Personal Care Workers Research Articles

Compassion Fatigue Within Double Duty Caregiving: Nurse-Daughters Caring for Elderly Parents

This article examines compassion fatigue within double duty caregiving, defined here as the provision of care to elderly relatives by practicing nurses. Using qualitative data from our two studies of Canadian double duty caregivers, we identified and interviewed 20 female registered nurses whom we described as "living on the edge." The themes of context, characteristics, and consequences emerged from the findings. In this article, we argue that being both a nurse and a daughter leads to the blurring of boundaries between professional and personal care work, which ultimately predisposed these caregivers to compassion fatigue. We found that the context of double duty caregiving, specifically the lack of personal and professional resources along with increasing familial care expectations, shaped the development of compassion fatigue. Nurse-daughters caring for elderly parents under intense and prolonged conditions exhibited certain characteristics, such as being preoccupied and absorbed with their parents' health needs. The continual negotiation between professional and personal care work, and subsequent erosion of those boundaries, led to adverse health consequences experienced by the nurse-daughters. The study findings point to the need to move beyond the individualistic conceptualization and medical treatment of compassion fatigue to one that recognizes the inherent socio-economic and political contextual factors associated with compassion fatigue. Advocating for practice and policy changes at the societal level is needed to decrease compassion fatigue amongst double duty caregivers. In this article we review the compassion fatigue literature, report our most recent study methods and findings, and discuss our conclusions.

Health Workforce Remuneration Comparing Wage Levels, Ranking and Dispersion of 16 Occupational Groups in 20 Countries

This article focuses on remuneration in the Human Resources for Health (HRH), comparing wage levels, ranking and dispersion of 16 HRH occupations in 20 countries (Argentina, Belarus, Belgium, Brazil, Chile, Colombia, Czech Republic, Finland, Germany, India, Mexico, Netherlands, Poland, Russian Federation, South-Africa, Spain, Sweden, Ukraine, United Kingdom, United States). Research questions asked are to what extent are the wage rankings, wage dispersion, and standardized wage levels are similar between the 16 occupational groups in the HRH workforce across countries. The pooled data from the continuous, worldwide, multilingual WageIndicator web-survey between 2008 and 2011Q1 have been analysed (N=38,799). Hourly wages expressed in standardized USD, all controlled for PPP and then indexed to 2011 levels. The fi ndings show that the Medical Doctors have overall the highest median wages and they have so in 11 of 20 countries, while the Personal Care Workers have overall lowest wages and they have so in 9 of 20 countries. Health Care Managers lower earnings than Medical Doctors, but in 5 of 20 countries they have higher earnings (BLR, CZE, POL, RUS, UKR). The wage levels of Nursing & Midwifery Professionals vary largely across countries. The correlation of the overall ranking to the national ranking is more than .7 in 7 of 20 countries. The wage dispersion is defi ned as the ratio of the highest to the lowest median earnings in an occupation in a country. It is highest in Brazil (7.0), and lowest in Sweden, Germany, Poland, and Argentina. When comparing wage levels in occupations across countries, the largest wage differences for the Medical Doctors: the Ukraine doctor earns 19 times less compared to the US doctor. A correlation between country-level earnings and wage differentials across countries reveals that the higher the median wages in an occupation, the higher the wage difference across countries (r=.9). In conclusion, this article breaks new ground by investigating for the first time the wage levels, ranking and dispersion of occupational groups in the HRH workforce across countries. Findings illustrate that the assumption of similarity in cross-country wage ranking, wage dispersion, and purchasing power adjusted wage levels does not hold. These findings help to explain the complexity of migratory paths seen.

