Understanding Adaptive Leadership in the Context of Nursing Homes

Rapidly growing populations of older adults rely heavily on formal long-term care services such as those provided in nursing homes. Nursing home staff are confronted with complex challenges. We explored how staff (N = 88), particularly care aides, interpreted challenges and responded to them by taking adaptive leadership roles, and engaging in technical and adaptive work in nursing homes. We conducted analysis of the ethnographic case studies. In long-term care settings, staff face complex challenges in improving resident care due to contextual barriers. These include demanding work conditions and inadequate resources. Additionally, top-down communications, despite being well-intentioned, often lead to misinterpretation and a lack of staff motivation. Nonetheless, we found that certain staff managed to overcome these contextual barriers and effectively execute change initiatives by assuming adaptive leadership roles. Formal leaders have a vital role in empowering staff, including care aides, and facilitating their adaptive leadership behaviors.

The Complexity of Burnout Experiences among Care Aides: A Person-Oriented Approach to Burnout Patterns

Care aides working in nursing homes experience burnout attributed to various workplace stressors. Burnout dimensions (exhaustion, cynicism, and reduced professional efficacy) interact to form distinct burnout patterns. Using a person-oriented approach, we aimed to identify burnout patterns among care aides and to examine their association with individual and job-related factors. This was a cross-sectional, secondary analysis of the Translating Research in Elder Care 2019-2020 survey data collected from 3765 care aides working in Canadian nursing homes. We used Maslach Burnout Inventory to assess burnout and performed latent profile analysis to identify burnout patterns, then examined their associations with other factors. We identified an engaged pattern (43.2% of the care aide sample) with low exhaustion and cynicism and high professional efficacy; an overwhelmed but accomplished pattern (38.5%) with high levels of the three dimensions; two intermediate patterns-a tired and ineffective pattern (2.4%) and a tired but effective pattern (15.8%). The engaged group reported the most favorable scores on work environment, work-life experiences, and health, whereas the tired and ineffective group reported the least favorable scores. The findings suggest complex experiences of burnout among care aides and call for tailored interventions to distinct burnout patterns.

Cracks in the foundation: The experience of care aides in long-term care homes during the COVID-19 pandemic

BACKGROUND

Care aides (certified nursing assistants, personal support workers) are the largest workforce in long-term care (LTC) homes (nursing homes). They provide as much as 90% of direct care to residents. Their health and well-being directly affect both quality of care and quality of life for residents. The aim of this study was to understand the impact of COVID-19 on care aides working in LTC homes during the first year of the pandemic.

METHODS

We conducted semi-structured interviews with a convenience sample of 52 care aides from 8 LTC homes in Alberta and one in British Columbia, Canada, between January and April 2021. Nursing homes were purposively selected across: (1) ownership model and (2) COVID impact (the rate of COVID infections reported from March to December 2020). Interviews were recorded and analyzed using inductive content analysis.

RESULTS

Care aides were mainly female (94%) and older (74% aged 40 years or older). Most spoke English as an additional language (76%), 54% worked full-time in LTC homes, and 37% worked multiple positions before "one worksite policies" were implemented. Two themes emerged from our analysis: (1) Care aides experienced mental and emotional distress from enforcing resident isolation, grief related to resident deaths, fear of contracting and spreading COVID-19, increased workload combined with staffing shortages, and rapidly changing policies. (2) Care aides' resilience was supported by their strong relationships, faith and community, and capacity to maintain positive attitudes.

CONCLUSIONS

These findings suggest significant, ongoing adverse effects for care aides in LTC homes from working through the COVID-19 pandemic. Our data demonstrate the considerable strength of this occupational group. Our results emphasize the urgent need to appropriately and meaningfully support care aides' mental health and well-being and adequately resource this workforce. We recommend improved policy guidelines and interventions.

'I wouldn't choose this work again': Perspectives and experiences of care aides in long-term residential care

AIMS

To provide insight into the everyday realities facing care aides working in long-term residential care (LTRC), and how they perceive their role in society.

DESIGN

A qualitative ethnographic case study.

METHODS

Data were collected over. 10 months of fieldwork at one LTRC setting [September 2015 to June 2016] in Western Canada; semi-structured interviews (70 h) with 31 care aides; and naturalistic observation (170 h). Data were analysed using reflexive thematic analysis.

RESULTS

The findings in this work highlight the underpinned ageism of society, the gendered work of body care, and the tension between the need for relational connections - which requires time and economic profit. Four themes were identified, each relating to the lack of training, support, and appreciation care aides felt about their role in LTRC.

CONCLUSION

Care aides remain an unsupported workforce that is essential to the provision of high-quality care in LTRC. To support the care aide role, suggestions include: (i) regulate and improve care aide training; (ii) strengthen care aides autonomy of their care delivery; and (iii) reduce stigma by increasing awareness of the care aide role.

IMPACT

What problem did the study address? The unsupportive working conditions care aides experience in LTRC and the subsequent poor quality of care often seen delivered in LTRC settings. What were the main findings? Although care aides express strong affection for the residents they care for, they experience insurmountable systemic and institutional barriers preventing them from delivering care. Where and on whom will the research have impact? Care aides, care aide educators, care aide supervisors and managers in LTRC, retirement communities, and home care settings.

