Certified Nursing Assistants Research Articles

Workplace Resilience and Stress Among Certified Nursing Assistants in Long-Term Care Institutions During the COVID-19 Pandemic.

To explore the relationship among resilience, stress, and demographic factors in certified nursing assistants (CNAs) who worked in long-term care institutions during the coronavirus disease 2019 pandemic. A cross-sectional correlation-based research design was used. Data were collected using a demographic questionnaire, Connor-Davidson Resilience Scale, and Occupational Stress Scale. CNAs from 21 long-term care institutions in Taiwan were recruited. This study included 118 female and 26 male CNAs (response rate = 80%). Mean age was 46.8 years. A moderately negative correlation was found between workplace resilience and stress. Overall, being a woman and parent were found to be significantly correlated with CNAs' resilience. Furthermore, resilience and shift work were important predictors of stress. We suggest that leadership and management pay more attention to CNAs' basic demographic background information. Furthermore, timely, relevant strategies can be provided to enhance resilience and reduce workplace stress. [Journal of Gerontological Nursing, 50(7), 19-26.].

Cultural Competency Challenges Certified Nursing Assistants Experience in Providing Palliative Care.

Increasing racial and ethnic diversity in U.S. nursing facilities has necessitated the provision of more culturally competent care. This study explored the cultural challenges in providing palliative care from the perspective of certified nursing assistants (CNAs) and nurses in nursing facilities. A thematic analysis approach was used to examine data from semi-structured interviews with 12 CNAs and 11 nurses from six nursing facilities in a U.S. Midwestern state. Four themes emerged from the data: Cultural Needs Expressed by Residents, Cultural Needs Expressed by Family Members, Accommodating Residents' Cultural Needs, and Organizational Responses to Cultural Competency Challenges. Results highlighted the training variations on diversity and cultural competency issues and the varying cultural competency levels possessed by staff. To support residents' culture-related needs, staff need education and support. Organizations can provide foundational resources for this diversity of cultural expression, including providing more culturally diverse programming facilities. [Journal of Gerontological Nursing, 50(7), 35-41.].

The Relationship between Nursing Home Staffing and Health Outcomes Revisited

ObjectiveNursing homes make staffing decisions in conjunction with choosing quality goals, potentially leading to endogeneity bias between staffing and quality. We use instrumental variables (IVs) to explore it. DesignRetrospective statistical analysis of 2017–2019 Payroll-Based Journal, Minimum Data Set, Nursing Home Care Compare, and Long-Term Care Focus. Settings and ParticipantsA total of 11,261 nursing homes nationally. MethodsWe estimated separate models for each of 6 quality measures as dependent variables, and registered nurses (RNs), certified nurse assistants (CNAs), and licensed practical nurses (LPNs) as independent variables, including other control variables associated with quality. The models were estimated using both ordinary least squares (OLS) and 2-stage least squares (2SLS) methods, the latter accounting for endogeneity. The IVs were defined as the average staffing of competing nursing homes in the same market as the index facility. ResultsEstimated coefficients for the quality measures in the 2SLS models were up to 5 times larger than in the OLS models. The 2SLS estimates for antipsychotic medications use increased with higher RN staffing [0.279 (0.004 to 0.553)] and decreased with higher CNAs [−0.125 (−0.198 to −0.052)]. Hospitalizations decreased with more RNs [−1.328 (−1.673 to −0.983)] and LPN staffing [−0.483 (−0.755 to −0.211])] and increased with CNA [0.201 (0.109 to 0.293)] staffing. Emergency room visits decreased with higher RNs [−1.098 (−1.500 to −0.696)] and increased with CNAs [0.191 (0.084 to 0.298)]. Long-stay activities of daily living [−0.313 (−0.416 to −0.209)] and short-stay functioning [−0.481 (−0.598 to −0.364)] improved only with higher CNA staffing and pressure sores improved only with increased RN staffing [−0.436 (−0.836 to −0.035)]. Conclusions and ImplicationsOur findings demonstrate the importance of accounting for endogeneity in studies of staffing and quality. Endogeneity changes conclusions about significance, direction, and magnitude of the relationship between staffing and specific quality measures. These findings highlight the need to further study and understand the nuanced relationship between different staffing types and different health outcomes such as the difference between the relationship of RN and CNA hours per resident day to antipsychotic quality measures.

