Long Term Care

Nursing assistants (NAs) provide most hands-on nursing home (NH) care and have a large influence on the patient experience. Particularly, NAs may exert strong influence on patient experience scores within the “communication and respect” domain of the nursing home CAHPS instrument. The objective of this analysis was to examine NAs self-perception of their roles in the daily experience of NH patients. Semi-structured interviews were completed with 25 NAs from within 25 separate organizations. Interviews addressed communication, work experiences, and narratives describing pivotal patient interactions. Data were analyzed by the research team through a conventional inductive content analysis approach: coding all interviews, modifying the coding schema as needed, then discussing emergent codes to develop a consensus around findings. Six thematic categories with multiple sub-themes emerged: 1) providing person-centered care, 2) knowing the rules, 3) spanning boundaries, 4) defining caregiver identity, 5) building relationships, and 6) handling difficult moments. Respondents spoke of involving patients in care decisions and the importance of listening; “knowing the rules” of care, such as NA role boundaries when communicating or performing care, and saying “no” when asked to go beyond their scope of practice; serving as chief communicators with families, while staying within their role and not over-communicating; providing information to nurses and physicians; “knowing” their residents, and the importance of reading their nonverbal cues during difficult moments such as patient aggression or loss of dignity; and providing comfort or calm. A negotiation emerged between “knowing the rules” and “person-centered care” that is worthy of further investigation.