Burnout among direct-care workers in nursing homes: Influences of organisational, workplace, interpersonal and personal characteristics.

AIMS AND OBJECTIVES: The many negative effects of burnout have prompted researchers to better understand the factors contributing to it. The purpose of this paper is to add to this body of knowledge through the study of burnout among direct-care workers in nursing homes. BACKGROUND: Perhaps the factor most often associated with employee burnout is the level of staffing-insufficient staffing results in work overload and eventually employee burnout. A closer look at research findings suggests that there are many other factors also contributing to burnout. These range from those at the organisational level, such as availability of training and resources to individual characteristics such as self-esteem and length of employment. METHODS: A self-administered survey instrument was completed by 410 direct-care workers working within 11 nursing homes in the north Texas region. Regression analyses were performed, adjusting for clustering by nursing home. Beta coefficients and structure coefficients are reported. Burnout was measured through three dimensions: emotional exhaustion, depersonalisation and personal accomplishment. RESULTS: Organisational, work design, interpersonal and individual characteristics were found to be associated with one or more dimensions of burnout. CONCLUSIONS: The analyses largely support previous research. Organisational variables of significance included the availability of resources to do the work, available training and fair pay. Work design variables of significance included adequate staffing. The individual characteristic, self-esteem, appeared to have the strongest impact on burnout. Commitment to the organisation also had a large impact. RELEVANCE TO CLINICAL PRACTICE: While the data do not allow for the testing of causal relationships, the data do suggest that providing adequate staffing, perceived fair pay, sufficient work resources (e.g., towels, gowns), management support and adequate training may result in less direct-care worker burnout on the job.

Family, neighbourhood, and children's health: Trends and racial/ethnic disparities between 2003 and 2007 in the U.S.

The present study examined the race/ethnicity-specific trend of parent-reported health among children aged 17 years and under in the U.S. between 2003 and 2007, and its relationship with family background, neighbourhood support and neighbourhood safety. Data from the 2003 and 2007 National Survey of Children's Health (NSCH) were merged and analysed after taking into account the weighting and the complex sampling design of the data. Trends in children's health and racial/ethnic disparities were identified for this time period. Multivariate models were analysed to examine the association between children's health and their family background variables, neighbourhood support and safety, and other socio-demographic variables. Race/ethnicity-specific stratified models were also performed. Our findings indicated an adverse trend in the parent-reported health among children in the U.S. from 2003 to 2007, and little progress has been made towards reducing the health disparities by race/ethnicity. Racial/ethnic disparities also existed in children's family background and neighbourhood support and safety. Further, the health effects of family background and neighbourhood characteristics differed in magnitudes and directions by race/ethnicity. These findings suggest that different intervention/prevention strategies should be employed in improving childhood health for different racial/ethnic groups.

Shared Decision-Making in Nursing Homes: Factors Associated With the Empowerment of Direct Care Workers.

OBJECTIVE: The advantages of empowering direct care workers (DCWs) within nursing homes (NHs) are well documented. Our objective is to identify factors that create DCW empowerment as this has not received adequate attention. METHOD: The data come from a larger study focused on the empowerment of DCWs in NHs. A self-administered instrument was completed by 372 DCWs within 11 NHs in the north Texas region. Cluster analysis and ordinary least squares (OLS) regression were performed. RESULTS: Feedback from nurse management to DCWs was positively associated with shared decision-making (SDM) and ranked highest followed by information exchange, trust in management, and wages linked to performance. DISCUSSION: SDM may be enhanced where nurse management shares relevant information with the DCWs, listens to their ideas, provides explanations when DCW suggestions are not used, and does so in a supportive environment. Organizational characteristics of importance include linking wages to DCW performance and providing an accessible training program.

Environment and subjective well-being of rural Chinese elderly: a multilevel analysis.

INTRODUCTION: The purpose of this study was to examine the effects of environment on the subjective well-being (SWB) of older Chinese villagers after controlling for personal and social characteristics. METHOD: Data collected from the Chinese Health and Retirement Longitudinal Survey Pilot Study were used to examine the relationship between (a) SWB (i.e., happiness and depressive symptoms) of Chinese rural elderly and (b) environmental characteristics, controlling for personal and social characteristics. A total of 850 older villagers from 2 Chinese provinces were analyzed using multilevel regression models. RESULTS: Five of the 8 environmental variables had significant effects on SWB: A natural disaster in the past 5 years, rainy days, and use of coal in the home were associated with lower SWB, whereas village wealth and sewer system were associated with higher SWB. Personal and social characteristics of importance included health, age, place of birth, perception that future help is available if needed, and providing help to others. DISCUSSION: The proposition that the environment of older Chinese villagers is associated with their SWB was supported after accounting for personal and social characteristics. SWB may be improved by improving environments as well as by changes to personal and social conditions.

