Front-line Care Staff Research Articles

Community Frontline Care Staff Perspectives on Covid-19 Restrictions: “It’s not what I was hired to do.”

The Covid-19 pandemic presented numerous challenges and changes for all frontline providers, but the impacts on care staff in community service agencies is less understood. The current study involving secondary data analysis explored how frontline care staff with a fetal alcohol spectrum disorder (FASD) program describe their work during the public health restrictions. Semi-structured focus groups were conducted with frontline care staff (N = 20). Inductive thematic analysis resulted in three themes: shifting procedures, adapting interactions, and declining motivation. Changes in work because of Covid-19 and feelings in response to those changes shed light on the as yet unknown cost of the pandemic on these services and the FASD community.

Stuck in Hospital: how can we make integrated care a reality for people with a learning disability and / or autism who experience long stays in assessment & treatment settings?

Introduction: Integrating care so that people with learning disabilities and/or autistic people can receive support at home rather than in institutional assessment and treatment units is a priority in the UK and many other countries. Despite the recognition of its importance, progress on timely and coordinated discharge has been slow. Surprisingly little previous research has engaged directly with people with learning disabilities and/or autistic people, their families or front-line care staff to understand the issues from their perspectives. This project has sought to address this gap.
 Community of Interest: Professionals, policy makers, researchers, people with a learning disability and / or autism, and family carers connected with this area of integrated care policy and practice.
 Engagement: We worked with a Reference Group of people with learning disabilities and/or autistic people and their families to co-design our approach, sense check findings and support dissemination. Reference Group members were reimbursed for any expenses, paid for their time, and received appropriate support and training for the tasks in which they are involved. The project was also designed and delivered in collaboration with a self-advocacy group.
 Overview: We initially conducted a formal review of the research and grey literature, identifying rates of delayed discharge for people with learning disabilities and/or autistic people in long-stay hospital settings, the methods used to identify such rates and the solutions proposed. 
 Next, we worked with three long-stay hospital sites from across the UK in order to conduct: 
 In-depth work with ten people with learning disabilities and/or autistic people per site, and with a family member, to understand their journey through services over time, their experience of long-stay hospital provision, how care was co-ordinated to meet their aspirations, the kinds of lives they would like to be living, and the barriers that are preventing them from leaving hospital
 Focus groups with front-line staff and interviews with a commissioners for each of the 30 people with learning disabilities and/or autistic people.
 The perspectives of social workers supporting our 30 participants, as well as of advocates and social care providers working with people leaving long-stay hospital settings
 Results: The data from the study is currently being analysed with the final report due by the end of December 2022.
 
 Insights: From our analysis to date, we have identified the following recommendations for policy & practice: see the person behind the labels; don’t make people jump through more hoops than is really needed; help hospital staff know what’s available in the community; give people the chance to try life outside; help people with the trauma they’ve experienced; and. don’t let people fall through the cracks between services.
 Next steps: Alongside completing the report, the research team have a practice guide in publication, a film highlighting main implications, and an accessible practice guide. The team are planning a follow up study with our lived experience reference group which will explore people’s quality of life post-discharge in relation to different approaches to facilitating more co-ordinated and person-centred care.

LIVING WITH DEMENTIA: EXPERIENCES OF LGBTQ PEOPLE WITH DEMENTIA AND SIGNIFICANT OTHERS

Abstract Dementia is commonly conceptualized in biomedical terms as a deterioration of brain function and a subsequent loss of self. However, dementia scholars have increasingly underscored how the self of the person with dementia may be maintained through social interactions in their everyday life. This may pose specific challenges for LGBTQ people who may not be out in care settings due to fear of discrimination and whose chosen family may not be recognized by formal care providers. This paper presents preliminary findings from a qualitative study conducted in Sweden with LGBT individuals living with dementia. The project builds on policy analysis as well as semi-structured interviews with LGBTQ people with dementia, people significant to them such as partners, family and friends, and interviews with frontline care staff and managers within dementia care. The thematic analysis illustrates how experiences of living with dementia as an LGBTQ person vary depending on the progression and type of dementia, the individuals’ social support network, how open one is with their sexual orientation or gender identity, living at home or in a dementia care facility, socioeconomics, and other factors. In line with how other ageing scholars have pointed to the potentiality of queer theory to move beyond framing dementia as pathology and decline, concepts of queer time and queer failure are used here to understand the results in ways that disrupt notions of self, temporalities, normativity, subjectivity and what it means to age successfully.

