months in office of the administrator, the type of corporation (ie, nonprofit), and Kantaki's profit from operating home-visit nursing offices. The break-even point, a surplus of users relative to the break-even point, and the number of months in office of the administrator were robust. In addition, support for reducing the burden on family helpers, a service sought by the system, significantly and negatively affected the utilization rate. In the analysis that removed the most influential factors, the cooperation of the home-visit nursing office, Kantaki's profit from operating the home-visit nursing office, and the number of full-time care workers were significantly related.

CONCLUSIONS

To improve the utilization rate, managers need to stabilize their organization and increase profitability. However, a positive relationship was found between the break-even point and utilization rate, suggesting that simply increasing users did not contribute to cost reduction. Moreover, providing services that meet the needs of individual clients may result in lower utilization rates. These results, which are inconsistent with common sense, reflect the divergence between the assumptions underlying the system's design and actual conditions. To solve these issues, institutional reforms, such as an increase in nursing care fee points, may be necessary.

Relationship between turnover intention and workplace personal relations among care workers employed by elder care facilities

BACKGROUND

This study focuses on care workers at elder care facilities to examine what factors (including workplace personal relations) influence turnover intention and to what extent. Based on this analysis, the study discusses the content of workplace personal relations problems in qualitative terms.

METHODS

The study targeted care workers at elder care facilities. There were 406 participants with no missing data who were analyzed. The survey period ranged from September to November 2021. Questions consisted of basic attributes, turnover intention, problems with workplace personal relations, content of personal relation problems, and psychological distress.

RESULTS

Female care workers were 2.25 times more likely than male care workers to have turnover intention. Care workers with workplace personal relation problems were 1.97 times more likely than those without these problems to have high turnover intention. Moreover, with regard to psychological distress, the ratio increased to 4.99 times. The following six categories were extracted from the text data on workplace personal relation problems: insufficient communication, bullying, sense of unfair workload, different attitudes to care work, difficulty in guidance for subordinates/new staff, and labelling.

CONCLUSIONS

Gender, workplace personal relation problems, and psychological distress have shown to affect care workers' turnover intentions. To prevent care worker turnover, future studies should focus on the development and impact of strategies to improve workplace personal relations specific to care workers, targeting the six factors identified in this study.

Exploring the relationship between co-worker and supervisor support, self- confidence, coping skills and burnout in residential aged care staff

BACKGROUND

Staff working in residential aged care facilities face unique challenges and stressors in their workplaces which increase their risk for occupational burnout. Burnout in this workforce results in low job satisfaction, increased levels of absenteeism and poor retention rates. Given Australia's ageing population and the demand for residential aged care staff, it is imperative to explore predictors of burnout in this cohort in order to help staff prevent and manage burnout.

METHODS

This study examined the extent to which co-worker and supervisor support, self-confidence and adaptive coping skills predicted burnout among residential aged care staff, after controlling for staff demographics, organisational climate and work patterns. One hundred and thirty three residential aged care staff across Australia were surveyed using online questionnaires measuring levels of co-worker and supervisor support, self- confidence, adaptive coping skills and burnout.

RESULTS

Regression analyses indicated that, overall, co-worker and supervisor support, self-confidence, and adaptive coping predicted each dimension of burnout (emotional exhaustion, depersonalization and personal accomplishment). After controlling for covariates and other predictors: confidence significantly predicted all three dimensions; support significantly predicted emotional exhaustion and depersonalization, and adaptive coping significantly predicted emotional exhaustion.

CONCLUSION

These findings suggest that co-worker and supervisor support, self- confidence and adaptive coping skills need to be addressed to prevent and manage occupational burnout for residential aged care staff in Australia.

Work engagement, well-being, and intent to continue working based on educational support among foreign care workers in Japan

Background

Global aging continues to progress. The shortage of human resources involved in long-term care (LTC) is a serious problem worldwide. It is necessary to promote the stable employment of foreign care workers. The purpose of this study was to identify which factors, including well-being, work engagement, and original items, contribute to foreign care workers’ intent to continue working.

Methods

We conducted an anonymous self-administered questionnaire survey of 259 foreign LTC workers at LTC facilities in Japan. The questionnaire survey items included the Japanese version of the Subjective Well-being Scale (J-SWBS), the Japanese version of the Utrecht Work Engagement Scale (J-UWES), and original items related to educational needs and issues. We used multiple regression analysis to predict variability from correlations among variables. And after that, we conducted a path analysis using structural equation modeling (SEM), and added that the explanatory variables (IV) were well-being, work engagement, and the original item component, and that the outcome variable (DV) was intention to continue working. We set a hypothetical model based on structural equations, corrected by path analysis, and examined its suitability.