One-year predictors of turnover among personal-care workers for older adults living at home in Italy

ABSTRACTThis paper reports a study that aimed to identify the predictors of the turnover of privately-employed personal-care staff that provide community-dwelling older adults in Italy with assistance in the activities of daily living. The prospective cohort study enrolled 121 older adults (mean age 85.6 years) living at home, along with their personal-care workers and 107 informal carers. The older participants underwent a comprehensive geriatric assessment. At a one-year follow-up between May 2006 and June 2008, 12 of the older participants had been placed in a nursing home and 26 had died. Of the 83 still living at home, 22 had changed their personal-care staff (26.5% turnover). Multivariate logistic regression analysis identified one characteristic of the personal-care staff, living far away from their families (odds ratio (OR) 16.30, p=0.01), and two characteristics of the elders, namely being widowed (OR 0.09, p=0.01) and having cognitive impairment (OR 0.10, p=0.01), as one-year predictors of turnover and of the retention of personal-care workers, respectively. Further studies are needed both to evaluate whether immigration politics that enable family reconjunction would reduce the turnover of personal-care workers, and to investigate the lower turnover among personal-care staff caring for widowed elders and older adults with cognitive impairment.

The evolution of a new discourse for vocational psychology

Este artigo, discutindo acerca de questões próprias da psicologia vocacional, reflecte o percurso que a autora realizou ao longo da sua vida profissional. Esta reflexão perpassa três fases caracterizadas por três mudanças de linguagem e dos discursos: de carreira para trabalho; de trabalho para trabalho e relação; e da associação estreita entre a ideia de trabalho ligada especificamente ao Mercado de trabalho e o trabalho pessoal. São apresentadas, nessa sequência, as alterações que decorrem de cada uma das fases atrás enumeradas.

Validating a marking rubric for evaluating staff knowledge of dementia for competency in residential aged care

The shift to Vocational Education and Training (VET) for the training of the Australian residential aged care workforce has resulted in significant variance in the competencies at graduation of those caring for people with dementia. Competence may be also be enhanced, or conversely, decline over time as a result of implicit learning gained from workplace experience. Evaluating the skills and knowledge of the workforce is a challenge for supervisors. A single valid assessment tool that can evaluate staff knowledge across the competence continuum, from personal care workers to registered nurses, is required. An existing case study‐based summative test of knowledge was chosen to be used in conjunction with a newly‐developed marking rubric. The rubric was designed to differentiate between answers from different levels of staff. The assessment task and rubric were tested on a representative sample of the competent Australian residential aged care workforce with the appropriate skills mix. Evidence of the adequacy with which the test represents the national dementia‐care competency, the responses of test users to the problem‐solving content of the case study and the validity of the scores have been established. The validated scores were found to establish normal distributions, or ranks of knowledge for the different levels of staff. Potentially these permit the evaluation of the performance of groups of staff in residential aged care facilities against the distributions of scores.

Towards healthy professional-client relationships: The value of an interprofessional training course

Boundary violations that threaten professional-client relationships are rarely discussed at the coalface. There is an assumption that healthcare practitioners have the skills necessary to manage professional boundary dilemmas with clients. The issue, if addressed, is usually confined to discipline specific education and training. A one-day Professional Boundaries for Health Professionals (PBHP) training program was developed in response to real life practice dilemmas experienced by health practitioners across the continuum of care. The program was delivered to 109 participants throughout the state of Queensland, Australia, from government and non-government organizations. Participants were doctors, nurses, allied health (physiotherapists, occupational therapists, social workers, psychologists, dietitians, speech therapists), therapy assistants and personal care staff from a diverse range of hospital and community settings. Evaluations of PBHP suggest that the interprofessional learning context was valued with specific advantages identified in the use of adult learning approaches, the teaching of ethical decision making principles, the value of supervision and peer support and the opportunities provided for critical reflection. The effectiveness of training for healthcare practitioners in this area is discussed as a meaningful way of developing skills and engendering collaborative relationships between professional (e.g., occupational therapist, social worker) and paraprofessional (e.g., therapy assistant, personal care worker) groups. A combination of intensive training in professional boundaries and opportunities for ongoing professional development are important for all health practitioners.

Factors Associated with Life Satisfaction of Personal Care Workers Delivering Dementia Care in Day Care Centers

This study examined the overall life satisfaction of personal care workers (PCWs) delivering dementia care in elderly day care centers in Hong Kong. A total of 142 PCWs participated in the present study. Regression analysis results showed that self-efficacy in dementia care was a robust predictor for PCWs' life satisfaction. Female gender, perceived adequacy of training, low staff to client ratio, and high emotional support from colleagues predicted a high level of self-efficacy. To promote a higher level of life satisfaction among PCWs, it is essential for organizations to enhance their sense of self-efficacy. Providing PCWs with adequate training that address areas specific to their perceived needs is of utmost importance in achieving this goal.