INTERPROFESSIONAL CO-LEARNING AT MULTIPLE LEVELS OF LTSS: PRO-HOME PROGRAMS AND RESEARCH

Abstract Promoting Seniors’ Health with Home Care Aides (Pro-Home), a randomized controlled trial (RCT) of a gentle physical activity program delivered by home care aides (HCAs) for their older clients in English or Spanish, provided unprecedented opportunities for collaboration and co-learning across multiple disciplines and professions (public health, health services research, sociology, medicine, physical/occupational therapy, kinesiology, social work, psychology, economics, medicine, nursing; frontline care workers, leaders and staff members of state and home care agencies, , social service agencies, researchers, undergraduate and graduate students). The turbulent long-term services and supports (LTSS) environment, which culminated in the COVID-19 pandemic, provided the study participants (HCAs and their older clients), multiple levels of LTSS stakeholders and the research team with rapidly evolving new contexts for the RCT. This paper presents how the Pro-Home project developed into a learning organization where individuals and organizations learn from each other to pivot at every new turn in the environment, focusing on the development of a novel interactive training for HCAs in-person or remotely. The initial training activities were conducted in-person. After adapting the material for remote delivery, we provided the latter sessions via phone with digital and physical tools. For each training session, we assessed outcome quality using an exit survey and other methods capturing HCAs’ program delivery. The presentation concludes with implications for research and practice in LTSS.

Sustaining and expanding telehealth activity: Training requirements for Australian residential aged care front-line staff.

To identify the training needs of front-line aged care staff as perceived by senior clinicians and managers at selected residential aged care facilities (RACFs). A qualitative explorative designed study using semi-structured interviews with a convenience sample of RACF senior managers and nurses. A hybrid analysis approach using a framework deductive analysis followed by inductive analysis for sub-themes. Four sub-themes emerged to sustain increased telehealth activity: technology knowledge and digital literacy skills, including understanding telehealth ecosystems and technical skills; evidence-based reviews and clinical frameworks for telehealth consultations to identify appropriate consultations and successful use cases; telehealth best practice guidelines and workflows including telehealth consultations protocols, communicating by videoconferencing, how to support families in attending telehealth consultations and optimal training models; and telehealth policy and legal guidance. Staff require comprehensive training to sustain and expand telehealth use in RACFs. Training should focus on knowledge, skills and competencies in using telehealth as well as the broad factors of policies and understanding ICT systems to support staffs' abilities and confidence. This study provides innovative findings that identify key components and associated activities and resources for training RACF staff to ensure they have sufficient knowledge, competency, skills and confidence to integrate telehealth into care provision.

Using the Theoretical Framework of Acceptability to understand the acceptability of e-training for nurse led prevention of unwanted sexual behaviour in Australia’s residential aged care services