Results

The number of returned questionnaires for 259 foreign care workers was 147 (response rate 56.7%), and the number of analyzable questionnaires was 129 (valid response rate 49.8%). For intention to continue working, the results of structural equation modeling showed direct effects for satisfaction with low back pain measure guidance (β = .255), satisfaction with the national examination guidance method (β = .217), well-being (β = .046), and work engagement (β = .026). In work-engagement, there was a direct effect of happiness (β = .715), willingness to learn good care (β = 4.849), and confidence in my ability (β = 2.902,), whilst in well-being, satisfaction with low back pain measure guidance (β = 1.582) and confidence in my ability (β = 1.999) were found to have direct effects.

Conclusions

To increase the intent of foreign care workers to continue working, appropriate guidance should be given related to the development of lumbago. In addition, to provide a place and scene where they can learn good care, having a relationship in practice where foreign care workers can feel that their abilities are being utilized, and developing and maintaining educational support that motivates them to learn good care may be effective.

Becoming part of an upwards spiral: Meanings of being person-centred in nursing homes

INTRODUCTION

Previous research suggests that person-centred care is positive for people living in nursing homes, but less is known on what motivates people working in nursing homes to be person-centred. Previous research has focused on person-centred care in relation to people in need of care, which may lead to a risk of viewing person-centred care as a means to achieve quality of care, and not as a means in itself. Therefore, this study aimed to illuminate meanings of being person-centred as narrated by people working in nursing homes.

METHODS

A total of 23 persons working in a nursing home in rural Australia participated in group and individual interviews, conducted and interpreted in respect to a phenomenological hermeneutic approach.

RESULTS

The thematic structure as emerging from structural analyses of the text indicated that being person-centred involved a joint effort to think differently on what you do and why you do it interpreted as; Doing what you know and feel is the right thing to do, Being a person with and for another person, and Striving to do and be better together. The comprehensive understanding of these findings was that being person-centred means becoming part of an upwards spiral of doing person-centred actions and being person-centred to become even more person-centred and to feel a sense of belonging to a person-centred culture.

CONCLUSIONS

Denoting the importance of being more of a person in one's professional role, this study highlights health aspects of being person-centred from the perspective of people working in nursing homes, and complements previous research that describes the impact of person-centred care on people in need of care. The findings could be applied to facilitate person-centred care in nursing home contexts, and to develop prevention strategies to diminish negative impacts on person-centred doing, being, becoming and belonging.

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.

Understanding the nature and impact of occupational stress on Australian rural aged care workers

This study explored the nature and impact of occupational stress on direct-care workers employed by aged care providers in rural Australia. The Job demands-Resources (JD-R) model of occupational stress provided the theoretical framework to guide this qualitative investigation. A series of four FGs were conducted with direct-care workers (n = 23), who reported their job demands, job resources and personal resources. Direct-care workers identified six themes related to job demands: time pressure, physical demands, hindrance demands, an inadequate mix of staff, insufficient training to deal with complex conditions and work schedule demands. Four themes related to job resources were identified: collaboration with colleagues, equipment, opportunities for development and work schedule control. Disposition and self-care were identified as necessary personal resources for aged care workers. While the generic JD-R questionnaire captures many relevant workplace characteristics, further investigations with this work group should also consider the inclusion of items related to shift work, disposition and self-care.

Person-Centered Care Environment Associated With Care Staff Outcomes in Long-Term Care Facilities

BACKGROUND

Although a general implementation of person-centered care in Korean long-term care delivery systems would be challenging, person-centered care has the potential to improve resident and staff outcomes through changes in current care services. However, little empirical evidence currently supports a positive relationship between person-centered care environments and staff outcomes.

PURPOSE

This study was designed to examine the relationship between person-centered care environments and staff outcomes, including job satisfaction and turnover intention, among care staff in Korean long-term care facilities.

METHODS

This descriptive, correlational study used data from 235 care staff (94 nursing staff and 141 personal care workers) in 13 long-term care facilities in Korea. Data were collected using structured survey questionnaires, including items related to the person-centered care environment, job satisfaction, and turnover intention. Multilevel linear and logistic regression analyses were performed using Mplus Version 7.0.

RESULTS

After controlling for individual (age, education, monthly income, position, shift work, and job tenure) and organizational (type of facility, location, ownership, bed size, and staffing levels) characteristics, a significant relationship was found between the person-centered care environment and job satisfaction and turnover intention among staff in Korean long-term care facilities.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The study findings indicate that working in a person-centered care environment is key to higher job satisfaction, which is a significant predictor of turnover intention among staff in long-term care facilities. To recruit and retain qualified staff to provide high-quality person-centered care in long-term care facilities, a supportive work environment is crucial. Fostering a person-centered care environment will ultimately improve quality of care for residents.

[Educational support for obtaining national qualifications of foreign care workers: A qualitative analysis]

OBJECTIVES

The purpose of this study was to clarify the needs and issues of continuing employment and educational support for foreign care worker candidates (hereinafter referred to as candidates) to acquire national qualifications.

METHODS

Semi-structured interviews were conducted with 12 people who took and passed the National Examination for Care Workers. The data was analyzed using the constant comparative method of the grounded theory approach. The validity of the results was examined by member checks and peer debriefing.