Characteristics of healthcare personnel with SARS-CoV-2 infection: 10 emerging infections program sites in the United States, April 2020-December 2021.

Understanding characteristics of healthcare personnel (HCP) with SARS-CoV-2 infection supports the development and prioritization of interventions to protect this important workforce. We report detailed characteristics of HCP who tested positive for SARS-CoV-2 from April 20, 2020 through December 31, 2021. CDC collaborated with Emerging Infections Program sites in 10 states to interview HCP with SARS-CoV-2 infection (case-HCP) about their demographics, underlying medical conditions, healthcare roles, exposures, personal protective equipment (PPE) use, and COVID-19 vaccination status. We grouped case-HCP by healthcare role. To describe residential social vulnerability, we merged geocoded HCP residential addresses with CDC/ATSDR Social Vulnerability Index (SVI) values at the census tract level. We defined highest and lowest SVI quartiles as high and low social vulnerability, respectively. Our analysis included 7,531 case-HCP. Most case-HCP with roles as certified nursing assistant (CNA) (444, 61.3%), medical assistant (252, 65.3%), or home healthcare worker (HHW) (225, 59.5%) reported their race and ethnicity as either non-Hispanic Black or Hispanic. More than one third of HHWs (166, 45.2%), CNAs (283, 41.7%), and medical assistants (138, 37.9%) reported a residential address in the high social vulnerability category. The proportion of case-HCP who reported using recommended PPE at all times when caring for patients with COVID-19 was lowest among HHWs compared with other roles. To mitigate SARS-CoV-2 infection risk in healthcare settings, infection prevention, and control interventions should be specific to HCP roles and educational backgrounds. Additional interventions are needed to address high social vulnerability among HHWs, CNAs, and medical assistants.

Evaluation of a Training Course for Certified Nursing Assistants

Evaluation of a Training Course for Certified Nursing Assistants

Ownership Matters: Not-for-Profit Chain Nursing Homes Have Higher Utilization of Agency Nursing Staff.

Nursing homes (NHs) have long struggled with nurse shortages, leading to a greater reliance on agency nurses. The purpose of this study was to examine the impact of NH ownership on agency nurse utilization. Data were derived from multiple sources, including the Payroll-Based Journal and NH Five-Star Facility Quality Reporting System (n: 38,550 years: 2020-2022). A 2-part logistic regression model with 2-way fixed effects (state and year) was used to assess the association of ownership and agency nurse utilization. Model 1 compared facilities with and without agency nurse use, while Model 2 focused on NHs using agency nurses, examining high utilization (top 10%). The dependent variables were agency nurse utilization ratios for registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs). The primary independent variable was ownership/chain affiliation: for-profit chain (FPC), for-profit independent (FPI), not-for-profit chain (NFPC), and not-for-profit independent (NFPI). Model 1 showed that NFPC facilities had higher odds of using agency RNs (OR = 1.65), LPNs (OR = 1.53), and CNAs (OR = 1.38) compared to NFPI facilities (all P < .001), while FPC facilities also had increased odds for RNs (OR = 1.43), LPNs (OR = 1.30), and CNAs (OR = 1.15) (all P < .001). Model 2 indicated that NFPC, FPC, and FPI facilities were more likely to be high utilizers (top 10%) of agency nurses, with NFPC facilities having the highest odds across all categories. Pairwise comparisons showed that NFPC had the highest utilization of agency RNs and LPNs compared to other ownership groups. These results highlight the significant impact of NH ownership on staffing practices, suggesting that ownership type influences agency nurse utilization.

Nursing Home Staffing: Share Of Immigrant Certified Nursing Assistants Grew As US-Born Staff Numbers Fell, 2010-21.