Objective: The aim of this study was to evaluate the acceptability of one specific e-training (intervention) for prevention of unwanted sexual behaviour in Australia’s residential aged care services using the Theoretical Framework of Acceptability. Background: Aged care staff are of fundamental importance in unwanted sexual behaviour incident management and prevention. The research team developed and implemented an evidence-informed intervention designed to increase awareness, promote collaborative practice, and improve prevention and management of such incidents in aged care. Current acceptability of training on this topic is yet to be studied despite it being recognised as a key factor for successful implementation and translation into practice. Study design and methods: This is a qualitative, cross-sectional study employing semi-structured telephone interviews with actively working enrolled and registered aged care nurses who had completed the intervention. Acceptability of the intervention was measured with the Theoretical Framework of Acceptability. Of the 36 participants that signed the consent form, 18 completed interviews. One participant was excluded from analysis as they did not complete all modules of the intervention. Results: Analysis revealed favourable evaluation in all seven domains of the Theoretical Framework of Acceptability, finding high acceptability of the intervention amongst all participants. The intervention aligned with participant’s values and the content was perceived to fill a knowledge gap. This is showcased in participants unanimous belief that it would be helpful for all front-line aged care staff to receive the intervention frequently. Although participants showcased high acceptability of the intervention, participants recommended that sexuality content be included before detailing unwanted sexual behaviour, and that this content inclusion may increase awareness and understanding of unwanted sexual behaviour. Conclusion: Participants reported this e-training to be highly acceptable. They believed it has potential to improve attitudes and awareness of incidents in aged care. However, favourable results may reflect a personal interest with the topic, for example, the content aligned with their personal values, experience, and beliefs. More research is needed to understand both the acceptability and the efficacy of the training short and long-term. Implications for research, policy, and practice: This study indicates that larger scale national staff training on this topic is possible and considered necessary by the sample. Future national policy should explore the inclusion of this topic in the curriculum standards. Future research should focus on evaluating the efficacy of the training in changing attitudes, awareness and influencing professional practice. What is already known about the topic? Known prevalence of unwanted sexual behaviour in aged care suggests most nursing staff will be required, at some stage, to provide care to a resident who has been a target, or exhibitor of unwanted sexual behaviour. Previous studies of this pilot intervention indicate that it provides a useful model and curriculum of specific topics to guide development of training on unwanted sexual behaviour initiatives nationally and internationally. Acceptability of healthcare interventions is a critical measure in facilitating their implementation and in this instance, capacity of the aged care workforce to be trained on unwanted sexual behaviour. What this paper adds E-training about prevention of unwanted sexual behaviour is acceptable to aged care nurses. E-training filled an existing program gap in education provision and addressed current staff knowledge deficits that aged care nurses perceived as important for better resident care and reducing work related stress. Lack of prior learning about intimacy and sexuality hampered optimal learning about prevention of unwanted sexual behaviour.

What has employee loyalty to do with “love” to clients? Testing approaches to work as mediators

PurposeDrawing on the organizational psychology literature and social resource theory, this research aimed to investigate how attitude toward the employer (i.e. loyalty) and attitude toward the client (i.e. approach to work: professional, market-oriented and person-centered) relate to the perceived importance of socio-emotional resources in providing care to older people.Design/methodology/approachSwedish frontline care staff members participated in an electronic survey using a cross-sectional design. Mediation analyses were conducted to examine proposed direct and indirect effects of loyalty on the perceived importance of socio-emotional resources in care through three different approaches to work in care settings.FindingsIn general, the results confirmed the hypotheses. Thus, the analyses showed a positive association between employee loyalty and the perceived value of socio-emotional resources in care, which was partially mediated by the person-centered and professional approaches to work. Moreover, the analyses showed that the person-centered approach was more strongly related to the perceived value of socio-emotional resources in care than the other two approaches, lending support to the superiority of the person-centered approach in this context.Originality/valueThe study highlights that there exist multiple approaches to work in care settings. Also, the insights about how loyalty toward the employer relates to approach to work in care settings and the perceived value of socio-emotional resources in care are novel and of crucial importance to practitioners and the outcomes of care.

Mandatory vaccination against the coronavirus and frontline care staff

Mandatory vaccination against the coronavirus and frontline care staff

Leveraging management engineering and business consulting for rapid response, mitigation and recovery during a pandemic