RESULTS

With "the wall in the process of acquiring national qualifications" as the core category, four categories were extracted as factors related to foreign care workers and accepting facilities, and six categories were extracted as factors related to accepting facilities and educational support.

CONCLUSIONS

We considered that the needs and issues of continuation of employment and educational support from the perspective of successful applicants are diverse across both training and practical aspects, and are related to the protection of the rights of foreign candidates. Educational support for acquiring national qualifications should meet various needs related to working and learning at the same time, and there are limitations to current training programs. It is necessary to evaluate and improve the current program based on this new knowledge.

Facilitating Staff Adoption of New Policies and Procedures in Aged Care Through Training for Readiness for Change

This study examined whether training staff in preparation for organizational changes, such as the implementation of new practices, can increase levels of change readiness in residential aged care. Four aspects of organizational readiness were compared across time and between training and control conditions. Participants (n = 129) were employed in eight residential aged care facilities in Australia. Survey data were collected at four time-points: preintervention and three postintervention time-points. The two conditions (training and control) differed significantly from one another on the subscales of appropriateness, personal valence, and efficacy postintervention but not at preintervention. The finding of support diminishing at 6 month and 12 months following the intervention for the training group was unexpected. The findings suggest that within aged care facilities, training in change processes may enhance an organization's readiness for change, and booster training may be needed to help to sustain all aspects of change readiness over time.

Career mentoring in aged care: Not all it seems

Understanding the nature of career mentoring is important for improving the career experience of aged care workers. This study explores the career mentoring behaviours of sponsorship, coaching, advocacy, challenging assignments, exposure and visibility in the residential aged care context. Interviews were conducted with 32 aged workers from several occupations within the care context. It was found that career mentoring in the aged care context was limited. The mentor behaviours of coaching, sponsorship and advocacy were limited and there was no opportunity in aged care to provide challenging assignments or promote exposure and visibility. Organisations and managers can facilitate learning and personal development by providing inclusive training for all workers regardless of the need to meet professional registration requirements. Learning needs to be continuous as careers and clinical techniques evolve. Extension of existing mentoring programmes to include all care workers would improve overall quality of care in residential aged care facilities.

The importance of keeping employees satisfied

Purpose

The purpose of this paper is to investigate the relationship between three antecedents, namely, work self-determination, managerial support (i.e. interpersonal motivation style) and person–organization fit (P-O) (i.e. shared values among employees and the overall organization) on employee work satisfaction in a French Canadian health care context. Assessing the relationships between such intrapersonal, interpersonal and macro-level variables will help to better comprehend work satisfaction in health care and shed light on applicable transformations for management.

Design/methodology/approach

The study tested a judicious model grounded in self-determination theory in order to capture and construe the three levels of influence. Participants were recruited from four health centers in the Suroît (Quèbec, Canada) region. Management was provided with the questionnaire and asked to distribute to all employees including nurses and allied health. A serial multiple mediation analysis was used to test the proposed model.

Findings

The findings revealed that nearly 60 percent of the participants from each of the professional groups reported feeling moderately to not at all satisfied with their job (follow-up ANOVA revealed that nurses were the least satisfied). Through closer examination, the findings revealed that 46 percent of the variance in reported job satisfaction was explained by the three focal antecedents from the hypothesized model (work self-determination, managerial support and P-O fit). Therefore the model, in its entirety, represents a comprehensive perspective for influencing employee work satisfaction in particularly demanding health care work contexts.

Originality/value

The study is the first to indicate the prevailing factors necessary to pursue and support employee satisfaction within a health care context among French Canadians.

Positive organizational scholarship in healthcare: The impact of employee training on performance, turnover, and stress

Based on positive organizational scholarship in healthcare, this study examined the relationships between four dimensions of employee perception of training: workplace stress, organizational outcomes, job performance, and turnover intentions. We hypothesized that employee training perception would have a negative relationship with workplace stress and that stress would mediate the relationship between employee training perception, job performance, and turnover intentions. We obtained data on 317 elderly-care workers in Northern Cyprus and analyzed it using structural equation modeling. Employee training perception was negatively related to workplace stress, and stress was negatively related to job performance and positively related to turnover intention. In line with Job Demand-Resource theory (JD-R), workplace stress partially mediated the relationship between employee training perception and organizational outcomes. The study contributes to the literature by confirming that elderly-care organizations that provide training opportunities for employees can reduce workplace stress, build organizational strengths, and facilitate positive outcomes.

