Hostname: page-component-76d6cb85b7-hqrjx Total loading time: 0 Render date: 2026-07-14T08:32:36.383Z Has data issue: false hasContentIssue false
  • English
  • Français

A qualitative study of nursing assistants' awareness of person-centred approaches to dementia care

Published online by Cambridge University Press:  20 May 2015

PAULETTE V. HUNTER ,
THOMAS HADJISTAVROPOULOS  and
SHARON KAASALAINEN
PAULETTE V. HUNTER*
Affiliation:
Department of Psychology, St Thomas More College, University of Saskatchewan, Saskatoon, Canada.
THOMAS HADJISTAVROPOULOS
Affiliation:
Department of Psychology and Centre on Aging and Health, University of Regina, Canada.
SHARON KAASALAINEN
Affiliation:
School of Nursing, McMaster University, Hamilton, Canada.
*
Address for correspondence: Paulette V. Hunter, Department of Psychology, St Thomas More College, University of Saskatchewan, Saskatoon, Canada, S7N 0W6. E-mail: phunter@stmcollege.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

Recently, the number of education programmes addressing person-centred approaches to long-term residential dementia care has increased, and nursing assistants (NAs) are often the target audience. The effectiveness of employee education programmes is actively debated, and our objective is to contribute to this discussion by exploring the knowledge NAs acquire through practice. We examined approaches to person-centred care generated during a series of interviews with NAs, and compared these to the content of five frameworks for person-centred dementia care. Our results suggest that although NAs acquire significant knowledge about person-centred dementia care during the course of their work, application of person-centred care strategies varies across NAs. We propose ways of enhancing NA education in order to address gaps in knowledge. We also recommend sustained attention to organisational factors that contribute to variability in practice.

Keywords

long-term caredementianursing assistanteducationcontent analysisperson-centred care

Information

Type
Articles
Information
Ageing & Society , Volume 36 , Issue 6 , July 2016 , pp. 1211 - 1237
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Anderson, R. A., Ammarell, N., Bailey, D., Colón-Emeric, C., Corazzini, K. N., Lillie, M., Scotton Piven, M. L., Utley-Smith, Q. and McDaniel, R. R. 2005. Nurse assistant mental models, sensemaking, care actions, and consequences for nursing home residents. Qualitative Health Research, 15, 8, 1006–21.CrossRefGoogle ScholarPubMed
Ayalon, L., Arean, P., Bornfeld, H. and Beard, R. 2009. Long term care staff beliefs about evidence based practices for the management of dementia and agitation. International Journal of Geriatric Psychiatry, 24, 2, 118–24.CrossRefGoogle ScholarPubMed
Aylward, S., Stolee, P., Keat, N. and Johncox, V. 2003. Effectiveness of continuing education in long-term care: a literature review. The Gerontologist, 43, 2, 259–71.CrossRefGoogle ScholarPubMed
Beattie, W. 1998. Current challenges to providing personalized care in a long term care facility. Leadership in Health Services, 11, 2, 1–5.CrossRefGoogle ScholarPubMed
Beck, C., Ortigara, A., Mercer, S. and Shue, V. 1999. Enabling and empowering certified NAs for quality dementia care. International Journal of Geriatric Psychiatry, 14, 3, 197–212; discussion 211–2.3.0.CO;2-Q>CrossRefGoogle Scholar
Bowers, B. J., Esmond, S. and Jacobson, N. 2000. The relationship between staffing and quality in long-term care facilities: exploring the views of nurse aides. Journal of Nursing Care Quality, 14, 4, 55–64.CrossRefGoogle ScholarPubMed
