Certified Nursing Assistants (CNAs) are responsible for the care of America's aging population. CNAs are paid a miniscule amount of money and are often ineligible for medical benefits through their employers. CNAs bathe, change, feed, and help toilet the residents of long-term care facilities. The stressful work and personal lives of CNAs leads to many problems such as high turnover rates, absenteeism, health problems, and elder abuse. In the United States, food insecurity is a concern for many of the uninsured working poor. The purpose of this study was to assess the overall perceived concerns, barriers, and solutions of CNAs in both their work and family environments, identify where nutrition and food security fits into the priorities of CNAs, and identify educational strategies to improve their health and overall quality of life. Twenty-nine CNAs participated in six focus groups across the state of Virginia. Triangulation techniques were used to compare both qualitative (focus groups) and quantitative (participatory activities and questionnaires) research. Participatory activities showed that the top home concern of CNAs was money management. CNAs ranked keeping their family healthy fourth (9.6%), and they ranked preparing fast easy meals eighth (1.7%). The top work concern of CNAs was time management. Staying healthy at work ranked fourth (12.9%), while packing a nutritious lunch was sixth (3.4%). The preferred methods of education for the participants were watching videotapes, attending classes at a central location, and having a mentor to help them with their problems. / Master of Science

The majority of individuals in nursing homes have cognitive-communication impairments which impact quality of care because direct care providers, certified nursing assistants, (CNAs) are unsure how to respond to resident’s communication behaviors. One intervention that facilitates staff-resident communication in nursing homes is communication plans; however, the research to date about communication plans has not specifically involved CNAs. The purpose of this study, using a grounded theory qualitative approach, was to describe development, implementation and evaluation of communication care plans (CCPs) for residents with cognitive-communication impairments in nursing homes by CNAs who did and did not receive professional support. Communication care plans are communication plans with the addition of autobiographical information. Twenty residents and ten CNAs from two nursing homes participated in the study. Once CCPs were created, CNA participants in one facility received support each day. Following two weeks, CNAs participated in a semi-structured interview. Interviews were transcribed and analyzed using open, axial and selective coding. Findings revealed a core category, meeting resident’s needs through professional support and communication, which describes the progressive process these CNAs underwent to effectively communicate with residents in nursing homes using CCPs. Evolution of this process occurred as CNA participants became familiar with residents. An underlying component facilitating this familiarity was support during CCP implementation. Initially, these CNAs had negative views about nursing home care because they were unsure how to communicate with residents and received little support from higher levels of nursing authority. Over time and with application of CCPs, CNAs became familiar with residents and their communication behaviors. Application of specific communication strategies on CCPs required ongoing support from the investigator/speech-language pathologist which was evident by the comments between CNA participants from each facility. Participants from both facilities reported positive experiences during application of the autobiographical information on the CCPs. This personal information coupled with increased knowledge about resident’s specific communication abilities fostered the formation of a relationship between residents and CNAs. In summary, support during application of CCPs supplements CNAs’ abilities to meet residents’ needs.

In this study, certified nursing assistants (CNAs) who work regularly with long-term care residents with dementia were interviewed to investigate whether they considered providing social and emotional support to people with dementia an important part of their jobs. They were given an online survey, then each participated in an in-person interview that was recorded and later transcribed and analyzed for common themes. Through data analysis, I found that the participating CNAs unanimously considered social support to be an important aspect of caring for someone with dementia, and several personal values were associated with this perspective. They also reported the trainings they had received in preparation for dementia care were largely not sufficient to prepare them for interacting effectively with the residents. Additionally, they cited various other barriers that impede their ability to provide the social support they feel is necessary to provide. Overall, this sample of CNAs did not provide great diversity, and future research should compare these results to more diverse groups.

There is a worldwide shortage of direct care workers who help older adults in their own homes. The purpose of this multiple case study was to explore strategies that owners of home health care businesses can use to retain adequate direct care workers for their businesses. Five home care agency owners from Wake County, North Carolina, participated. Each owner had successfully implemented strategies to ensure adequate caregivers to sustain the business. Human relations theory was used to address the business problem. Data collection involved interviewing the 5 owners of home care agency businesses in their offices. Through a process of methodological triangulation, observations and documentary evidence supplemented data collected through semistructured interviews. Deductive and inductive coding were used to arrange and identify 3 emergent themes: company reputation, training and career development, and the role of government. The results of this study may contribute to social change because home care agency owners and other business owners can use the findings to improve on their treatment of low income workers which may help eradicate discrimination to ethnic minorities.

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The nursing home industry has been saturated for decades with culture change initiatives in an effort to improve resident quality of care. The direct care worker (DCW) is considered a critical position to achieving nursing facility quality improvements. Understanding what leads to job satisfaction for DCWs could result in improved resident care. The relationship DCWs have with their direct supervisor or upper-level manager can impact employee satisfaction. The purpose of this research is to identify factors that are associated with DCWs satisfaction with supervisor and management support. Data was obtained from 307 DCWs who were employed at 11 North Texas nursing homes. It was expected that factors affecting satisfaction with direct supervision and upper-level management would differ. In fact, the study found that the antecedents for employee satisfaction with supervisor support were participative decision-making/empowerment, age, information exchange and feedback. Furthermore, participative decision-making/empowerment, perceived competence, staffing, information exchange and feedback were found to affect direct care workers' satisfaction with manager support. In conclusion, this research provides a starting point towards a more holistic view of employee satisfaction with supervisor support by considering the preceding factors and its subsequent effects.

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