1
|
Yan E, Wan D, To L, Ng HKL, Lai DWL, Cheng ST, Kwok T, Leung EMF, Lou VWQ, Fong D, Chaudhury H, Pillemer K, Lachs M. Staff Turnover Intention at Long-Term Care Facilities: Implications of Resident Aggression, Burnout, and Fatigue. J Am Med Dir Assoc 2024; 25:396-402. [PMID: 37972647 DOI: 10.1016/j.jamda.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/06/2023] [Accepted: 10/05/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Staff shortages and the high turnover rate of nursing assistants pose great challenges to long-term care. This study examined the effects of aggression from residents of long-term care facilities, burnout, and fatigue on staff turnover intention. The findings will help managers to devise effective measures to retain their staff. DESIGN Cross-sectional descriptive study design. SETTING AND PARTICIPANTS A total of 800 nursing assistants were recruited from 70 long-term care facilities using convenience sampling. METHODS The participants were individually interviewed and provided information about their turnover intention, resident aggression witnessed and experienced, self-efficacy, neuroticism, burnout, fatigue, and personal and facility characteristics. RESULTS Hierarchical multiple regression analysis revealed that the size and organizational practices of long-term care facilities were not associated with staff turnover intention. Staff who spent less time in the industry reported witnessing resident-to-resident aggression, experienced resident-to-staff aggression, reported high levels of burnout, had acute or chronic fatigue, and had low levels of inter-shift recovery were more likely than others to report a high turnover intention. CONCLUSIONS AND IMPLICATIONS Staff turnover poses great challenges to staff, residents, and organizations. This study identified important factors that may help support staff in long-term care facilities. Specific measures, such as person-centered care to diminish resident aggression by addressing residents' unmet needs, work-directed programs to mitigate burnout and improve staff mental health, and flexible schedules to prevent fatigue should also be advocated to prevent staff turnover.
Collapse
Affiliation(s)
- Elsie Yan
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China.
| | - Debby Wan
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Louis To
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Haze K L Ng
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Daniel W L Lai
- Faculty of Social Sciences, Hong Kong Baptist University, Hong Kong SAR, China
| | - Sheung-Tak Cheng
- Department of Health and Physical Education, Education University of Hong Kong, Hong Kong SAR, China
| | - Timothy Kwok
- Department of Medicine and Therapeutics and School of Public Health, Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Vivian W Q Lou
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong SAR, China
| | - Daniel Fong
- School of Nursing, University of Hong Kong, Hong Kong SAR, China
| | - Habib Chaudhury
- Department of Gerontology, Simon Fraser University, Vancouver, Canada
| | - Karl Pillemer
- Cornell College of Human Ecology, Cornell University, New York, NY, USA
| | - Mark Lachs
- Weill Cornell Medicine, Cornell University, New York, NY, USA
| |
Collapse
|
2
|
Yan E, Lai DWL, Cheng ST, Ng HKL, Lou VWQ, Fong D, Kwok T. Typology of family caregivers of older persons: A latent profile analysis using elder mistreatment risk and protective factors. J Elder Abuse Negl 2023:1-31. [PMID: 37021959 DOI: 10.1080/08946566.2023.2197269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
This study sought to identify subpopulations of caregivers of older persons based on their profiles of individual characteristics and caregiving contexts and aimed at examining the associations between caregiver profiles and elder mistreatment. A convenient sample of 600 adult caregivers of community-dwelling older people in Hong Kong participated. Results of latent profile analysis support a typology of 3 distinctive caregiver profiles: (a) non-vulnerable caregivers; (b) isolated, vulnerable caregivers; and (c) traumatized, vulnerable caregivers. Isolated and traumatized caregivers reported greater risk factors related to elder mistreatment: They had higher levels of caregiver stress and burden, lower levels of social support and resilience, greater neurotic personality orientation and problematic gambling behavior, and more severe childhood traumatic experiences. The two groups also display significantly higher level of abusive behaviors than non-vulnerable caregivers.