Bravo, G., Dubois, M. F., Demers, L., Dubuc, N., Blanchette, D., Painter, K., Lestage, C. and Corbin, C. 2014. Does regulating private long-term care facilities lead to better care? A study from Quebec, Canada. International Journal for Quality in Health Care, 26, 3, 330–6.CrossRefGoogle Scholar
Brooker, D. 2007. Person-centred Dementia Care: Making Services Better. Jessica Kingsley Publishers, Philadelphia.Google Scholar
Burgio, L. D., Allen-Burge, R., Roth, D. L., Bourgeois, M. S., Dijkstra, K., Gerstle, J., Jackson, E. and Bankester, L. 2001. Come talk with me: improving communication between nursing assistants and nursing home residents during care routines. The Gerontologist, 41, 4, 449–60.CrossRefGoogle ScholarPubMed
Canadian Institute for Health Information 2011a. Health Care Cost Drivers: The Facts. Canadian Institute for Health Information, Ottawa.Google Scholar
Canadian Institute for Health Information 2011b. Health Care in Canada, 2011: A Focus on Seniors and Aging. Canadian Institute for Health Information, Ottawa.Google Scholar
Canadian Study of Health and Aging Working Group 1994. Canadian Study of Health and Aging – study methods and prevalence of dementia. Canadian Medical Association Journal, 150, 6, 899–913.Google Scholar
Caspar, S. and O'Rourke, N. 2008. The influence of care provider access to structural empowerment on individualized care in long-term-care facilities. Journals of Gerontology: Psychological Sciences and Social Sciences, 63B, 4, S255–65.CrossRefGoogle Scholar
Castle, N. G. and Engberg, J. 2005. Staff turnover and quality of care in nursing homes. Medical Care, 43, 6, 616–26.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J. 1997. Turnover among nursing home staff: a review. Nursing Management, 28, 5, 59–64.CrossRefGoogle ScholarPubMed
Colón-Emeric, C. S., Ammarell, N., Bailey, D., Corazzini, K., Lekan-Rutledge, D., Piven, M. L., Utley-Smith, Q., Ammarell, N., Bailey, D., Corazzini, K., Piven, M. L. and Anderson, R. A. 2006. Patterns of medical and nursing staff communication in nursing homes: Implications and insights from complexity science. Qualitative Health Research, 16, 2, 173–188.CrossRefGoogle ScholarPubMed
Culley, H., Barber, R., Hope, A. and James, I. 2013. Therapeutic lying in dementia care. Nursing Standard, 28, 1, 35–9.CrossRefGoogle ScholarPubMed
Day, A. M., James, I. A., Meyer, T. D. and Lee, D. R. 2011. Do people with dementia find lies and deception in dementia care acceptable? Aging & Mental Health, 15, 7, 822–9.CrossRefGoogle ScholarPubMed
Decker, F. H., Gruhn, P., Matthews-Martin, L., Dollard, K. J., Tucker, A. M. and Bizette, L. 2003. Results of the 2002 AHCA Survey of Nursing Staff Vacancy and Turnover in Nursing Homes. American Health Care Association, Washington DC.Google Scholar
Dewing, J. 2004. Concerns relating to the application of frameworks to promote person centredness in nursing with older people. Journal of Clinical Nursing, 13, s1, 39–44.CrossRefGoogle Scholar
Dupuis, S. L., Wiersma, E. and Loiselle, L. 2012. Pathologizing behavior: meanings of behaviors in dementia care. Journal of Aging Studies, 26, 2, 162–73.CrossRefGoogle Scholar
Edvardsson, D., Winblad, B. and Sandman, P.-O. 2008. Person-centred care of people with severe Alzheimer's disease: current status and ways forward. The Lancet Neurology, 7, 4, 362–7.CrossRefGoogle ScholarPubMed
Ehrenberg, A. and Estabrooks, C. A. 2004. Why using research matters. Journal of Wound Ostomy & Continence Nursing, 31, 2, 62–4.CrossRefGoogle ScholarPubMed