The novel severe acute respiratory syndrome coronavirus 2, which causes coronavirus disease 2019 (COVID-19), has presented healthcare delivery challenges the world has never encountered before. Healthcare and its practitioners, while finding themselves in difficult situations, must still care for patients with emergent needs and ensure the safety and well-being of all patients and staff. At Mayo Clinic, effective navigation of the dynamic and complex situation created by COVID-19 required unique multidisciplinary collaborations to design and implement solutions quickly. Frontline care providers and staff of ancillary services and other critical healthcare functions partnered with the Department of Management Engineering and Consulting (ME&C) team to organise and re-engineer operations to iteratively adapt to the dynamic ‘new normal’. Health systems engineers (HSEs) and project managers (PMs) accelerated the implementation of innovative interventions by leveraging advanced engineering and consulting frameworks, models and methods. Utilising a patient and staff-centric systems approach to align electronic systems, operational processes, staffing resources and organisational infrastructure has been invaluable for speed and effectiveness. Harnessing the promise of digital technology and advanced analytics was imperative and set the stage for a broader set of possibilities to transform healthcare. These possibilities include scaling of consumerfocused virtual services in multiple and unfamiliar settings, new assets that could be reused for future emergencies, accelerating the implementation of time-sensitive solutions, applied analytics and modelling to predict clinical, financial and community impacts and reimaging the healthcare supply chain. As more has been learned about the trajectory and management of COVID-19, the need to rapidly evolve and pivot interventions for short-, medium-, and long-term applications continues. This article addresses the unique contributions of ME&C during the COVID-19 crisis and the results-oriented collaborations with staff in critical business functions. We believe that the experiences, outcomes and lessons learned through this journey are broadly transferable to other healthcare and nonhealthcare organisations.

Comparison of the Mental Status of COVID-19 Intensive Care Unit and General Intensive Care Unit Staff

Aim: The coronavirus disease 2019 (COVID-19) pandemic may predispose front-line intensive care staff to experience mental health problems. The aim of this study was to compare the COVID-19 fear experienced by COVID-19 intensive care unit staff and general intensive care unit staff, and the effects of this fear on mental health. Material and Methods: In this cross-sectional study, a total of 156 participants, 90 (57.7%) participants from the COVID-19 intensive care unit and 66 (42.3%) from the general intensive care unit, were included. A printed questionnaire consisting of the Fear of COVID-19 Scale (FCV-19S), Depression Anxiety Stress Scale (DASS-21), and demographic data were used. Results: Female gender, being a nurse, and working in COVID-19 intensive care unit, were associated with higher depression, anxiety, and stress scores. A significant relationship was found between fear of COVID-19 and depression (ρ=0.399, p=0.044), anxiety (ρ=0.456, p=0.019), and stress (ρ=0.418, p=0.033). Furthermore, as compared to general intensive care unit staff, COVID-19 intensive care unit staff who may have high-risk contact were approximately twice times more likely to experience anxiety and fear of COVID-19 and 3.5 times more likely to suffer from depression and stress. Conclusion: The COVID-19 pandemic has adversely affected the mental health of intensive care staff. Attention should be paid to the mental health of females and nurses working in the COVID-19 intensive care unit. The mental health of intensive care workers should be supported to protect the health workforce.

“Dempathy” ‐ From empathy to synchronization in understanding people with dementia

AbstractBackgroundIn Hong Kong, dementia is one of the significant reasons for the family caregivers to send their beloved one to the residential care homes. Nevertheless, over 50% of current residents are in cognitive impairment and different stages of dementia. The caring staff face a lot of challenges and uncertainty, even worries and anxiety in taking care of people with dementia. How to facilitate the care staff to implement person‐centred care is what we all would like to find out. The research began two reflective training sessions, each of which lasted 90 minutes with over 25 frontline care staff, by presenting some of the subjective experiences of residents with dementia with the aim of arousing empathy for their self‐perceptions. Afterwards, I asked the attendees a series of reflective questions as prompts to promote their reconsideration of how people with dementia might be cared for by following the person‐centred approach. The same semi‐structured questions were designed for both focus groups to gain insight into the staff’s thoughts about the self‐perception of people with dementia and the reflective training. The participating care staff had reflected upon their attitudes, skills and knowledge related to dementia care. Hardly any care staff reported having ever thought about the self‐perception or subjective views of people with dementia. On the contrary, they had assumed that people with dementia were incapable of giving rational responses and that it was therefore unnecessary to listen to their points of view. Themes including (1) From Stigmatization to Acceptance; (2) From Perceiving the Patient to Perceiving the Person; (3) From Ignoring to Responding; (4) From Being Tasked‐Oriented to Being Relationship‐Oriented; (5) From Denying to Recognizing People with Dementia were found. In the focus groups, however, the care staff suggested that they had become aware of ways to understand people with dementia from their perspectives and in their context. The implementation of person‐centred approach is associated with the change of caring attitude and perception of dementia at the fundamental level. The reflective training facilitated the care staff to transform from empathy to synchronization towards the context of people with dementia, which I called “Dempathy”.

