SOCIAL INTERACTIONS BETWEEN CERTIFIED NURSING ASSISTANTS AND CLIENTS WITH DEMENTIA: A QUALITATIVE STUDY

Abstract

Abstract Certified nursing assistants (CNAs) provide direct care for persons with dementia in formal settings and are therefore positioned to engage socially with clients during care. Our prior published observational study in memory care (7000 minutes of observation over 1 year) identified infrequent negative interactions of CNAs with clients, but many opportunities where CNAs did not socially engage a client, including ignoring attempts for engagement. This followup study seeks to understand CNAs experiences and attitudes towards social interaction with clients with dementia. Through semi-structured interviews with 11 CNAs at two care facilities (not included in the prior study), we examined the perceived role that CNAs have towards engaging socially with clients with dementia, barriers to interactions, and behaviors and attitudes that promote quality social interactions. Thematic analyses with multiple trained coders identified that all CNA participants reported feeling personally responsible for engaging with clients socially, having learned this through observation and trial and error, rather than formal training. Barriers to social interaction were lack of time, training, and managing symptoms of dementia. In describing quality social interactions, CNAs highlighted multiple verbal and nonverbal behaviors, including touch, eye contact, body posture, and volume and tone of voice. CNAs emphasized that quality social interactions were facilitated by internal attitudes of valuing personhood, getting on the client’s level, and being a friend. Our findings highlight that CNAs identify the importance of social interactions in their work in memory care, and they identify needing training in effective interaction techniques, specifically with their clients with dementia.