Eraut, M. 2000. Non-formal learning and tacit knowledge in professional work. British Journal of Educational Psychology, 70, 1, 113–36.CrossRefGoogle ScholarPubMed
Eraut, M. 2004. Informal learning in the workplace. Studies in Continuing Education, 26, 2, 247–73.CrossRefGoogle Scholar
Eraut, M. 2007. Learning from other people in the workplace. Oxford Review of Education, 33, 4, 403–22.CrossRefGoogle Scholar
Estabrooks, C. A. 1998. Will evidence-based nursing practice make practice perfect? Canadian Journal of Nursing Research, 30, 1, 15–36.Google ScholarPubMed
Estabrooks, C. A., Rutakumwa, W., O'Leary, K. A., Profetto-McGrath, J., Milner, M., Levers, M. J. and Scott-Findlay, S. 2005. Sources of practice knowledge among nurses. Qualitative Health Research, 15, 4, 460–76.CrossRefGoogle ScholarPubMed
Fereday, J. and Muir-Cochrane, E. 2006. Demonstrating rigor using thematic analysis: a hybrid approach of inductive and deductive coding and theme development. International Journal of Qualitative Methods, 5, 1, 80–92.CrossRefGoogle Scholar
Fisher, J. E., Drossel, C., Yury, C. and Cherup, S. 2007. A Contextual Model of Restraint-free Care for Persons with Dementia . In Sturmey, P. (ed.), Functional Analysis in Clinical Treatment. Elsevier, San Diego, California, 211–38.CrossRefGoogle Scholar
Foner, N. 1994. The caregiving dilemma: Work in an American nursing home. Oakland, CA: University of California Press.Google Scholar
Garrard, J., Makris, L., Dunham, T., Heston, L. L., Cooper, S., Ratner, E. R., Zelterman, D. and Kane, R. L. 1991. Evaluation of neuroleptic drug use by nursing home elderly under proposed Medicare and Medicaid regulations. Journal of the American Medical Association, 265, 4, 463–7.CrossRefGoogle ScholarPubMed
Ghandehari, O. O., Hadjistavropoulos, T., Williams, J., Thorpe, L., Alfano, D. P., Dal Bello-Haas, V., Malloy, D., Martin, R. R., Rahaman, O., Zwakhalen, S., Carleton, R. N., Hunter, P. V. and Lix, L. M. 2013. A controlled investigation of continuing pain education for long-term care staff. Pain Research and Management, 18, 1, 11–18.CrossRefGoogle ScholarPubMed
Graham, J. E., Rockwood, K., Beattie, B. L., Eastwood, R., Gauthier, S., Tuokko, H. and McDowell, I. 1997. Prevalence and severity of cognitive impairment with and without dementia in an elderly population. The Lancet, 349, 9068, 1793–6.CrossRefGoogle Scholar
Graneheim, U. H. and Lundman, B. 2004. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24, 2, 105–12.CrossRefGoogle ScholarPubMed
Hadjistavropoulos, T., Marchildon, G., Fine, P., Herr, K., Palley, H., Kaasalainen, S. and Beland, F. 2009. Transforming long-term care pain management in North America: the policy clinical interface. Pain Medicine, 10, 3, 506–20.CrossRefGoogle ScholarPubMed
Hunter, P. V., Hadjistavropoulos, T., Smythe, W. E., Malloy, D. C., Kaasalainen, S. and Williams, J. 2013. The Personhood in Dementia Questionnaire (PDQ): establishing an association between beliefs about personhood and health providers’ approaches to person-centred care. Journal of Aging Studies, 27, 3, 276–87.CrossRefGoogle ScholarPubMed
Institute of Medicine 1986. Improving the Quality of Care in Nursing Homes. National Academy Press, Washington DC.Google Scholar
James, I. A., Wood-Mitchell, A. J., Waterworth, A. M., Mackenzie, L. E. and Cunningham, J. 2006. Lying to people with dementia: developing ethical guidelines for care settings. International Journal of Geriatric Psychiatry, 21, 8, 800–1.CrossRefGoogle ScholarPubMed