Producing ‘Top Tips’ for Care Home Staff During the COVID-19 Pandemic in England: Rapid Reviews Inform Evidence-Based Practice but Reveal Major Gaps

<strong>Context:</strong> The work presented in this paper was undertaken during the first three months of the COVID-19 crisis in the UK. <strong>Objectives:</strong> The project is aimed to respond to questions and concerns raised by front-line care staff during this time, by producing research-based ‘Top Tips’ to complement emerging COVID-19 policy and practice guidelines. <strong>Methods:</strong> Eight rapid, expert reviews of published, multidisciplinary research evidence were conducted to help answer care home workers’ questions about ‘how’ to support residents, family members and each other at a time of unprecedented pressure and grief and adhere to guidance on self-distancing and isolation. A review of the emerging policy guidelines published up to the end of April 2020 was also undertaken. <strong>Findings:</strong> The rapid reviews revealed gaps in research evidence, with research having a lot to say about what care homes should do and far less about how they should do it. The policy review highlighted the expectations and demands placed on managers and direct care workers as the pandemic spread across the UK. <strong>Implications:</strong> This paper highlights the value of working with the sector to co-design and co-produce research and pathways to knowledge with those who live, work and care in care homes. To have a real impact on care practice, research in care homes needs to go beyond telling homes ‘what’ to do by working with them to find out ‘how’.

Reinventing Palliative Care Delivery in the Era of COVID-19: How Telemedicine Can Support End of Life Care.

Telemedicine technology has become essential to healthcare delivery in the COVID-19 era, but concerns remain regarding whether the intimacy and communication that is central to high-quality palliative care will be compromised by the use of this technology. We employed a business model approach to identify the need for system innovation in palliative care, and a quality improvement approach to structure the project. Products from this project included a standard operating procedure for safe use of tablet computers for inpatient palliative care consultations and family visitations; tablet procurement with installation of video telehealth software; and training and education for clinical staff and other stakeholders. We describe a case illustrating the successful use of palliative care telehealth in the care of a COVID-19-positive patient at the end of life. Successful use of video telehealth for palliative care involved overcoming inertia to the development of telehealth infrastructure and learning clinical video telehealth skills; and engaging front-line care staff and family members who were open to a trial of telehealth for communication. Information gleaned from family about the patient as a person helped bedside staff to tailor care toward aspects meaningful to the patient and family and informed best practices to incorporate intimacy into future palliative video consultations and family visit.

Engaging Community Health Workers and Social Care Staff as Social First Responders during the COVID-19 Crisis.

In this public health practice vignette, we describe an ongoing community and system intervention to identify and address social determinants of health and related needs experienced by ChristianaCare patients and the greater community during the Coronavirus pandemic. This intervention, being conducted by the ChristianaCare Office of Health Equity, in partnership with ChristianaCare’s embedded research institute, the Value Institute, and the Community Outreach and Education division of the Helen F. Graham Cancer Center and Research Institute, engages more than 25 community health workers, health Guides, Latinx health promoters and other social care staff as social first responders during the COVID-19 crisis. These experienced front-line social care staff screen patients and community members for social needs; make referrals to agencies and organizations for needed assistance (e.g., food, housing, financial assistance); assess people’s understanding of COVID-19 and preventive measures; provide education about COVID-19; and, connect patients and community members to COVID-19 testing and any relevant clinical services. While this ongoing intervention is under evaluation, we share here some preliminary lessons-learned and discuss the critical role that social first responders can play in reducing the growing adverse social and health impacts of COVID-19 across the state of Delaware.

