|Understand how NAs organize their work
Distinguish differences between short term and
- 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
- 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
- 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|
|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)
|Identify unofficial NA work that is hidden from supervisors
- Worked as a NA in nursing home for 13 months
- Ethnographic methods
- 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
|Describe how different interactions between staff and residents affect autonomy
in long-term care settings.
- 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.
- 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|
|Examine the personal life and working life of NAs
- 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
- 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;
- 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|