Jansen, I. 2010. Residential long-term care: public solutions to access and quality problems. Healthcare Papers, 10, 4, 8–22.CrossRefGoogle Scholar
Johns, C. 1994. The Burford NDU Model: Caring in Practice. Times Mirror Professional Publishing, Markham, UK.Google Scholar
Jones, E. E., and Nisbett, R. E. 1971. The Actor and the Observer: Divergent Perceptions of the Causes of Behavior. General Learning Press, Morristown, NJ.Google Scholar
Kaasalainen, S., Williams, J., Hadjistavropoulos, T., Thorpe, L., Whiting, S., Neville, S. and Tremeer, J. 2010. Creating bridges between researchers and long-term care homes to promote quality of life for residents. Qualitative Health Research, 20, 12, 1689–704.CrossRefGoogle ScholarPubMed
Kane, R. L., Williams, C. C., Williams, T. F. and Kane, R. A. 1993. Restraining restraints: changes in a standard of care. Annual Review of Public Health, 14, 1, 545–84.CrossRefGoogle Scholar
Kayser-Jones, J. 2003. Continuing to conduct research in nursing homes despite controversial findings: reflections by a research scientist. Qualitative Health Research, 13, 1, 114–28.CrossRefGoogle ScholarPubMed
Kitwood, T. 1997 a. Dementia Reconsidered: The Person Comes First, p. 7–11. Open University Press, Philadelphia.Google Scholar
Kitwood, T. 1997 b. Cultures of care tradition and change. In Kitwood, T. and Benson, S. (eds), The New Culture of Dementia Care. Hawker Publications, London.Google Scholar
Long-term Care Task Force on Resident Care and Safety 2013. Delivering on the Action Plan to Address Abuse and Neglect in Long-term Care Homes: Update – January to September 2013. Available online at http://longtermcaretaskforce.ca/images/uploads/Task_Force_Update_-_Oct_2013_-_EN.pdf [Accessed January 2014].Google Scholar
Lopez, S. H. 2006. Culture change management in long-term care: a shop floor view. Politics & Society, 34, 1, 55–79.CrossRefGoogle Scholar
Luff, R., Ellmers, T., Eyers, I., Young, E. and Arber, S. 2011. Time spent in bed at night by care-home residents: choice or compromise? Ageing & Society, 31, 7, 1229–50.CrossRefGoogle Scholar
Mallidou, A. A., Cummings, G. G., Schalm, C. and Estabrooks, C. A. 2013. Health care aides use of time in a residential long-term care unit: a time and motion study. International Journal of Nursing Studies, 50, 9, 1229–39.CrossRefGoogle Scholar
McCormack, B. 2001. Negotiating Partnerships with Older People: A Person Centred Approach. Ashgate, Aldershot, UK.Google Scholar
McCormack, B. 2004. Person-centredness in gerontological nursing: an overview of the literature. Journal of Clinical Nursing, 13, s1, 31–8.CrossRefGoogle ScholarPubMed
McCormack, B., Roberts, T., Meyer, J., Morgan, D. and Boscart, V. 2012. Appreciate the ‘person’ in long-term care. International Journal of Older People Nursing, 7, 4, 284–94.CrossRefGoogle ScholarPubMed
Morgan, D. G., Crossley, M. F., Stewart, N. J., D'Arcy, C., Forbes, D. A., Normand, S. A. and Cammer, A. L. 2008. Taking the hit: focusing on caregiver ‘error’ masks organizational-level risk factors for nursing aide assault. Qualitative Health Research, 18, 3, 334–46.CrossRefGoogle ScholarPubMed
Nolan, M. R., Davies, S. and Grant, G. 2001. Working with Older People and Their Families: Key Issues in Policy and Practice. Open University Press, Buckingham, UK.Google Scholar
O'Connor, D., Phinney, A., Smith, A., Purves, B., Perry, J., Drance, E., Donnelly, M., Chaudhury, H. and Beattie, L. 2007. Personhood in dementia care: developing a research agenda for broadening the vision. Dementia, 6, 1, 121–42.CrossRefGoogle Scholar
