Table 6. Observations of Frontline Staff      page 1 of 3

Sample &
Findings Authors
Understand how NAs organize their work

Distinguish differences between short term and long-term NAs
  • Urban, Midwest City
  • 3 nursing homes
  • 30 NAs (15 worked 3 months or less and 15 worked 1 year or more)
  • 5 months of participant observation and in-depth interviews (worked 40 shifts)
  • Orientation taught tasks, but NOT how to organize & integrate tasks & develop an organizational style
  • One major difference was experienced NA's ability to integrate multiple and simultaneous demands
  • Experienced NAs often increased efficiency by sequencing residents that did not take account of residents' preferences
  • New NAs appeared to be more responsive by answering residents' requests. However, their residents were often found half bathed, half fed or sitting on a toilet.
  • All NAs cut corners. Experienced NAs cut corners that could not be traced to them.
  • NAs that left were:
  • 1) those who couldn't distinguish between visible and invisible infractions and
  • 2) those for whom cutting corners violated their perception of acceptable care.
Bowers & Becker, 1992
Identify how much NA work involves interacting with residents versus other work
  • Pennsylvania
  • 4 nursing homes
  • 214 NA
  • 480 observer hours -
  • > 3,371 recorded tasks over 12 months
  • 6 tasks = over 70% of the work
    (mobility assistance, stocking chores, bathing & hygiene, cleaning chores, socializing, independent of other tasks, & feeding assistance)
  • 69% = direct resident care work
  • 31% = chore work
  • Direct care work = 45% people, 9% data and 46% thing.
  • Least frequently observed tasks = reality orientation, ambulating, meal training and range of motion
Brannon, Streit, & Smyer, 1992
Analyze care from a nursing assistant perspective
  • Illinois
  • Participated as NA in three nursing homes for almost 2 years
  • Analyzed work and comments from nursing assistants
  • Themes drawn from work:
  •   - Minimum wages caused NAs to work 2 jobs.
  •   - Invisibility of caring work; if it isn't charted in accountable terms it didn't happen
  •   - Need ability to framing every day tasks into business, cost accounting terms
Diamond, 1986 & 1992

Table 6. Observations of Frontline Staff          Page 2 of 3

Sample &
Identify NA behaviors and perspectives
  • New York City
  • 1 nursing home
  • Followed & interviewed 35 NAs for 8 months
  • From 35 observed assistants:
  •   4 frequently abusive and mean
  •   4 often indifferent, sullen and unresponsive
  •   4 never unkind
  •   23 - occasionally psychologically abusive or unkind (generally very sensitive)
Foner, 1994
Identify unofficial NA work that is hidden from supervisors
  • Florida
  • Worked as a NA in nursing home for 13 months
  • Ethnographic methods
  • Themes:
  • Adaptive behaviors needed to be efficient
  •   - during meals 1 assistant pours all beverages
  •   - memorize personal habits of each resident (e.g., preferred # sugar packets, removing napkins if eat paper)
  • Folk Therapist Actions used, such as:; identifying subtle changes and acting on them (e.g., take vital signs, clear bowel impactions). If actions don't work, then alert nurse for further care
Henderson, 1994
Describe how different interactions between staff and residents affect autonomy in long-term care settings.
  • Pennsylvania
  • 2 nursing homes & 1 independent-living facility
  • 50 observation hours, survey & interviews with staff
Found the spoken value of autonomy was not supported in direct actions or conversations. Passive behaviors were much more favored.

This was not found with independent-living staff. The staff behaviors and conversations here favored autonomous seniors.
Lidz, Fischer, & Arnold, 1992
Describe the verbal and nonverbal behaviors of NAs while assisting residents with meals.
  • California
  • Urban proprietary nursing homes
  • 6 months of observing 60 meals
  • Observed both ineffective and effective interactions.
  • Ineffective Behaviors:
  •   - failure to address the resident (37%)
  •   - don't tell residents about meal or foods (71%)
  •   - NA assumed total control of meal (95%)
  • Effective Behaviors (occurred occasionally):
  •   - address the resident by name
  •   - sensitive to resident subtle cues to enhance eating
  •   - shares a meal or coffee with resident
  •   - provides socialization during mealtime
Schell & Kayser-Jones, 1999

Table 6. Observations of Frontline Staff          Page 3 of 3

Sample &
Examine the personal life and working life of NAs
  • Illinois
  • 8 nursing homes
  • 132 nursing assistants
  • (structured interviews)
  • 12 nursing homes
  • 53 nursing assistants
  • (non-structured interviews)
  • Numerous conferences with residents, families, staff, surveyors, etc;
  • Ethnographic observations
  • NA Profiles
  • Endurers live on the edge, some caught in exploitative marriages, some as single parents, some full of dreams but with few skills, others turned cynical.
  • Strivers have triumphed against the cruel odds of their personal circumstances. With sheer effort & singular determination these people seek a way out of an oppressive lifestyle.
  • Institutional culture of the nursing home:
  • Impersonal business - NAs know to keep problems to self, so may feel cynical with management's concern for "caring."
  • Routine indignities - few pats on the back, close supervision & may express their disdain
  • Personalize institutional problems - Residents blame their frustration on the lackadaisical ways of the assistants
Tellis-Nayak & Tellis-Nayak, 1989
Identify significant factors that influence NAs ability to implement a change in clinical resident management
  • Oregon
  • 1 nursing home
  • 8 months of observation of 10 NAs
  • New program was met with much resistance from the nursing assistants
  • Identified Barriers:
  • Patient Care "Rounds":
  • work organized in a routine with fewest steps to care for all residents; change interferes
  • Physical Environment:
  • often fosters inflexibility due to the inefficiency of extra steps
  • Organizational Environment:
  • old aides set norms and new aides seen as challenging it
  • Interpersonal Environment:
  • suggested changes seen as challenge to NA's efficiency.
Wagner & Colling, 1993