Original Study
Rushing Care by Care Aides Associated With Experiences of Responsive Behaviors From Residents in Nursing Homes

https://doi.org/10.1016/j.jamda.2021.10.017Get rights and content

Abstract

Objectives

Residents with cognitive impairment favor “slow care,” so rushed care may cause additional responsive behaviors (eg, verbal threats, hitting) among residents. We assessed the association of rushed care (physical and social) by care aides with their experiences of responsive behaviors from residents.

Design

Cross-sectional analysis of survey data.

Setting and Participants

A total of 3547 care aides (response rate: 69.97%) in 282 care units in a stratified random sample (health region, nursing home size, owner-operator model) of 87 urban nursing homes in Western Canada.

Methods

Data collection occurred between September 2019 and February 2020. The dependent variables were care aide self-report of 4 types of verbal and physical responsive behavior (yes/no). The independent variables were care aide self-report of rushed physical care (count, range = 0-6) and rushed social care (yes/no). We conducted a 2-level random-intercept logistic regression with each dependent variable, controlling for care aide, care unit, and nursing home characteristics.

Results

In their most recent shift, 2182 (61.5%) care aides reported having rushed at least 1 physical care task and 1782 (50.2%) reported having rushed talking with residents (social care task). When care aides rushed an additional physical care task, they had 8% higher odds of reporting having experienced yelling and screaming [odds ratio (OR) 1.08, 95% CI 1.01-1.15; P = .019]. When care aides rushed social care (talking with residents), they had 70% higher odds of reporting having experienced yelling and screaming (OR 1.70, 95% CI 1.28-2.25; P < .001). We observed the same pattern for the other types of responsive behaviors.

Conclusions and Implications

Rushing of physical or social care tasks by care aides was associated with increased likelihood of responsive behaviors from residents. One approach to reducing both rushed care and resident responsive behaviors may be to improve the care environment for care aides and residents.

Section snippets

Study Design

This cross-sectional analysis used care aide self-report survey data collected from September 2019 to February 2020.14 We follow STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) reporting guidelines here.24

Ethics

This study was approved by the University of Alberta Research Ethics Board (Pro00087578). Participating organizations provided operational approvals and care aide participants provided written informed consent.

Settings and Participants

Study sites were randomly selected from lists of

Results

Of the 3547 care aides in our sample, most were women (3165; 89.2%), aged ≥40 years (2478; 69.8%), and spoke English as a second language (2452; 69.1%). Most care aides had obtained a care aide certificate. They had an average of 6.2 years (SD = 6.3) of work experience on their current care unit. In their most recent shift, 2182 care aides (61.5%) reported having rushed at least 1 physical care task and 1782 (50.2%) reported having rushed talking with residents (social care task) (Table 2). In

Discussion

This is the first quantitative evidence associating rushing of care tasks by care aides with their experiences of verbal and physical responsive behaviors from nursing home residents, to our knowledge. In line with qualitative research about the negative impact of rushed care on both residents and staff,39,40 we found that when care aides rushed physical or social care tasks, they were more likely to experience responsive behaviors from residents, including yelling and screaming, verbal

Conclusions and Implications

Rushed care is common among care aides in Western Canadian nursing homes. Care aides commonly experience verbal and physical responsive behaviors from nursing home residents. Care aides who reported having rushed physical and social care also reported experiencing more responsive behaviors from residents.

Strategies that enable care aides to avoid rushed care may prevent resident responsive behaviors toward staff. Ensuring adequate staffing and care resources, and a favorable work environment,

Acknowledgments

Cathy McPhalen, PhD (thINK Editing Inc), provided editorial support in accordance with Good Publication Practice guidelines. Ruth Adjei-Donkor, MN, RN (Faculty of Nursing, University of Alberta), assisted with literature search. Both were funded by Carole Estabrooks’ Canada Research Chair, Ottawa, Ontario, Canada.

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    • Cited by (6)

    Funding was provided by the Canadian Institutes of Health Research, Canada and partners in the Ministries of Health in British Columbia, Alberta, and Manitoba (reference no. AHW FP13-580 TREC Estabrooks, BCPHSA Estabrooks), as well as regional health authorities in participating British Columbia and Alberta regions (reference no. FHA Estabrooks, WRHA TREC Estabrooks). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    The authors declare no conflicts of interest.

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