Nursing homes have long faced a shortage of direct care workers, a problem that was magnified during the COVID-19 pandemic. Using nationally representative data from three sources, we found that much of the certified nursing assistant (CNA) workforce in US nursing homes is filled by immigrant labor. The number of native-born CNAs has been declining rapidly since the mid-2010s, whereas the number of foreign-born CNAs has remained relatively constant. During the first two years of the COVID-19 pandemic, the share of immigrant CNAs employed by nursing homes surged, which can be explained by a simultaneous drop in the share of native-born staff. Staffing shortages observed during the pandemic would have been worse if not for foreign-born CNAs remaining in the workforce. However, the share of foreign-born CNAs varied considerably across states, from less than 1percent in West Virginia to more than 70percent in Hawaii. In an analysis of prepandemic data, we found that nursing homes in regions with a higher share of immigrant CNAs were associated with more direct care staff hours per resident day and better nursing home quality performance. With the growing demand for long-term care, creating pathways for job-seeking immigrants to fill the gaps in direct care will be crucial to meeting future staffing needs.

ENGAGING CERTIFIED NURSING ASSISTANTS TO SUPPORT COMMUNICATION FOR PEOPLE LIVING WITH DEMENTIA IN NURSING HOMES

Abstract Over 2 million Americans live in nursing homes (NHs), and the vast majority of them live with dementia negatively impacting their ability to communicate. Certified nursing assistants (CNAs) provide the majority of direct care to people living with dementia (PLWD) in NHs, yet they do not have access to person-centered, evidence-based tools to support communication with this population. When CNAs do not communicate with PLWD in effective ways, PLWD may demonstrate negative behavioral symptoms that interfere with care, impacting not only the PLWD, but also the CNA, contributing to CNA turnover and burnout. Most interventions designed to support communication between the PLWD and the CNA do not involve CNA engagement which may contribute to the lack of implementation and access of such interventions. The purpose of this presentation is to outline the process taken to engage CNAs in the implementation of an intervention designed to improve communication during care activities. Information about questions asked to CNAs both in formal (e.g., interviews, focus groups) and informal (e.g., hallway conversations) ways will be provided. Although a sample of CNAs from 6 NHs (n=12) initially rated the intervention as acceptable (M = 4.5, SD = .48), appropriate (M = 4.4, SD = .58), and feasible (M = 4.28, SD = .49) where a rating of ‘5’ equals more acceptable, appropriate, and feasible, and ‘1’ equals less acceptable, appropriate, and feasible, this presentation will highlight how additional levels of engagement prompted modifications to the intervention, supporting implementation.

STRATEGIES USED BY OHIO’S NURSING HOMES TO RETAIN CERTIFIED NURSING ASSISTANTS: DO THEY WORK?

Abstract A low retention rate of certified nursing assistants (CNA) in nursing homes (NHs) is a known problem; it drives up facilities’ operating costs and negatively impacts the quality of care provided. The COVID-19 pandemic exacerbated this problem and left facilities scrambling to retain workers. Using data from the 2021 Ohio Biennial Survey of Long-Term Care Facilities, this study examines strategies implemented by facilities to improve retention of their CNAs. Facilities have tried to implement a variety of workplace environment changes such as allowing staff teams to manage schedule and financial benefit strategies such as longevity wage increase to improve their CNA retention. The statewide average NH retention rate was 64% for CNAs ranging between 0 and 100%. Three groups were constructed from the retention data: high or rate of 75% or higher (N = 220), medium or between 50% and 75% (N = 254), and low or under 50% (N = 145). We found that a higher proportion of low-retention facilities implemented most of these strategies compared to facilities with high and medium CNA retention rates. At the same time, we found that a higher proportion of administrators in the high retention group knew all their CNAs by name compared to the low-retention group (50.0% vs 41.7%). These findings suggest that environmental and financial strategies may not have much of an impact on retention rates, but making people feel respected and appreciated could.