Collapse
Affiliation(s)
- Elsie Yan
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Daniel W L Lai
- Faculty of Social Sciences, Hong Kong Baptist University, Hong Kong, China
| | - Sheung Tak Cheng
- Department of Psychological Studies, Education University of Hong Kong, Hong Kong China
| | - Haze K L Ng
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | | | | | - Timothy Kwok
- Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
3
|
Yan E, To L, Ng HKL, Lai DWL, Bai X, Lee VWP. Trends in elder abuse and age discrimination during the COVID-19 pandemic in Hong Kong: Findings from a two-wave representative telephone survey study. Int J Geriatr Psychiatry 2023; 38:e5915. [PMID: 37096750 DOI: 10.1002/gps.5915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 04/18/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVES Empirical evidence about the heightened risks of elder abuse and age discrimination during the COVID-19 pandemic is scarce. This study aimed to track the changes in rates of both, and investigated their associated factors in the community-dwelling older population in Hong Kong. METHODS In this two-wave, cross-sectional telephone survey, we interviewed a population-based sample of individuals (≥55 years), and captured the situation of elder abuse and age discrimination before the COVID-19 outbreak (n = 1209, Wave 1: October-December 2019) and during the pandemic (n = 891, Wave 2: December 2020-January 2021). Participants reported their experiences of different types of abuse and discrimination, financial health, subjective well-being, satisfaction with environment, health and social services, and resilience. RESULTS Abuse was reported by 20.2% of the sample before the outbreak and 17.8% during the pandemic; while discrimination was reported by 24.6% and 29.8% at the two time points, respectively. A drop in physical abuse was observed, but it was accompanied by a rise in discrimination in the form of harassment or refusal of services. Findings of logistic regression analysis show that abuse during the pandemic was associated with younger age, poorer subjective well-being, and lower resilience; while discrimination was associated with female gender, being married, and poorer subjective well-being. CONCLUSIONS Elder abuse and discrimination were prevalent across time points. The pandemic has highlighted the marginalization of older persons in our communities. There is an urgent need for development of effective interventions to end abuse and discrimination.
Collapse
Affiliation(s)
- Elsie Yan
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Kowloon, China
| | - Louis To
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Kowloon, China
| | - Haze K L Ng
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Kowloon, China
| | - Daniel W L Lai
- Faculty of Social Sciences, Hong Kong Baptist University, Hong Kong, China
| | - Xue Bai
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Kowloon, China
| | - Vincent W P Lee
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Kowloon, China
| |
Collapse
|
4
|
Yan E, Ng HKL, Lai DWL, Lee VWP. Physical, psychological and pandemic fatigue in the fourth wave of COVID-19 outbreak in Hong Kong: population-based, cross-sectional study. BMJ Open 2022; 12:e062609. [PMID: 36521899 PMCID: PMC9755901 DOI: 10.1136/bmjopen-2022-062609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To examine the physical, psychological and pandemic fatigue during the COVID-19 pandemic, and to explore the correlates of fatigue using a representative, population-based, community sample of Chinese adults in Hong Kong. DESIGN Cross-sectional study. SETTING Telephone surveys in Hong Kong from December 2020 to January 2021 (during the fourth wave of COVID-19 outbreak). PARTICIPANTS 1255 adults living in Hong Kong aged 18 years or older sampled using a multistage approach (53% women). MAIN OUTCOME MEASURES Physical and psychological fatigue: The Fatigue Assessment Scale (with a cut-off score of 22). Pandemic fatigue: Adherence to six disease prevention measures (DPM) recommended by the government. RESULTS About 25.7% of the participants were feeling fatigued physically and psychologically. Physical and psychological fatigue was not directly associated with pandemic fatigue, and their association was fully mediated by self-perceived disruptions of COVID-19-related restrictions in daily life. Results from the hierarchical regression analysis showed that higher levels of fatigue were associated with economically inactive status (B=0.18, SE=0.04, p<0.001), having family or friend infected with COVID-19 before or during the study (B=0.17, SE=0.01, p<0.001), lower acceptability of DPM (B=-0.16, SE=0.03, p<0.001), greater disruptions in daily life (B=0.22, SE=0.02, p<0.001), and greater trust in authorities in ending the pandemic (B=0.11, SE=0.02, p<0.001). CONCLUSIONS Fatigue affected many individuals during the pandemic. Disruptions of DPM in daily life may serve as a mediator in the association between pandemic fatigue and physical and psychological fatigue, reflecting the need of effective interventions to reduce self-perceived disruptions of COVID-19-related restrictions in the general population. Resources should be allocated to provide sufficient services to individuals vulnerable to fatigue during the prolonged pandemic.