An international perspective on improving occupational conditions for direct care workers in home health

The occupational health and safety of direct care workers in the home health setting has been the focal point of a somewhat scarce, though highly important, body of research. Although the demand for home care services continues to expand with the rapidly growing population of older adults worldwide, home care workers - such as home health aides and personal care attendants - do not have the same level of protections by workplace safety policies such as those implemented in hospitals and nursing homes. This commentary synthesizes international perspectives on the occupational health and safety of home care workers, including the problem of workers’ rights violations and abuse by clients and their families. Prior policy and practice efforts have focused on improving the training, supervision, job satisfaction, and retention of home care workers, but have focused less on addressing issues of abuse. This paper recommends potential strategies to be developed and tested to provide a stronger support system for home care workers, more fully integrate them into the care team, and improve the occupational health and safety of this diverse, rapidly expanding workforce.

Using research evidence to inform staff learning needs in cross-cultural communication in aged care homes

BACKGROUND

Developed countries worldwide are facing an unprecedented demand for aged care services, with recent migrants of diverse linguistic and cultural backgrounds increasingly recruited as care workers while at the same time there is growing cultural diversity among aged care residents. This situation is compounded by rapidly changing technology and varied educational levels of care workers from diverse backgrounds.

OBJECTIVES

The objectives were threefold: to identify staff learning needs to enable them to provide high-quality cross-cultural care; to improve team cohesion; and identify preferred learning approaches.

DESIGN

An interpretive qualitative study utilising focus group and interview data informed the development of an education resource.

PARTICIPANTS AND SETTINGS

Fifty six care workers from four residential aged care facilities participated in either focus groups or interviews conducted in private meeting rooms within the care facilities. Participants included personal care attendants, registered and clinical nurses, managers, hospitality staff and allied health professionals.

METHODS

Focus group and interview data were categorised and thematically analysed. Data relevant to cross-cultural care, team cohesion and preferred learning approaches informed education resource development, including case studies.

RESULTS

Major themes identified the need to promote cultural awareness and understanding, and strategies for cross-cultural care and communication. Themes related to team cohesion demonstrated that staff were already sympathetic and sensitive to cross-cultural issues, and that culturally and linguistically diverse staff add value to the workforce and are supported by the organisation. Staff required clear, uncomplicated education resources to equip them with skills to address problematic cultural situations. Preferred learning approaches varied and highlighted the need for varied educational materials and approaches, as well as time efficient, opportunistic education strategies for the busy workplace.

CONCLUSION

An education package was developed to value cultural diversity in the aged care workplace for staff and residents, and provide an exemplar for evidence informed education.

Factors related to intention to stay in the current workplace among long-term care nurses: A nationwide survey

BACKGROUND

Keeping long-term care nurses employed is necessary to sustain the current and future demand for high-quality long-term care services. Understanding the factors relating to intention to stay among long-term care nurses is limited by the scarcity of studies in long-term care settings, lack of investigation of multiple factors, and the weakness of existing explanatory models.

OBJECTIVE

To identify the factors associated with long-term care nurses' intention to stay in their current workplace.

DESIGN

A cross-sectional questionnaire survey.

SETTING

Two hundred and fifty-seven hospitals with long-term care wards across Japan.

PARTICIPANTS

A total of 3128 staff nurses and 257 nurse managers from the long-term care wards of the participating hospitals.

METHOD

The questionnaire assessed nurses' intention to continue working in the current workplace as well as potential related factors, including individual factors (demographic data, reason for choosing current workplace, burnout, work engagement, somatic symptom burden) and unit factors (unit size, nurse-manager-related data, patients' medical acuity, average number of overtime hours, recreational activities, social support, perceived quality of care process, educational opportunities, feeling of loneliness, and ability to request days off). Multilevel logistic regression analysis was used to determine which variables best explained nurses' intention to stay in their workplace.

RESULTS

Only 40.1% of the respondents reported wanting to continue working at their current workplace. The regression analysis revealed that long-term care nurses' intention to stay was positively associated with nurses' age (odds ratio [95% confidence interval]: 1.02 [1.01-1.03]), work engagement (1.24 [1.14-1.35]), getting appropriate support from nurse managers (2.78 [1.60-4.82]), perceived quality of care process (1.04 [1.01-1.06]), educational opportunities (1.06 [1.0-1.13]), and various specific reasons for choosing their workplace (e.g., a good workplace atmosphere, being interested in gerontological nursing, and a high salary). By contrast, intention to stay was negatively associated with emotional exhaustion (0.93 [0.91-0.95]) and depersonalization (0.91 [0.89-0.93]). Intention to stay was associated with neither nurses' qualifications nor patient medical acuity.

CONCLUSION

Reason for choosing the workplace, work engagement, getting support from the nurse manager, and perceived quality of care process are significant predictors of long-term care nurses' intention to stay in the workplace. Promoting such nurses' work engagement, provision of high-quality care, and access to educational opportunities might augment long-term care nurses' intention to stay.

Organizational factors associated with readiness for change in residential aged care settings

BACKGROUND

Organizational change is inevitable in any workplace. Previous research has shown that leadership and a number of organizational climate and contextual variables can affect the adoption of change initiatives. The effect of these workplace variables is particularly important in stressful work sectors such as aged care where employees work with challenging older clients who frequently exhibit dementia and depression.