INCLUSION AND INTEGRATION OF COMMUNITY STAKEHOLDER PERSPECTIVES IN RESEARCH: INSIGHT FROM AND FOR GERONTOLOGISTS

Abstract Engaging diverse stakeholders in research is increasingly required by funding agencies though training, skills and capacity building for engaged approaches have not kept pace. To advance the science of community engaged research (CEnR) we convene leading scholars who will provide insight on the inherent issues of engaging stakeholders in research and strategies for overcoming obstacles. The first presentation will summarize findings from a study of gerontologists and aging trainees to understand the needs and challenges of engaging patient and community stakeholders in research. The second will present strategies for engaging Certified Nursing Assistants (CNAs) in a communication program for people living with dementia in skilled nursing facility. The third will present findings from community discussions that informed adaptations to the development of remote sensing technologies and discuss the continuing role for community engagement in implementation. The fourth presentation will offer insight on integrating diverse perspectives in the development of a dementia-focused intervention in a nursing home. The final presentation will summarize the results of a tobacco exposure study to inform the development of a harm-reduction intervention among long-term renters in extended-stay hotels and the benefits of stakeholder partnerships in building trust and aiding in renter recruitment. We will conclude with an attendee inclusive discussion to envision a path that may empower people of all ages and at all career stages to engage diverse stakeholders as partners to catalyze scientific research that is responsive and relevant to those who have a stake in healthy aging and results in social change. This is a collaborative symposium between the Community-Engaged Research and Patient/Person Engagement in Research Interest Groups.

Characteristics of United States nursing homes with high percentages of stage 2-4 pressure injuries among high-risk nursing home residents with obesity.

Obesity rates in nursing homes (NHs) are increasing. Residents with obesity are at risk for poor outcomes such as pressure injuries (PIs) due to special care needs such as bariatric medical equipment and special protocols for skin care. PIs among resident populations is a sign of poor quality NH care. The purpose of this retrospective observational study was to identify characteristics of NHs with high rates of stage 2-4 PIs among their high-risk residents with obesity. Resident assessment data were aggregated to the NH level. NH structure and process of care and antecedent conditions of the residents and environment measures were used in bivariate comparisons and multivariate logistic regression models to identify associations with NHs having high rates of stage 2-4 PIs among high-risk residents with obesity. We identified three characteristics for which the effect on the odds was at least 10% for clinical significance - for-profit status, large facilities, and the hours of certified nursing assistants (CNAs) per patient day (HRPPD). This study identified several NH characteristics that are associated with higher risk for PIs, which can be targeted with evidence-based interventions to reduce the risk of these adverse safety events occurring.

Scheduling Smarter: Scheduling Decision Impact on Nurse-Aide Turnover

Research problem: High turnover rates in long-term nursing facilities exacerbate the existing shortage of caregivers, a trend that will only worsen as the population of the United States ages. Part-time certified nursing assistants (CNAs) provide a significant amount of patient care in these facilities. CNAs also have high annual rates of turnover, which can harm health outcomes and increase the cost of care. In this study, we empirically analyze the effect of scheduling decisions on part-time CNA turnover. We explore three research questions that examine both how much and with whom a CNA is scheduled to work. We seek to empirically answer how (1) hours worked and (2) coworker variability influence turnover for part-time CNAs and if (3) coworker variability moderates the relationship between hours worked and CNA turnover. Methodology/results: Using novel data from one of the nation’s largest nursing home organizations, which includes data for 6,221 part-time CNAs at 157 facilities in the United States over a 26-month period, we identify two scheduling levers managers may be able to use to influence turnover. As hours worked increase, turnover first decreases and then increases, demonstrating a nonlinear U-shaped relationship between hours worked and turnover. We also find that high coworker variability increases turnover while also moderating the effects of hours worked on turnover. In post hoc analyses, we demonstrate that high CNA turnover has negative impacts on patient health. Managerial implications: These findings suggest that managers may be able to leverage part-time CNA scheduling to reduce turnover, improving both the quality and cost of care. Specifically, we demonstrate that managers can reduce CNA turnover by increasing hours worked, scheduling coworkers together consistently and doing both simultaneously. Supplemental Material: The online appendices are available at https://doi.org/10.1287/msom.2021.0533 .

