Measuring Empathetic Care: Development and Validation of a Self-Report Scale.

PURPOSE: This study describes the development of a self-report survey measure of empathetic care. Empathetic care is defined as caregiving that supports clients' socioemotional capabilities and addresses their emotional needs. It is distinct from instrumental care, which involves assisting with physical needs such as activities of daily living. DESIGN AND METHOD: Based on a literature review, structured interviews, and focus groups, we identify three dimensions of empathetic care: extra-role behavior, emotional support, and relational richness. We then developed a large pool of items that could tap into these dimensions and administered versions of the survey to nearly 300 health care paraprofessionals. RESULTS: After performing exploratory factor analyses on a larger survey of 138 paraprofessionals, a 10-item, three-factor measure, the Empathetic Care Scale (ECS), was developed that predicts decisions on consequential allocation scenarios. A second sample of 125 paraprofessionals provided data for a confirmatory factor analysis; results suggested that the ECS has desirable psychometric properties and evidence of convergent and discriminant validity. Further samples demonstrated acceptable levels of test-retest reliability and no social desirability bias. IMPLICATIONS: This study provides a short self-report measure that can be used to gauge care workers' individual levels of empathetic care. Future research can use this measure to explore relationships between ECS responses and previously proposed but untested outcomes such as patient well-being and employee burnout or turnover rates.

Stayers, leavers, and switchers among certified nursing assistants in nursing homes: a longitudinal investigation of turnover intent, staff retention, and turnover.

PURPOSE: Studies of certified nursing assistant (CNA) turnover in nursing homes are typically cross-sectional and include full-time and part-time workers. We conducted a longitudinal study to evaluate the job factors and work attitudes associated with just full-time staying or leaving. For those who did not stay, we assessed reasons for leaving and satisfaction following job transition. DESIGN AND METHODS: A random sample of CNAs identified through the Pennsylvania Department of Health's CNA registry, working ≥ 30 hr weekly in a nursing facility was surveyed by telephone at baseline and 1 year later. RESULTS: Of the 620 responding to both surveys, 532 (85.8%) remained (stayers), 52 (8.4%) switched to another facility (switchers), and 36 (5.8%) left the industry (leavers). At baseline, switchers reported higher turnover intentions and fewer benefits compared with stayers and left for new opportunities. Leavers had lower job satisfaction and emotional well-being and left for health reasons. Turnover intentions were predicted by low job satisfaction and low emotional well-being. Actual turnover was predicted only by turnover intentions and by the absence of health insurance. Pay was not a predictor of turnover intent or turnover. IMPLICATIONS: There are two distinct groups of CNAs contributing to turnover. Attitudinal factors, such as job satisfaction and emotional well-being, are mediated via turnover intentions to effect actual turnover. Even accounting for methodological differences, this turnover rate is lower than previous studies, which use alternative methods and include part-time workers. This study should help nursing home administrators better understand the work-related factors associated with staff turnover.