Above and beyond: A qualitative study of the work of nurses and care assistants in long term care

BACKGROUND

As the Canadian population ages, there is a need to improve long-term care (LTC) services. An increased understanding of the positive work experiences of LTC staff may help attract more human health resources to LTC.

OBJECTIVE

To describe the perceptions of the roles and work of nurses and care assistants in LTC from interprofessional perspectives.

METHODS

This study used qualitative data collected from a larger mixed-methods study, Care by Design. The qualitative phase explored the lived experience of LTC staff from the perspectives of key stakeholders via focus groups and individual interviews.

RESULTS

One central theme that emerged from the study was that of LTC staff going "above and beyond" their clinical duties to care for residents. This above and beyond theme was categorized into subthemes including: 1. familial bonds between residents and staff; 2. staff spending additional time with residents; 3. the ability to provide comfort to family members; and 4. staff dedication during end-of-life care.

CONCLUSIONS

The findings show that staff develop a kinship with residents, demonstrate respect towards residents' families and provide comfort at the end-of-life. In emphasizing these themes of positive and fulfilling work, the present study provides insight into why staff work in LTC.

The information-seeking patterns of care aides who work in nursing homes

AIM

To explore the information-seeking patterns of care aides who work in nursing homes.

BACKGROUND

Under the direction and supervision of nursing professionals, care aides provide the majority of direct care to nursing home residents. Understanding how, why, when and where they seek information to perform their duties is important for managers, policymakers and stakeholders.

METHOD

Semi-structured interviews with eight care aides employed in three Canadian nursing homes were analysed using the Braun and Clarke method of thematic analysis.

RESULTS

Five prominent information-seeking patterns emerged as themes.

CONCLUSIONS

Care aides were motivated to seek information for personal and job-based reasons that included wanting to avoid mistakes and preparing physically, mentally and emotionally for the work ahead. They described depending on a social hierarchy of verbal information and using personal time (before/after work) to seek the information they needed. Due to time constraints, they relied on established patterns, accessed online information once a day at most and preferred paper-based sources.

IMPLICATIONS FOR NURSING MANAGEMENT

Programs to enhance care aide communication skills to include the importance of information-seeking are warranted. Time for formal information-seeking during working hours should be provided and encouraged. When care aides initiate information-seeking to improve care this should be recognized and respected by others on the team. Programs to enhance care aide communication skills to include the importance of information-seeking are warranted. Time for formal information-seeking during working hours should be provided and encouraged. When care aides initiate information-seeking to improve care this should be recognized and respected by others on the team.

Détresse chez les préposés aux bénéficiaires en centre d'hébergement exposés à des symptômes comportementaux

ABSTRACTCare aides working in nursing homes are often exposed to responsive behaviours in older adults living with Alzheimer's disease. As these behaviors may induce psychological distress, the current research aims to estimate the contribution of a set of variables on the psychological distress reported by care aides. Variables include perceived frequency of responsive behaviours, primary and secondary cognitive appraisal, and coping strategies. A total of ninety-two day care aides were recruited in nursing homes in the Quebec City area. Standard multiple regression was completed and findings show that frequency of responsive behaviours, primary appraisal of threat, secondary appraisal (feeling incapable of changing the situation) and seeking emotional support contribute to care aides' psychological distress. This study highlights the importance of responsive behaviours on the units and discusses the psychological mechanisms used by care aides.

Staff personhood in dementia care settings: "Do they care about me?"

AIMS AND OBJECTIVES

This article aims to examine RCAs' own experiences of personhood in dementia care settings.

BACKGROUND

Conceptually, person-centred care entails fostering the personhood of residents and the residential care aides (RCAs) who provide much of their hands-on care. To date, however, staff personhood has been overlooked in the empirical literature.

DESIGN

The study was part of a larger focused ethnographic project exploring how the organisational care environment impedes or facilitates the provision of quality dementia care.

METHODS

Semi-structured interviews with 23 RCAs and more than 230 hours of participant observation were conducted in two nursing homes with specialised dementia units in British Columbia, Canada.

RESULTS

Two overarching themes, "personhood undermined-management-staff relations" and "personhood undermined-workplace policies and practices" emerged, illustrating how, despite exposure to features believed beneficial to their working environment (e.g., favourable staffing ratios, relatively good remuneration), RCAs encountered repeated affronts to their personhood. The first theme encompasses the importance of being known (i.e., as persons and of their job demands) and valued (i.e., appreciated for their work in non-monetary terms). The second highlights the salience of work-life balance, full-staffing coverage and supportive human resource practices.

CONCLUSIONS

RCAs' experiences reveal how the ongoing search for cost-efficiencies, cost-containment and cost-accountability overshadows their individuality, indicating a key disconnect between conceptual ideals and workplace realities.

IMPLICATIONS FOR PRACTICE

Organisations are encouraged to consider creating person-centred management and workplace practices that provide tangible evidence that RCAs, and their work, matter.