METHODS

This study sought to examine the effect of organizational climate and leadership variables on organizational readiness for change across 21 residential aged care facilities. Staff from each facility (N = 255) completed a self-report measure assessing organizational factors including organizational climate, leadership and readiness for change.

RESULTS

A hierarchical regression model revealed that the organizational climate variables of work pressure, innovation, and transformational leadership were predictive of employee perceptions of organizational readiness for change.

CONCLUSION

These findings suggest that within aged care facilities an organization's capacity to change their organizational climate and leadership practices may enhance an organization's readiness for change.

Factors Associated With Care Workers' Intention to Leave Employment in Nursing Homes: A Secondary Data Analysis of the Swiss Nursing Homes Human Resources Project

The emerging care personnel shortage in Swiss nursing homes is aggravated by high turnover rates. As intention to leave is a predictor of turnover, awareness of its associated factors is essential. This study applied a secondary data analysis to evaluate the prevalence and variability of 3,984 nursing home care workers' intention to leave. Work environment factors and care worker outcomes were tested via multiple regression analysis. Although 56% of care workers reported intention to leave, prevalences varied widely between facilities. Overall, intention to leave showed strong inverse relationships with supportive leadership and affective organizational commitment and weaker positive relationships with stress due to workload, emotional exhaustion, and care worker health problems. The strong direct relationship of nursing home care workers' intention to leave with affective organizational commitment and perceptions of leadership quality suggest that multilevel interventions to improve these factors might reduce intention to leave.

Associations Between Age, Psychosocial Work Conditions, Occupational Well-Being, and Telomere Length in Geriatric Care Professionals: A Mixed-Methods Study

OBJECTIVE

We identified associations between age, psychosocial work characteristics, occupational well-being, and-as a measure of biological age-leukocyte telomere length in geriatric care professionals.

METHODS

This is a multisource study of self-reports on psychosocial work characteristics, standardized physician's evaluations of health, and relative telomere length measures of peripheral blood leukocytes. We included 141 geriatric care professionals. Telomere length was assessed by an improved polymerase chain reaction (PCR)-based method.

RESULTS

Increased depersonalization was associated with shorter telomeres. Their association with age was not moderated by psychosocial work conditions. There was, however, a significant three-way interaction of social support and work ability with the age-telomere association. Additionally, social support and adverse general health moderated the age-telomere length relationship.

CONCLUSIONS

A supportive work environment and work-related health may influence the association between age and telomere length.

The Effects of Occupational Stress, Work-Centrality, Self-Efficacy, and Job Satisfaction on Intent to Quit Among Long-Term Care Workers in Korea

A large and growing population of elderly Koreans with chronic conditions necessitates an increase in long-term care. This study is aimed at investigating the effects of occupational stress, work-centrality, self-efficacy, and job satisfaction on intent to leave among long-term care workers in Korea. We tested the hypothesized structural equation model predicting the intention to quit among long-term care workers in Korea. Survey data were collected from 532 long-term care workers in Seoul, Korea. Results showed that occupational stress was positively associated with intention to leave the job. The study also identified several possible mediators (self-efficacy, work-centrality, job satisfaction) in the relationship between stress and intent to quit. Evidence-based stress management interventions are suggested to help the workers better cope with stressors. Mentoring programs should also be considered for new workers.

Organizational factors related to the confidence of workers in working with residents with dementia or depression in aged care facilities

OBJECTIVES

There has been limited research examining how organizational factors are associated with the level of confidence of residential aged care staff in managing both residents' depression and the behavioural and psychological symptoms of residents with dementia (BPSD). This study investigated this issue.

METHOD

A cross-sectional study design was employed. In total, 255 aged care staff (131 senior staff, 124 junior staff) from 21 residential care facilities participated in the study. All staff completed measures of self-efficacy in managing BPSD as well as confidence in working with older people with depression. They also completed measures of organizational climate (autonomy, cohesion, trust, pressure, support, recognition, fairness and encouragement of innovation) and measures of workplace experience (job role, number of years working in aged care facilities), job stress and satisfaction, and knowledge of depression.

RESULTS

The results demonstrated that autonomy, trust, support, and job stress were associated with confidence in managing BPSD, while the factors related to confidence in managing depression were autonomy, support, job stress, job satisfaction, and knowledge of depression.

CONCLUSION

These findings highlight that organizational climate factors need to be addressed in order to increase staff confidence in managing BPSD and depression. In particular, the findings demonstrate the importance of fostering organizational environments in which autonomy is promoted and there is support and cooperation among aged care staff. Attention to these factors is likely to increase the confidence of staff as they carry out their carer role.