‘We were called guardian angels; Was that sincere? I do not think so’: retention of certified nurse assistants during the COVID-19 crisis in long-term care facilities in Montreal, Quebec, Canada

ABSTRACT The COVID-19 pandemic in the Canadian province of Quebec has increased demand for labour in long-term care facilities, or ‘Centre d’hébergement de soins de longue durée (CHSLDs)’. This study explored the challenges experienced by Certified Nurse Assistants (CNAs) in CHSLDs in Montreal, Quebec’s largest city, during the COVID-19 pandemic and how these challenges affected their job retention. We employed an analytical descriptive qualitative research approach, using semi-open interviews to collect data from three categories of CNAs between October and December 2021 in Montreal CHSLD. Our interview guide was based on two Canadian theoretical frameworks: one on nurses' retention and one on work-family balance. A thematic analysis method was employed to analyze the data. Our findings reveal that the vicious circle of service failure, including stress, exhaustion, and poor relationships with management and coworkers, influenced CNAs’ decision to quit their jobs. Poor working conditions, difficulty balancing work-family-personal life, and lack of appreciation for the profession all contributed to some CNAs quitting their jobs. At the same time, emotional attachment to the work and support from managers, organizations, and the government played a critical role in retaining CNAs. The CHSLDs network in Quebec, already marked by job instability, has been further weakened by the COVID-19 pandemic. Improved working conditions, respect for the CNA profession, and a recruitment process that accounts for candidates’ professional motivations are necessary to improve CNA retention.

Associations between Complaints and Organizational Characteristics among Ohio Nursing Homes

ObjectivesIn recent years, Ohio nursing homes (NHs) have received an increasing number of complaints. The current study aims to gain a better understanding of the relationship between NH organizational characteristics and the number of complaints. DesignSecondary data analysis was used. Setting and ParticipantsFour data sources on Ohio NHs were merged. Ohio NH complaints data reported in 2018 and 2019 was linked with the 2017 Ohio Biennial Survey of Long-Term Care Facilities, 2017 Ohio Nursing Home Resident Satisfaction Survey, and 2018 Ohio Nursing Home Family Satisfaction Survey. MethodsDescriptive analysis, bivariate tests (ie, analysis of variance and χ2 test), and multinomial logistic regression analyses were conducted. ResultsFindings included that urban location, NH administrator (NHA) and director of nursing (DON) turnover in the previous 3 years, NH size, occupancy rate, certified nursing assistant (CNA) retention, and overall family satisfaction were significantly associated with total complaints. NHA and DON turnover, NH size, CNA retention, and overall family satisfaction were found to be significantly associated with substantiated complaints. Conclusions and ImplicationsThe importance of leadership (ie, NHA and DON) turnover, CNA retention, and family satisfaction indicates that specifically targeted efforts to improve in these areas can have a positive impact on NH quality.

Staffing Shortages, Staffing Hours, and Resident Deaths in US Nursing Homes During the COVID-19 Pandemic.

Staffing shortages at nursing homes during the COVID-19 pandemic may have impacted care providers' staffing hours and affected residents' care and outcomes. This study examines the association of staffing shortages with staffing hours and resident deaths in nursing homes during the COVID-19 pandemic. This study measured staffing hours per resident using payroll data and measured weekly resident deaths and staffing shortages using the Centers for Disease Control and Prevention's National Healthcare Safety Network data. Multivariate linear regressions with facility and county-week fixed effects were used to investigate the association of staffing shortages with staffing hours and resident deaths. 15,212 nursing homes. The primary outcomes included staffing hours per resident of registered nurses (RNs), licensed practical nurses (LPNs), and certified nursing assistants (CNAs) and weekly total deaths per 100 residents. Between May 31, 2020, and May 15, 2022, 18.4% to 33.3% of nursing homes reported staffing shortages during any week. Staffing shortages were associated with lower staffing hours per resident with a 0.009 decrease in RN hours per resident (95% CI 0.005-0.014), a 0.014 decrease in LPN hours per resident (95% CI 0.010-0.018), and a 0.050 decrease in CNA hours per resident (95% CI 0.043-0.057). These are equivalent to a 1.8%, 1.7%, and 2.4% decline, respectively. There was a positive association between staffing shortages and resident deaths with 0.068 (95% CI 0.048-0.088) total deaths per 100 residents. This was equivalent to an increase of 10.5%. Our results showed that self-reported staffing shortages were associated with a statistically significant decrease in staffing hours and with a statistically significant increase in resident deaths. These results suggest that addressing staffing shortages in nursing homes can save lives.