Ontario Ministry of Health and Long-term Care 1999. Ontario's Strategy for Alzheimer Disease and Related Dementias – Preparing for Our Future. Queen's Printer for Ontario, Toronto. Available online at http://www.health.gov.on.ca/en/common/ministry/publications/reports/alz/summary.aspx [Accessed January 2014].Google Scholar
Ozsoy, S. A. and Ardahan, M. 2008. Research on knowledge sources used in nursing practices. Nurse Education Today, 28, 5, 602–9.CrossRefGoogle ScholarPubMed
Parker, L. E., Kirchner, J. E., Bonner, L. M., Fickel, J. J., Ritchie, M. J., Simons, C. E. and Yano, E. M. 2009. Creating a quality-improvement dialogue: utilizing knowledge from frontline staff, managers, and experts to foster health care quality improvement. Qualitative Health Research, 19, 2, 229–42.CrossRefGoogle ScholarPubMed
Rycroft-Malone, J., Kitson, A., Harvey, G., McCormack, B., Seers, K., Titchen, A. and Estabrooks, C. 2002. Ingredients for change: revisiting a conceptual framework. Quality and Safety in Health Care, 11, 2, 174–80.CrossRefGoogle ScholarPubMed
Schindel-Martin, L. and Dupuis, S. 2005. Gentle Persuasive Approaches Curriculum. Available online at http://marep.uwaterloo.ca/research/GPAProjectFinalReportJuly2005.pdf [Accessed January 2014].Google Scholar
Sloane, P. D., Hoeffer, B., Mitchell, C. M., McKenzie, D. A., Barrick, A. L., Rader, J., Stewart, B. J., Amann Talerico, K., Rasin, J. H., Zinc, R. C. and Koch, G. G. 2004. Effect of person centered showering and the towel bath on bathing associated aggression, agitation, and discomfort in nursing home residents with dementia: a randomized, controlled trial. Journal of the American Geriatrics Society, 52, 11, 1795–804.CrossRefGoogle ScholarPubMed
Smyer, M., Brannon, D. and Cohn, M. 1992. Improving nursing home care through training and job redesign. The Gerontologist, 32, 3, 327–33.CrossRefGoogle ScholarPubMed
Teddlie, C. and Yu, F. 2007. Mixed methods sampling: a typology with examples. Journal of Mixed Methods Research, 1, 1, 77–100.CrossRefGoogle Scholar
Thomas, W. H. 1994. The Eden Alternative: Nature, Hope, and Nursing Homes. Eden Alternative Foundation, Sherberne, UK.Google Scholar
Titchen, A. 2001. Skilled companionship in professional practice. In Higgs, J. and Titchen, A. (eds), Practice Knowledge and Expertise in the Health Professions. Butterworth Heinemann, Oxford, 69–79.Google Scholar
Tuckett, A. G. 2004. Truth-telling in clinical practice and the arguments for and against: a review of the literature. Nursing Ethics, 11, 5, 500–13.CrossRefGoogle ScholarPubMed
Tuckett, A. G. 2007. Stepping across the line: information sharing, truth telling, and the role of the personal carer in the Australian nursing home. Qualitative Health Research, 17, 4, 489–500.CrossRefGoogle ScholarPubMed
Wang, P. S., Schneeweiss, S., Avorn, J., Fischer, M. A., Mogun, H., Solomon, D. H. and Brookhart, M. A. 2005. Risk of death in elderly users of conventional vs. atypical antipsychotic medications. New England Journal of Medicine, 353, 22, 2335–41.CrossRefGoogle ScholarPubMed
Ward, R., Vass, A. A., Aggarwal, N., Garfield, C. and Cybyk, B. 2008. A different story: exploring patterns of communication in residential dementia care. Ageing & Society, 28, 5, 629–51.CrossRefGoogle Scholar
Waxman, H., Carmen, E. and Berkenstock, G. 1984. Job turnovers and job satisfaction among nursing home aides. The Gerontologist, 24, 5, 503–9.CrossRefGoogle ScholarPubMed
Yury, C. A. and Fisher, J. E. 2007. Preventing excess disability in an elderly person with Alzheimer's disease. Clinical Case Studies, 6, 4, 295–306.CrossRefGoogle Scholar