The Homecare Aide Workforce Initiative: Implementation and Outcomes

Improved training and support are thought to improve retention among direct care workers. However, few studies have examined actual retention. This study examined satisfaction and retention among home health aides enrolled in the “Homecare Aide Workforce Initiative” (HAWI) at three New York agencies. Data included surveys of HAWI trainees and new hires and payroll data for HAWI graduates and others. Three months after hire, 91% of HAWI hires reported they were “very satisfied” or “satisfied” with the job; 57% reported they were “not at all likely” to leave their job in the coming year. At 365 days, 60% were still working. In logistic regression, the odds of being retained at 3, 6, and 12 months were significantly higher among HAWI graduates than non-HAWI new hires. Although not a randomized trial, the study demonstrates an association between participation in an innovative entry-level workforce program and superior 3-, 6-, and 12-month retention.

The influence of work characteristics, emotional display rules and affectivity on burnout and job satisfaction: A survey among geriatric care workers

BACKGROUND

Previous studies have demonstrated that geriatric care employees are exposed to a large number of factors that can affect their levels of job satisfaction and occupational stress. Although working with elderly people is emotionally demanding, little research has been done on the role played by perceptions of emotional display rules, alongside more traditional work characteristics and individual factors, in the prediction of geriatric care employees' wellbeing.

OBJECTIVES

The aim of the present study was to examine the role played by work characteristics (job demands, job control, emotional display rules) and individual (affectivity) factors to predict job satisfaction and burnout among French geriatric care nurses.

METHOD AND PARTICIPANTS

Questionnaires were sent to 891 employees working in 32 geriatric care centers in France. A total of 371 valid questionnaires (response rate: 41.60%) were analyzed using structural equation modeling techniques.

RESULTS

Results revealed two main processes of burnout and job satisfaction among women geriatric care workers, namely a salutogenic process and a pathogenic process. As expected, negative affectivity, low job status, perceived negative display rules and job demands are involved in the pathogenic process; while positive affectivity, perceived positive display rules and job control are implied in the salutogenic one. More specifically, as expected, negative affectivity is a positive predictor of burnout, both directly and indirectly through its impact on perceived negative display rules and job demands. Moreover, negative affectivity was negatively related to job satisfaction. Simultaneously, positive affectivity can predict job satisfaction, both directly and indirectly through its impact on perceived positive display rules and job control. Positive affectivity is also a negative predictor of burnout.

CONCLUSIONS

Practical implications are discussed to support intervention programs that develop healthy workplaces, and also to inform nurses about how to manage emotional display rules in retirement homes.

Does enhancing personal care assistants' own oral health influence their attitudes and practices towards oral care for residents - a pilot study

OBJECTIVES

To investigate whether, within a residential care facility, increasing personal care assistants' (PCAs) awareness of their own oral health status and self-care skills would alter existing attitudes and behavioural intentions related to the oral health care of residents.

METHODS

PCAs (n = 15) in the dementia care unit of a residential care facility in Melbourne, Australia, were invited to participate in a small research project that appeared to test the effectiveness of a work-place oral health educational programme in enhancing their own oral health whilst masking the actual outcome of interest, namely its effect on PCAs oral healthcare attitudes and practices towards the residents.

RESULTS

Post-intervention, the self-reported confidence of the PCAs to identify their personal risk for oral health problems, identifying common oral health conditions and determining the factors contributing to their personal oral health was increased significantly (P < 0.05). Post-intervention, the self-reported confidence of the PCAs to feeling confident to identify factors that could contribute to poor oral health of residents, identify resident's higher risk for poor oral health and feeling confident in identifying common oral health conditions in residents was also increased significantly (P < 0.05).

CONCLUSION

The results of this pilot study show that the educational intervention to increase the personal care assistants' (PCAs) awareness of their own oral health status and self-care skills increased the confidence of the carers to identify oral health risks in the residents, as well as increasing their self-reported confidence in providing oral care to residents.

Uncovering the care setting-turnover intention relationship of geriatric nurses

In times of global demographic changes, strategies are needed for improving nursing staff retention. We examined the association of care setting (nursing homes and home care) with geriatric nurses' intention to leave their job and their profession. Thus far, it is unclear why nurses' turnover intention and behaviour do not differ between care settings, although working conditions tend to be better in home care. We used the Job Demands-Resources model to explain indirect and buffering effects by job demands (time pressure, social conflicts) and resources (task identity, supervisor support, and co-worker support) via nurses' perceived health and job satisfaction on nurses' leaving intentions. The present cross-sectional questionnaire study was conducted with a sample of N = 278 registered nurses and nursing aides in German geriatric care. As expected, there was no direct relationship between care setting and leaving attitudes. Demands and resources predicted the intention to leave with job satisfaction as mediator. We found more demands in nursing homes but no differences in resources. Serial mediation effects of care setting on intentions to leave via demands/resources and health/job satisfaction as mediators were found only for time pressure and social conflicts. Unexpectedly, there were no clear differences between intention to leave the job and the profession. As hypotheses were only partly confirmed, other buffering and detrimental effects on leaving intentions are discussed. The present data suggest that detailed concepts for personnel and career planning in geriatric care are needed.