Association of Receipt of Paycheck Protection Program Loans With Staffing Patterns Among US Nursing Homes

Staffing shortages in nursing homes (NHs) threaten the quality of resident care, and the COVID-19 pandemic magnified critical staffing shortages within NHs. During the pandemic, the US Congress enacted the Paycheck Protection Program (PPP), a forgivable loan program that required eligible recipients to appropriate 60% to 75% of the loan toward staffing to qualify for loan forgiveness. To evaluate characteristics of PPP loan recipient NHs vs nonloan recipient NHs and whether there were changes in staffing hours at NHs that received a loan compared with those that did not. This economic evaluation used national data on US nursing homes that were aggregated from the Small Business Administration, Nursing Home Compare, LTCFocus, the Centers for Medicare & Medicaid Services Payroll Based Journal, the Minimum Data Set, the Area Deprivation Index, the Healthcare Cost Report Information System, and the US Department of Agriculture Rural-Urban Continuum Codes from January 1 to December 23, 2020. Paycheck Protection Program loan receipt status. Staffing variables included registered nurse, licensed practical nurse (LPN), and certified nursing assistant (CNA) total hours per week. Staffing hours were examined on a weekly basis before and after loan receipt during the study period. An event-study approach was used to estimate the staffing total weekly hours at NHs that received PPP loans compared with NHs that did not receive a PPP loan. Among 6008 US NHs, 1807 (30.1%) received a PPP loan and 4201 (69.9%) did not. The median loan amount was $664 349 (IQR, $407 000-$1 058 300). Loan recipients were less likely to be part of a chain (733 [40.6%] vs 2592 [61.7%]) and more likely to be for profit (1342 [74.3%] vs 2877 [68.5%]), be located in nonurban settings (159 [8.8%] vs 183 [4.4%]), have a greater proportion of Medicaid-funded residents (mean [SD], 60.92% [21.58%] vs 56.78% [25.57%]), and have lower staffing quality ratings (mean [SD], 2.88 [1.20] vs 3.03 [1.22]) and overall quality star ratings (mean [SD], 3.08 [1.44] vs 3.22 [1.44]) (P < .001 for all). Twelve weeks after PPP loan receipt, NHs that received a PPP loan experienced a mean difference of 26.19 more CNA hours per week (95% CI, 14.50-37.87 hours per week) and a mean difference of 6.67 more LPN hours per week (95% CI, 1.21-12.12 hours per week) compared with nursing homes that did not receive a PPP loan. No associations were found between PPP loan receipt and weekly RN staffing hours (12 weeks: mean difference, 1.99 hours per week; 95% CI, -2.38 to 6.36 hours per week). In this economic evaluation, a forgivable loan program that required funding to be appropriated toward staffing was associated with a significant increase in CNA and LPN staffing hours among NH PPP loan recipients. Because the PPP loans are temporary, federal and state entities may need to institute sufficient and sustainable support to mitigate NH staffing shortages.

Preliminary Evidence for Dementia Collaborative Coaching.

The primary purpose of this study was to obtain preliminary evidence for a communication coaching intervention, Dementia Collaborative Coaching. The secondary aim of this study was to assess the acceptability, appropriateness, and feasibility of the intervention according to routine care providers. In a pre-/posttest design, speech-language pathologists (SLPs) delivered Dementia Collaborative Coaching to certified nursing assistants (CNAs) and people living with dementia (PLWD) in six different skilled nursing facilities over a period of 6 weeks. A self-perceived knowledge and efficacy measure regarding the use of external memory aids to support communication in PLWD was administered to CNA and SLP participants. The Cohen-Mansfield Agitation Inventory was administered to PLWD participants. The Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure were administered post-intervention. For CNAs, self-perceived knowledge and efficacy increased from pre-intervention (M = 3.73, SD = 0.69) to post-intervention (M = 4.07, SD = 0.44), t(11) = -1.97, one-sided p = .037. There was a significant improvement (e.g., reduction) in scores on the Cohen-Mansfield Agitation Inventory for PLWD (n = 10) from pre-intervention (M = 73.10, SD = 29.98) to post-intervention (M = 58.6, SD = 18.82), t(9) = 2.83, p = .01. CNA participants (n = 12) rated the intervention as acceptable (M = 4.48, SD = 0.48), appropriate (M = 4.33, SD = 0.61), and feasible (M = 4.19, SD = 0.48). SLPs rated the intervention as slightly more acceptable, appropriate, and feasible than CNAs with scores of M = 4.54, SD = 0.51; M = 4.54, SD = 0.51; and M = 4.46, SD = 0.51, respectively. Dementia Collaborative Coaching showed preliminary positive outcomes for CNAs and PLWD. The intervention was acceptable, appropriate, and feasible for routine providers and warrants further study.

