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Lifting the ‘Violence Veil’: Examining Working Conditions in Long-term Care Facilities Using Iterative Mixed Methods*

  • Tamara Daly (a1), Albert Banerjee (a1), Pat Armstrong (a1), Hugh Armstrong (a2) and Marta Szebehely (a3)...


We conducted a mixed-methods study – the focus of this article – to understand how workers in long-term care facilities experienced working conditions. We surveyed unionized care workers in Ontario (n = 917); we also surveyed workers in three Canadian provinces (n = 948) and four Scandinavian countries (n = 1,625). In post-survey focus groups, we presented respondents with survey questions and descriptive statistical findings, and asked them: “Does this reflect your experience?” Workers reported time pressures and the frequency of experiences of physical violence and unwanted sexual attention, as we explain. We discuss how iteratively mixing qualitative and quantitative methods to triangulate survey and focus group results led to expected data convergence and to unexpected data divergence that revealed a normalized culture of structural violence in long-term care facilities. We discuss how the finding of structural violence emerged and also the deeper meaning, context, and insights resulting from our combined methods.

Le présent document se concentre sur les méthodes mixtes nous avons utilisé pour comprendre conditions de travail de leur travailleurs dans les établissements de soins de longue durée. Nous avons mené une enquête auprès des syndiqués travailleurs de santé en Ontario (n = 917), et une autre enquête dans trois provinces (n = 948) et quatre pays Scandinaves (n = 1625). Neuf groupes de discussion avec les Canadiens ont eu lieu; les répondants ont été présentés avec des questions du sondage et aussi descriptive des résultats statistiques et ont été demandé: “Est-ce le reflet de votre expérience?” Les contraintes de temps pour les travailleurs et la fréquence des expériences des travailleurs de la violence physique et attentions sexuelles non désirées sont signalés. Nous discutons comment de le façon dont nous utilisé des méthodes qualitatives et quantitatives étè itératif. Nous avons trouvé pas seulement la cohérence des données mais aussi la divergence des données qui montrent comment une culture de la violence dans les établissements de soins de longue durée est acceptée par les travailleurs comme d’habitude. Comment le constat de la violence structurelle vu le jour et la signification profonde, le contexte et les idées qui proviennent de la combinaison de nos méthodes itératives sont discutées.


Corresponding author

Correspondence and requests for offprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Tamara Daly, Ph.D. 4700 Keele St. Rm 411 HNES York University Toronto, ON M3J 1P3 (


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This research was funded with a Canadian Institutes of Health International Opportunity Program One Time Collaborative Research Grant (OPC – 74350) and with research assistance funding from Pat Armstrong’s CHSRF/CIHR Chair in Women’s Health and Nursing Research. The Scandinavian Study was led by Marta Szebehely of Stockholm University and was financed by the Swedish Council for Working Life and Social Research. The Canadian Union of Public Employees (CUPE), the Canadian Auto Workers (CAW), the National Union of Public and General Employees (NUPGE), the Service Employees International Union (SEIU), and the Canadian Federation of Nurses Unions (CFNU) partnered in the Canadian arm of the research. The Institute for Social Research at York University was responsible for the Ontario and Canadian survey sample, distribution, collection, and data entry. Thank you to Lynn Spink and Susan Braedley for conducting focus groups, to Stirling LaFrance for research assistance, and to the Scandinavian Research Team for their contributions. The data analysis and content of this article remain the sole responsibility of the authors.



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Canadian Journal on Aging / La Revue canadienne du vieillissement
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