Technological Frames and Care Robots in Eldercare

Care robots are often portrayed as an exciting new technology for improving care practices. Whether these robots will be accepted and integrated into care work or not, is likely to be affected by the assumptions, expectations and understandings held by potential end users, such as frontline staff and the people that are cared for. This paper describes how the conceptual framework of technological frames was used to identify the nature of care robots, care robots in use and care robot strategy as shared group level assumptions, expectations and understandings of care robots among care staff and potential care receivers. Focus groups were conducted with 94 participants. These groups consisted of line managers, frontline care staff, older people and students training to become carers. The technological frame of the nature of care robots revealed two complementary components: care robots as a threat to the quality of care, and care robots as substitute for humans and human care, held together by imaginaries of care robots. The technological frame of care robots in use revealed aspects of prospective end-users’ uncertainty of their ability to handle care robots, and their own perceived lack of competence and knowledge about care robots. In addition, the following potential criteria for successful use of care robots were identified: adequate training, incentives for usage (needs and motives), usability, accessibility and finances. The technological frame of care robot strategy was revealed as believed cost savings and staff reduction. The novelty of the results, and their relevance for science and practice, is derived from the theoretical framework which indicates that adoption of care robots will be dependent on how well societies succeed in collectively shaping congruent technological frames among different stakeholders and aligning technological development accordingly.

The older person as a client, customer or service user?

PurposeThe purpose of this paper is to describe three different approaches to work in elderly care (i.e. professional, market-oriented and person-centred) and examine whether these theoretically derived approaches can be confirmed empirically. Additional aims were to examine the endorsement of these approaches and whether there were differences in the endorsement of these approaches in nursing home vs home care and municipality vs privately run care units.Design/methodology/approachData were collected using a cross-sectional survey study of frontline care staff (n=1,342). Exploratory factor analysis was used to investigate the empirical validity of the proposed approaches to work in elderly care. A series of paired and independent samples t-tests were conducted to analyse mean differences between the proposed approaches to work.FindingsA principal axis factoring analysis yielded three theoretically meaningful factors as proposed. These results indicated that the respondents were able to differentiate between three distinct but related approaches to work with older persons. The results also showed that the professional care approach was the highest endorsed and the market-oriented the lowest endorsed approach. No notable differences in approaches to work were observed in nursing home vs home care and municipality vs privately run care units.Originality/valueThis is the first study to examine multiple approaches to work in elderly care as previous research studies mainly have investigated the person-centred care approach. Current findings indicate that these approaches to work often coexist in various combinations and that the care staff adopts all these approaches but to varying degrees. The approaches differ in several important respects (e.g. legitimacy and view of the older person) and most likely affect the way care staff treats the older person and how the older person perceives their relationship with the care staff. Knowledge about these differences facilitates management of the care staff’s work situation and helps to improve the quality of care.

Meal context and food offering in Quebec public nursing homes: the perspectives of first-generation immigrant residents, family members, and frontline care aides

PurposeThe purpose of this paper is to gain a better understanding of the meal context and the food offering in Quebec public nursing homes for non-autonomous seniors, particularly with respect to first-generation immigrants.Design/methodology/approachA focused ethnography approach was used. Semi-structured interviews were conducted with three distinct groups: non-Quebec-born residents (n=26), their families (n=24) and frontline care staff (n=51). Structured non-participative observations were made in facilities.FindingsFirst-generation immigrants, however, long ago they arrived in Quebec, adapted with difficulty and often not at all to the food offering. Resident’s appetite for food offer was a problem for reasons related primarily to food quality, mealtime schedules, medication intake, physical and mental condition, and adaptation to institutional life. Family/friends often brought in food. Care staff tasks were becoming increasingly tedious and routinized, impacting quality of care.Practical implicationsInstitutions should render procedures and processes more flexible and adapt their food offering to the growing diversity of their client groups. For residents, the meal experience is profoundly transformed in nursing homes in terms of form, conditions, rituals and meaning. A better understanding of lived situations shaped by a more refined cultural sensitivity would go a long way toward achieving a better quality of life not only for residents but also for their families and friends. Care aides, on whose shoulders rests the responsibility of ensuring that meals are safe and pleasant moments for socializing and maintaining social dispositions, are ambivalent about their work.Originality/valueThe paper is based on an original study. To the authors’ knowledge, the literature on the meal context and food offering in Quebec public nursing homes, regardless of population type, was non-existent. Analyzing and interpreting the results by crossing the discourses of immigrant residents, their family and friends, and frontline care staff made it possible to reveal different aspects of the phenomenon, which, if considered together, shed light on the meal context in public nursing homes.