Use and Acceptance of Smart Elderly Care Apps Among Chinese Medical Staff and Older Individuals: Web-Based Hybrid Survey Study.

With the advent of China's aging population and the popularization of smartphones, there is a huge demand for smart elderly care apps. Along with older adults and their dependents, medical staff also need to use a health management platform to manage the health of patients. However, the development of health apps and the large and growing app market pose a problem of declining quality; in fact, important differences can be observed between apps, and patients currently do not have adequate information and formal evidence to discriminate among them. The aim of this study was to investigate the cognition and usage status of smart elderly care apps among older individuals and medical staff in China. From March 1, 2022, to March 30, 2022, we used the web survey tool Sojump to conduct snowball sampling through WeChat. The survey links were initially sent to communities in 23 representative major cities in China. We asked the medical staff of community clinics to post the survey link on their WeChat Moments. From April 1 to May 10, 2022, we contacted those who selected "Have used a smart elderly care app" in the questionnaire through WeChat for a request to participate in semistructured interviews. Participants provided informed consent in advance and interviews were scheduled. After the interviews, the audio recordings were transcribed into text and the emerging themes were analyzed and summarized. A total of 810 individuals participated in this study, 54.8% (n=444) of whom were medical staff, 33.1% (n=268) were older people, and the remaining participants were certified nursing assistants (CNAs) and community workers. Overall, 60.5% (490/810) of the participants had used a smart elderly care app on their smartphone. Among the 444 medical staff who participated in the study, the vast majority (n=313, 70.5%) had never used a smart elderly care app, although 34.7% of them recommended elderly care-related apps to patients. Among the 542 medical staff, CNAs, and community workers that completed the questionnaire, only 68 (12.6%) had used a smart elderly care app. We further interviewed 23 people about their feelings and opinions about smart elderly care apps. Three themes emerged with eight subthemes, including functional design, operation interface, and data security. In this survey, there was a huge difference in the usage rate and demand for smart elderly care apps by the participants. Respondents are mainly concerned with app function settings, interface simplicity, and data security.

Supporting Persons With Dementia: Perspectives From Certified Nurse's Assistants.

Many persons with Alzheimer's disease or related dementias (ADRD) receive care from paid staff in residential communities. The most common staff in these communities are certified nursing assistants (CNAs). Although CNAs have a high number of interactions with residents, and thus the possibility of engaging in social interactions, evidence suggests that they provide limited social support to persons with ADRD. Little is known about the attitudes of CNAs toward providing social support to persons with ADRD and their perception of components of quality social interactions with these individuals. We conducted a thematic analysis of semistructured interviews with 11 CNAs (91% female participants, mean age 23.6) to understand their perceptions about providing social support to persons with ADRD and the components of effective social interactions. Our results show that CNAs consider providing social support to be an important part of their role as CNAs. Additionally, participants emphasized the interplay of verbal communication, nonverbal communication, and internal beliefs and attitudes toward persons with ADRD in creating effective social interactions. Participants highlighted multiple barriers to providing residents with social support, including lack of time, lack of training, and the behavioral and psychological symptoms of dementia. We offer implications for expanding training for CNAs working with persons with dementia and improving policy based on our results.

Cleaning the Medical Misinformation Mess

Cleaning the Medical Misinformation Mess