Social capital and self-rated health among middle-aged and older adults in China: a multilevel analysis.

This study examined the association between social capital, at both the individual and the community level, and self-rated health among older adults in China. Using data from the 2008 Pilot Survey of China Health and Retirement Longitudinal Study, a series of multilevel logistic models were estimated in SAS 9.2. The association between social capital and self-rated health was examined among 996 adults aged 45 or older from two provinces in China, while controlling for demographic characteristics and socioeconomic variables. Our results suggest the significant association between certain aspects of social capital, at both the individual and the community level, and self-rated health. The individual-level social capital in the form of perceived help in the future and the social capital of community in the form of the availability of amenities and associations within the community were significantly related to self-rated health. A significant cross-level interaction effect between individual- and community-level social capital was also observed.

Social support and life satisfaction among older adults in China: family-based support versus community-based support.

Family-based support has been the traditional care arrangement for the elderly in China. With the maturing of its "one child per couple" policy and the changing scenarios of family structure and cultural norms, these traditional care arrangements for the Chinese elderly are becoming dismantled. Centers and associations within the community have gradually become the major infrastructures to provide old age service and support in China. This study examined the effects of family-based and community-based support on life satisfaction among older Chinese adults, using data from the pilot survey of China Health and Retirement Longitudinal Study (CHARLS) in 2008. A series of multilevel models were assessed with statistical package SAS 9.2 among 1,398 Chinese adults aged 45 or older. The results suggest that even with the inclusion of community-based support, family-based support variable, the perceived future help from family members, still significantly predicted the life satisfaction among older Chinese adults.

Village characteristics and health of rural Chinese older adults: examining the CHARLS Pilot Study of a rich and poor province.

Community (or village) characteristics have received growing attention as researchers have sought factors affecting health. This study examines the association between a variety of environmental, economic, and social village characteristics and health of Chinese older rural adults with health measured in terms of physical limitations. The Chinese Health and Retirement Longitudinal Survey (CHARLS) Pilot Study data were used. Older villagers from a low-income province (Gansu) and a relatively wealthy province (Zhejiang) were surveyed between July and September, 2008. The sample included 1267 respondents in 73 villages age 45 and older. The relationship between a variety of village characteristics and physical limitations of older adults was examined using negative binomial regression (NBR) with standard errors adjusted to account for non-independence of respondents in a village. A comparison of means/percentages shows that Gansu and Zhejiang were significantly different on the dependent and most independent variables. The NBR models show that at the personal-level, decreased risk of physical limitations was associated with being male, less than 60 years old, married, higher in education, and higher in household expenditures (proxy for income). At the village-level, decreased risk of limitations was associated with a continuous supply of electricity, not using coal in the household, the existence of a sewage system, low cost of electricity, and village wealth. Decreased risk of physical limitations was also associated with various characteristics of China's New Cooperative Medical Scheme (NCMS), an insurance program for rural older adults. Policy implications for improved health of rural older adults include: (1) continued use of China's NCMS, (2) establishment of village sewage systems, (3) ending the use of coal in the home, and (4) increased educational opportunities focused on health.

Nurse aide decision making in nursing homes: factors affecting empowerment.

AIMS AND OBJECTIVES: To evaluate factors affecting structural empowerment among nurse aides in nursing homes. BACKGROUND: Structural empowerment can be defined as the actual rather than perceived ability to make autonomous decisions within an organisation. Given the paucity of research on the subject, this study helps to close the gap by identifying factors that affect nurse aide empowerment, that is, decision-making among nurse aides. METHODS: The data for the study come from self-administered questionnaires distributed to direct-care workers (nurse aides) in 11 nursing homes in a southern state in the USA. Ordinary least square regression models were estimated to analyse the effects of demographic predictors, personal factors (competency, emotional exhaustion and positive attitude) and structural characteristics (coworker and supervisor support, information availability and shared governance) on nurse aide decision-making. RESULTS: Findings suggest race among demographic predictors, emotional exhaustion among personal characteristics, and supervisor support, and shared governance among structural factors, significantly affect nurse aide decision-making. CONCLUSION: It is important to explore race as one of the central determinants of structural empowerment among nurse aides. In addition, the nature and type of emotional exhaustion that propels decision-making needs to be further examined. RELEVANCE TO CLINICAL PRACTICE: The study shows the importance of shared governance and supervisor support for fostering nurse aide empowerment.