High Performance Work Systems and Employee Experience of Work in the Service Sector: The Case of Aged Care

AbstractIn spite of the growing body of research on high performance work systems (HPWS), there is little evidence on their application in the service sector. It is commonly argued, however, that occupational segmentation in services is a barrier to HPWS. Analysis of data from aged‐care workers indicates that: HPWS have positive outcomes for workers; highly skilled nurses are no more likely than lowly skilled personal care workers to be subject to HPWS; and in some cases, HPWS are associated with more positive outcomes for low‐skilled than high‐skilled workers. These findings suggest that HPWS may well be widely applicable in service settings.

Self-Employed Workers Organize: Law, Policy and Unions

Over a million self-employed Canadians work every day but many of them are not entitled to the basic labour protections and rights such as minimum wages, maternity and parental leaves and benefits, pay equity, a safe and healthy working environment, and access to collective bargaining. The authors of Self-Employed Workers Organize offer a multi-disciplinary examination of the legal, political, and social realities that both limit collective action by self-employed workers and create huge impediments for unions attempting to organize them. Through case studies of newspaper carriers, rural route mail couriers, personal care workers, and freelance editors - four groups who have led pioneering efforts to organize - the authors provide a window into the ways political and economic conditions interact with class, ethnicity, and gender to shape the meaning and strategies of working men and women and show how these strategies have changed over time. They argue that the experiences of these workers demonstrate a pressing need to expand collective bargaining rights to include them.

A strategy to increase the palliative care capacity of rural primary health care providers

To pilot and evaluate an intervention aimed at increasing the palliative care capacity of primary health care providers in rural and remote communities. Pre- and post-workshop, and three months follow-up questionnaires. Four locations in Far North Queensland. One hundred and forty-nine primary health care providers ranging from personal care workers to general practitioners (GPs). Fourteen workshops were conducted. These were tailored to local palliative case loads facilitated by a specialist palliative care team from the Mt Olivet Hospice Service. Workshop content consisted of introductory didactic teaching based on participant-nominated topics, small group case management discussions and a session devoted to psychosocial and counselling inputs. Cost, GP reach, evaluation of educational and clinical objectives. Average cost per participant--excluding wages--was 271 dollars. Thirty-two per cent of local GPs attended the workshops and 93.2% of participants reported that the workshops had satisfied their educational learning objectives. Evaluation of GP clinical performance revealed significant improvements in confidence regarding palliative care knowledge and skill levels as well as the management of common palliative symptoms. Evaluation of other primary health care providers' clinical performance showed significant improvements in skills, management and rated knowledge. This intervention is relatively inexpensive, has reasonable reach and is effective as measured by educational and clinical outcomes.

Occupational Exposures and Asthma in 14,000 Adults from the General Population

The association of asthma with occupational exposures was studied in 14,151 adults, aged 25-59 years, from the general population of the 1975 French Pollution Atmospherique et Affections Respiratoires Chroniques (PAARC) Survey. Associations of asthma with specific jobs, such as personal care workers, waiters, and stock clerks, were observed, with age-, sex-, and smoking-adjusted odds ratios between 1.5 and 1.7. Exposures to 18 asthmagenic agents (low and high molecular weight and mixed environment) were estimated by an asthma-specific job exposure matrix. Risks associated with asthma increased when subjects with imprecise estimates of exposure were excluded. Risks increased further with increasing specificity of the definition of asthma when considering jobs or specific agents, such as industrial cleaning agents, latex, flour, highly reactive chemicals, and textiles. For example, for industrial cleaning agents, odds ratios increased from 1.55 (95% confidence interval (CI): 1.08, 2.23) for "ever asthma," to 2.17 (95% CI: 1.41, 3.34) for asthma onset after age 14 years, to 2.35 (95% CI: 1.38, 4.00) for asthma onset after beginning current job, and to 2.51 (95% CI: 1.33, 4.75) for asthma with airflow limitation. Results underlined the importance of the specificity of exposure and asthma definitions and indicated a deleterious role of occupational exposure on asthma, especially for cleaning agents.