Collapse
Affiliation(s)
- Elsie Yan
- Applied Social Sciences, The Hong Kong Polytechnic University Faculty of Health and Social Sciences, Kowloon, Hong Kong
| | - Haze K L Ng
- Applied Social Sciences, The Hong Kong Polytechnic University Faculty of Health and Social Sciences, Kowloon, Hong Kong
| | - Daniel W L Lai
- Faculty of Social Sciences, Hong Kong Baptist University, Hong Kong, Hong Kong
| | - Vincent W P Lee
- Department of Social Work, The Hong Kong Polytechnic University Faculty of Health and Social Sciences, Kowloon, Hong Kong
| |
Collapse
|
5
|
Yan E, Lai DWL, Lee VWP, Bai X, K L Ng H. Abuse and Discrimination Experienced by Older Women in the Era of COVID-19: A Two-Wave Representative Community Survey in Hong Kong. Violence Against Women 2022; 28:1750-1772. [PMID: 35475662 PMCID: PMC9047603 DOI: 10.1177/10778012221085998] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Although there is a growing volume of research on violence against women, violence against older women has received little attention to date. Little is known about the experience of elder abuse, discrimination, loneliness, and health among older women, in particular in the era of COVID-19 when our lives have been changed drastically. Using two waves of survey data (N = 1,498), this study compared the estimates of elder abuse and age discrimination before and during the COVID-19 pandemic, examined their associations with physical and mental health, and explored the mediating effects of loneliness on the associations in two independent samples of older women in Hong Kong. Reductions in some forms of abuse and discrimination against older women during the pandemic were observed. Findings from regression analyses show that elder abuse and age discrimination were associated with poorer health, and these associations were mediated by loneliness.
Collapse
Affiliation(s)
- Elsie Yan
- 26680Hong Kong Polytechnic University, Hong Kong SAR, China
| | | | | | - Xue Bai
- 26680Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Haze K L Ng
- 26680Hong Kong Polytechnic University, Hong Kong SAR, China
| |
Collapse
|
6
|
Yan E, Lai DWL, Lee VWP, Ng HKL. Predicting Public Adherence to COVID-19 Preventive Measures: A Cross-Sectional Study in Hong Kong. Int J Environ Res Public Health 2021; 18:12403. [PMID: 34886130 PMCID: PMC8657394 DOI: 10.3390/ijerph182312403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 12/23/2022]
Abstract
Objectives: To effectively control the spread of COVID-19, the public's adherence to relevant disease preventive measures (DPM) is critical. This study examined individuals' adherence to various DPM and identified facilitators and barriers to adherence in a community sample in Hong Kong. Methods: In this cross-sectional study, telephone surveys were conducted over December 2020 and January 2021. Participants provided responses on their adherence to DPM as well as other psychosocial and cognitive factors via the phone. Results: Of the sample of 1255 Chinese adults (aged >18 years, 53% women), 94.4% wore face masks in public areas; 88.4% avoided touching their eyes, nose, and mouth; 82.1% performed hand hygiene practices; 81.5% used alcohol-based hand rubs; 74.6% abided by social distancing; and 39.7% tested for COVID-19 on a voluntary basis. Perceived benefits, perceived barriers, self-efficacy, cues to action, perceived acceptability, and disruptions to daily life related to COVID-19 were associated with individuals' adherence to DPM. Conclusions: Adherence to DPM was strong in Hong Kong, and the adherence level could be predicted by various factors. It is vital to consider these factors in order to improve the public's adherence.
Collapse
Affiliation(s)
- Elsie Yan
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China; (V.W.P.L.); (H.K.L.N.)
| | - Daniel W. L. Lai
- Faculty of Social Sciences, The Hong Kong Baptist University, Hong Kong, China;
| | - Vincent W. P. Lee
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China; (V.W.P.L.); (H.K.L.N.)
| | - Haze K. L. Ng
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China; (V.W.P.L.); (H.K.L.N.)
| |
Collapse
|