Facilitators and barriers to optimizing eating performance among cognitively impaired older adults: A qualitative study of nursing assistants' perspectives.

Cognitively impaired individuals are at increased risk for functional and behavioral difficulties at mealtimes, leading to compromised eating performance, low food and fluid intake, and negative functional and nutritional outcomes. Nursing assistants are the most critical front-line care staff and best positioned to manage the personal and environmental factors that influence resident eating performance. Identifying nursing assistants' perceptions of barriers and facilitators to engaging residents in eating will provide important experientially based foundation for developing and testing evidence-driven interventions to promote mealtime care. A qualitative descriptive study was conducted in three sites: two nursing homes and one hospital gero-psychiatric inpatient unit. Six focus groups were conducted with a purposive sample of 23 nursing assistants who regularly provided mealtime care to residents with cognitive impairment. Interview questions addressed barriers and facilitators at resident, caregiver, environmental (facility), and policy levels in optimizing mealtime care. Audio recordings of focus groups were transcribed and analyzed using qualitative descriptive content analysis. Both barriers and facilitators were organized into a hierarchical taxonomy based on similarities and differences framed by the Social Ecological Model. The majority of barriers and facilitators were at the caregiver level. Caregiver-level barriers included lack of preparation and training, competing work demands, time pressure, and frustration. Caregiver-level facilitators included caregiver preparation and motivational, technical, informational, and instrumental assistance. Environmental-level barriers and facilitators related to the physical, social, and cultural environment and facility practices. Only barriers to optimizing mealtime care were identified at resident and policy levels. Nursing assistants identified multilevel barriers as well as a wide range of caregiver and environmental facilitators to optimizing dementia mealtime care. Findings can inform the development and implementation of multifaceted innovative mealtime assistance and staff training programs to promote resident eating performance while fostering person-centered individualized mealtime care practice.

Sexual Situations in Spanish Long-Term Care Facilities: Which Ones Cause the Most Discomfort to Staff?

This study aimed to explore which kinds of residents’ sexual expressions cause the most discomfort to staff and to determine the situational circumstances that might be related to this perception of discomfort. The sample was made up of 1895 front-line care staff employed at 152 Spanish long-term care facilities. Participants’ answers to an open-ended question regarding the sexual situation that caused them the most discomfort were content-analyzed. Results showed that most participants were able to mention at least one sexual situation that had caused them discomfort. Moreover, the range of sexual situations mentioned by our participants clearly goes beyond the typical behaviors associated with inappropriate sexual behaviors in dementia. Situational circumstances were related to participants’ perception of discomfort. Our results suggest the importance of including sexual issues on the formal training of staff and developing explicit guidelines and institutional policies regarding sexual expression in long-term care facilities.

Accounting for job satisfaction: Examining the interplay of person and situation.

In the present study, we investigate the interplay of personality traits (i.e., person) in frontline care staff in nursing homes and the way they relate to the residents (i.e., situation) to account for their job satisfaction. Participants completed a survey including Mini-IPIP tapping the five-factor model of personality, Individualized Care Inventory tapping four aspects of person-centered care and job satisfaction. The results revealed that staff scoring high on neuroticism experienced less job satisfaction. This relationship was partly accounted for by resident autonomy, suggesting that part of the adverse influence of neuroticism on job satisfaction may be mitigated by organizations providing a supportive care environment. In contrast, staff scoring high on agreeableness experienced higher job satisfaction. This relationship was accounted for by another aspect of person-centered care, that is, knowing the person. This suggests that agreeableness in a sense facilitated adjustment of acts of care toward the unique needs and preferences of residents and this partly explained why the more agreeable the staff was the more they felt satisfied at work. In sum, effects of personality traits on job satisfaction in care staff are partially mediated by the perception of working conditions and care policy and to the extent that a certain personality trait affects whether the staff have a positive or negative perception of the way they relate to the residents, they will experience, respectively, higher or a lower job satisfaction. This finding has implications for how to combine a focus on delivering person-centered care with improving personal job satisfaction.