Implications for training HACC personal care workers in complex care

Implications for training HACC personal care workers in complex care

Caring Together for Elderly Mothers: A Qualitative Study of Relations Between Adult Daughters and Supportive Home Care Workers

ABSTRACT This qualitative study examines relationships between adult daughters caring for elderly disabled mothers and the mothers' personal care workers (PCWs) paid directly by the Wisconsin Community Options Program (COP). A subset of a larger study, in these five cases PCWs provide substantial hands on care without substituting for the heavy care also provided by the daughters. Direct payment offers the daughters and workers freedom to schedule around their family obligations and other limits and tailor care to the abilities of all three participants. It also allows the daughter to be the paid provider when she chooses. Expansion of such supportive services could benefit many more low and middle income families.

Violence in the Workplace

This integrative review of research on workplace violence in Canada and the United States showed that risk factors for homicide and nonfatal assault injuries differed significantly. In 1993, there were 1,063 work-related homicides in the United States (Bureau of Labor Statistics, 1994). Workplace homicide was the second leading cause of fatal occupational injuries overall, but the primary cause for women. The highest risk for workplace homicide was observed among males, the self-employed, and those employed in grocery stores, eating and drinking establishments, gas service stations, taxicab services, and government service, including law enforcement. The majority of workplace homicides occurred during robberies. Unlike workplace homicide, the majority of nonfatal assaults that involved lost work time occurred to women, primarily employed in health care or other service sector work. The assault rates for residential care and nursing and personal care workers were more than ten times that of private non-health care industries. Minimal intervention research has been reported. In recent years, some governmental agencies and professional organizations have begun to address policy issues related to workplace violence.

Caring for profit: Alienation and work stress in nursing assistants in Canada

Abstract Personal care work in proprietary nursing homes was contrasted with similar work in non-profit long-term care facilities. One quarter of Manitoba long-stay beds are operated by proprietary (profit-making) institutions. In both types of home, the nursing assistants were younger women with children; essential wage earners for their families. Wages were low, but nursing assistants said they worked because they liked taking care of elderly people. Nursing home residents have cognitive and mobility impairments and need help with activities of daily living. The proportion of cognitively-impaired residents is higher in profit-making homes, and probably contributed to job pressure and workload, which were taken as markers of potential alienation experienced by these workers.

Reward Structures and Organizational Design

This article is concerned with the issues of motivation and control of nursing home personnel to increase their responsiveness to the needs of the elderly. The perspective taken is one of organizational analysis and, specifically, a consideration of the functions and dysfunctions of particular reward structures. The reward structures analyzed are (1) reimbursement schemes for homes in relation to the performance of home administrators and (2) supervisory arrangements for personal care workers in regard to the delivery of nonroutine services to patients. We point out some of the difficulties inherent in existing organizational structures and suggest modifications to increase the influence of patients and their relatives.

Domestic work count! Characteristics and transformations of the domestic service in Spain

This paper explores the characteristics of and transformations that Spanish domestic service has undergone in the since 2000. The paper also analyzes the domestic service’s contribution to the Spanish economy since the beginning of the country’s economic crisis. Relying on quantitative analysis of the domestic work data from the Active Population Survey, the most relevant changes identified are the increase of its demand and the consolidation of migrants workers in it. The paper also looks at the tasks carried out in the households of employers. The recent conversion of the domestic services in a nonprofessional care sector seems to mitigate the burden of personal care work that Spanish families aim to provide to their older relatives. This transformation of domestic work into care work has changed some traditional features of this occupation: the outcomes of qualitative data show changes in the intensification of the tasks carried out, a tendency to higher male workers, a reappearance of live-in workers, and key modifications in the relationship between employer families and employees. Finally, this paper incorporates a short assessment of Real Royal Decree 1620/2011 (which regulates domestic service) and Law 39/2006 (Law on the Promotion of Personal Autonomy and Care for Dependent Persons) to analyze which is the legal space delegate to the labor category related with the non-professional caregivers in private homes.