Factors Affecting Job Satisfaction Among Agency-Employed Home Health Aides

To examine the predictors of job satisfaction by home health aides, we conducted structural equation modeling to identify how the predicting variables directly and indirectly influence job satisfaction by home health aides. A total of 3,274 female home health aides working in home health care industry were selected for this study from the nationally representative sample. Support from organizations and supervisors, and personal support have positive direct effects on the job satisfaction of home health aides. Organizational support and supervisor support have important roles in weakening the negative relationship between job-related stressors and job satisfaction. We conclude that support from organizations and supervisors might improve job satisfaction by home health aides through reducing stress.

Affective Organizational Commitment in Swiss Nursing Homes: A Cross-Sectional Study

PURPOSE OF THE STUDY

This substudy of the Swiss Nursing Homes Human Resources Project (SHURP) explored the relationships between affective organizational commitment (AOC) levels and organizational, situational, and care personnel characteristics, and between AOC and care personnel outcomes.

DESIGNS AND METHODS

SHURP was a representative national cross-sectional study in 163 Swiss nursing homes. Its data sources were: (a) a care personnel questionnaire, (b) a facility questionnaire, (c) a unit questionnaire, and (d) administrative resident data. Generalized estimating equations (GEEs) were applied to examine AOC's relationships with selected antecedents and care personnel outcomes.

RESULTS

Data were collected from 5,323 care personnel in 163 nursing homes (return rate: 76%). On a scale from 1 to 5, the mean level of AOC was 3.86 (standard deviation = 0.81). Variations in AOC regarding care personnel characteristics (age, education, and experience in nursing home) and organizational characteristics (size, profit status) were statistically significant with minimal effect sizes. The main factors positively related to AOC were leadership, job satisfaction, quality of care, and collaboration with the nursing home director. Care personnel outcomes significantly related to higher AOC were reduced intention to leave, health complaints, presenteeism, and absenteeism.

IMPLICATIONS

As leadership is a crucial factor of AOC, its development might improve care personnel outcomes such as intention to leave or absenteeism.

Enjoying the front-line of dementia care: an integrative analysis of what care home staff report makes them happy at work

Purpose

– High turnover of staff in the long-term dementia care sector contributes to poor quality care and lack of continuity of care in the UK and many other countries. The purpose of this paper is to explore the research evidence on what care assistants report they enjoy when working in front-line dementia care jobs in long-term care facilities.

Design/methodology/approach

– An integrative analysis was used to study research findings focusing on the front-line workforce in care homes. The literature review sought to capture key findings, including overviews of research, from studies from 1990 to mid-2014 that have considered the positive experiences of front-line care home staff working with people with dementia.

Findings

– There is a great deal of research investigating care home staff's job satisfaction. Much of this highlights the importance of personal, social and managerial relationships. Common themes continue to be reported. There is potential for work on improving care assistant experiences in care homes but also a need to address long-standing inequities affecting the care home sector.

Research limitations/implications

– Some studies are not precise about which staff groups they are investigating in studies about care homes and many concentrate on the problems staff report. Measures of job satisfaction vary. When exploring dementia-related care not all studies are clear if care home residents have dementia or not.

Practical implications

– Many studies have investigated the views of care assistants working with people with dementia in care homes that address happiness in their work, often reported as job or work satisfaction, and these should be consulted when developing dementia services or managing care homes. As with other parts of the social care workforce, employers and managers need to be aware of effective and acceptable workforce reforms and ways to reduce turnover.

Originality/value

– This review suggests the value of investigating positive aspects of care work with people with dementia living in care homes. Greater attention could be paid to job satisfaction in social care more widely.

Determinants of regulated nurses' intention to stay in long-term care homes

AIM

To examine determinants of intent to stay among regulated nurses employed in long-term care facilities.

BACKGROUND

Elderly persons living in long-term care have increasingly complex care needs, putting greater demands on health-care providers. Indeed, regulated nursing staff employed in long-term care facilities represent the largest group of health-care providers who intend to leave their current jobs.

METHODS

Survey responses from 155 nurses from 12 long-term care facilities were analyzed to test the impact of six predictors on intent to stay.

RESULTS

Intention to stay was positively associated with lower burnout, higher job satisfaction, older nurses and resident relationships. Work relationships were negatively associated with intention to stay. Leadership support was not a significant predictor.

CONCLUSION

Most predictors were correlated with intention to stay as hypothesized. Further research is warranted to investigate the influence of management practices and work relationships on regulated nursing staff's intent to stay in long-term care.

IMPLICATIONS FOR NURSING MANAGEMENT

To retain qualified nursing staff and ensure quality of care, long-term care administrators should focus on creating a work environment that reduces burnout, increases job satisfaction, and enables nurses to foster relationships with residents. Recommendations for long-term care administrators include: (1) provide opportunities for self-scheduling, full-time work and benefits; (2) develop models of care that enhance resident relationships; (3) examine existing regulated nursing staff responsibilities and adjust to minimize burnout.