The perception of "training availability" among certified nurse aides: relationship to CNA performance, turnover, attitudes, burnout, and empowerment.

The purpose of this study was to examine the relationship between the certified nurse aides' (CNAs) perception that "training is always available when needed" and the CNAs' performance, turnover, attitudes, burnout, and empowerment. The data came from a larger study where a self-administered survey instrument was completed by 359 CNAs working in 11 nursing homes in the North Texas region. The data analyses largely support previous research. Perceived training availability was most highly associated with participation in decision making, information exchange, the procedures used, and satisfaction/commitment. The data suggest that the CNAs surveyed may not have received substantial training related to the depersonalization of residents, self-esteem, and direct decision making. Further, the findings suggest an opportunity to improve training by including a component to help CNAs transfer the skills and knowledge learned during the training to the actual provision of resident care.

CNA empowerment: effects on job performance and work attitudes.

In this analysis, the effects of empowerment were examined among a sample of certified nursing assistants (CNAs) representing a wide range of empowerment levels. On the basis of survey responses from 298 CNAs and 136 nurses in five nursing homes where CNA-empowered work teams had been implemented and five nursing homes with more traditional management approaches, the results indicated that CNA empowerment had a variety of effects. CNAs with high empowerment and the nurses who worked with them tended to report better CNA performance and work-related attitudes. Both were also less likely to be thinking about leaving their jobs. With the help of lessons learned from new culture change initiatives, and with commitment, effort, and attention, nursing homes and other health care providers can reap the benefits associated with employee empowerment strategies, such as CNA-empowered work teams.

Consequences of empowered CNA teams in nursing home settings: a longitudinal assessment.

PURPOSE: Recent studies have concluded that there is a lack of "patient-centered" care in nursing homes and subsequently a need for nursing home culture change. As a result, a variety of new, promising initiatives have been introduced, with most of these incorporating the use of "empowered" employees. The purpose of this study was to evaluate the effects of empowered work teams--a work design specifically established to empower certified nurse aides (CNAs)--within the long-term-care setting. DESIGN AND METHODS: We used a multimethod, pretest-post-test design to examine the effects of these teams. Our qualitative analysis included observations of over 270 team meetings. The quantitative analyses included five pairs of nursing homes, with five implementing empowered work teams and five acting as comparisons. RESULTS: The quantitative as well as qualitative analyses indicate that the work teams had a variety of modest, positive effects: increased CNA empowerment; better CNA performance; improved resident care and choices; improved procedures, coordination, and cooperation between CNAs and nurses; and possibly reduced turnover. There appeared to be mixed effects on work attitudes. IMPLICATIONS: As new initiatives strive to move away from the medical model and toward a person-centered model, the data suggest that empowered CNA work teams can help.

Self-managed work teams in nursing homes: implementing and empowering nurse aide teams.

PURPOSE: This article describes the progress of our study to examine the advantages and costs of using self-managed nurse aide teams in nursing homes, steps that are being taken to implement such teams, and management strategies being used to manage the teams. DESIGN AND METHODS: A quasi-experimental design is underway where certified nurse aide (CNA) teams are being established in five nursing homes (NHs) in the Dallas-Fort Worth metropolitan area, and five additional NHs are being treated as comparison NHs. RESULTS: As of March 2004 CNA teams were established in five NHs, and baseline survey data were collected from the CNAs, nurses, residents, and family members in each of these NHs as well as from those in the five comparison homes. IMPLICATIONS: Qualitative analyses show positive effects of CNA teams. Quantitative analyses will not be complete until follow-up survey data are collected 12 months after team implementation. Steps for implementing teams include surveying management to be sure that they want nurse teams; orienting and training the managers, nurses, and nurse aides; and facilitating the teams. Management of the teams includes routine feedback from management to the teams and vice versa while using a give-and-take approach.