Models for predicting turnover of residential aged care nurses: a structural equation modelling analysis of secondary data

BACKGROUND

Nurse turnover in the residential aged care industry is a pressing issue. Researchers have shown ongoing interest in exploring how the factors that are amendable to change in aged care policy, regulation and funding and in organizational procedures (e.g. job demands, coping resources and psychological health of nurses) impact on turnover. However, the findings are mixed.

OBJECTIVE

This study tested two theoretical models of turnover to examine the structural relationships among job demands, coping resources, psychological health and turnover of residential aged care nurses. Although many previous studies operationalized turnover as intention to leave, the present study investigated actual turnover by following up with the same individuals over time, and thus provided more accurate predictive models of turnover behaviour.

DESIGN AND METHODS

The sample, 239 Australian residential aged care nurses, came from the Nurses and Midwives e-cohort Study. Job demands, coping resources, and psychological health were measured using standardized instruments. Structural equation modelling was used to test the measurement and structural models.

RESULTS

Controlling for a number of workforce and individual characteristics, coping resources (measured by job control, supervisor support, and co-worker support) were negatively and directly associated with turnover. Additionally, the findings supported the Job Demand-Control-Support model in that higher coping resources and lower job demands (indicated by psychological demands, physical demands, and effort) were related to better psychological health (measured by vitality, social functioning, role emotional, and mental health), and higher job demands were related to lower coping resources.

CONCLUSIONS

Findings suggest that aged care policy makers and service providers might consider increasing coping resources available to nurses and minimizing job demands of care work to reduce turnover and improve nurses' psychological health. Moreover, findings from this Australian study may provide valuable practical and policy implications for other developed countries.

A prospective study of factors associated with risk of turnover among care workers in group homes for elderly individuals with dementia

OBJECTIVES

A prospective study was conducted to assess factors associated with risk of turnover among care workers in group homes (GHs) for elderly individuals with dementia.

METHODS

In January, 2010, 51 out of 238 GHs in Sapporo City responded to our request for participation in a survey. During February and March of 2010, 438 out of 700 care workers (62.6%) in the GHs returned a completed questionnaire to us. They were followed up with until March of 2012, and 395 subjects (90.1%) responded to our survey, which was conducted twice. Over the course of 2 years, 91 subjects left their jobs. Cox's proportional hazards model was used for analysis, adjusting for gender and age.

RESULTS

Less provision of social support by supervisors, colleagues, family or friends was significantly associated with increased risk of turnover. Financial aids for off-the-job training was marginally significantly associated with reduced risk of turnover. Longer duration of working for frail elderly care was significantly associated with decreased risk of turnover. Habitual smoking was significantly associated with increased risk of turnover.

CONCLUSIONS

Social support in the workplace may be important to reduce the risk of turnover in care workers at GHs. Further prospective studies are required in other areas in Japan.

Work-Related Injuries

Objective: To examine whether certain personal and workplace factors increase risk for work-related injuries among home health aides. Method: A cross-sectional analysis was conducted using data from the 2007 National Survey of Home Health Aides among workers who provided formal caregiving to older adults or people with disabilities ( N = 3,377, weighted sample = 160,720). Results: Multivariate logistic regression identified six factors associated with injury: White race (OR = 2.07, 95% CI 1.18, 3.63); inappropriate workload (OR = 3.27, 95% CI 1.55, 6.93); having multiple jobs (OR = 2.73, 95% CI 1.30, 5.71); job dissatisfaction (OR = 2.71, 95% CI 1.23, 5.96); higher hourly pay rate (OR = 2.38, 95% CI 1.31, 4.33); and working in two locations (inpatient facility and patient’s home) compared with working in patient’s home only (OR = 2.57, 95% CI 1.51, 4.40). Discussion: Interventions should be developed to address preventable risk factors. Evaluations of candidate interventions should control for other related factors that are not modifiable.

A cross-sectional study on association of work environment, coping style, and other risk factors with depression among caregivers in group homes in Japan

A cross-sectional study was conducted to explore the potential association between work environment and/or stress coping ability, and depressive status among caregivers working for "group homes (GHs)" in Japan. In January 2010, 438 out of 700 caregivers working at GHs in Sapporo City returned completed questionnaires to us. The questionnaires consisted of the Center of Epidemiological Scales-Depression, items about worker's attributions, Ozeki's coping scale, and so on. An analysis using a logistic regression model was used to find the associations adjusting for gender and age. Subjects who were 45 yr or older, had a spouse, had job training, a standard workload and scored high in emotion-oriented coping were significantly associated with a decreased risk of depression. Subjects who were less proud of their job, less willing to continue care for the frail elderly and had fewer acceptances by their supervisors or colleagues for consultation were significantly associated with an increased risk of depression. This study supports our hypothesis that there can be possible variables among individual factors, work environment and/or coping style for stress which may modulate a risk on the depressive status of caregivers.