Understanding the direct care workforce in nursing homes a study of life circumstances and organizational factors and their relationship to caring behaviors and knowledge
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Certified nursing assistants (CNAs) provide the majority of hands on care to frail older adults in nursing homes. Older nursing home residents often have physical and mental challenges that complicate caregiving. In addition, certified nursing assistants frequently receive low wages, which, along with related sociocultural issues, complicate their lives. This study sought to quantify those challenges and life events and to explore whether they had an impact on the way certified nursing assistant performed their jobs, specifically caring behaviors and knowledge of older adult mental health needs. CNAs (n=106) were recruited from a convenience sample of three Rochester, NY area nursing homes. Each participant completed a series of questionnaires including a demographics, the Life Events Checklist (Gray, Litz, Hsu, & Lombardo, 2004), the Nursing Home Survey on Patient Safety Culture (Sorra, Franklin, & Streagle, 2008), an adaptation of the Caring Behaviors Inventory, Short Form (Wu, Larrabee, & Putnam, 2006), and the Mary Starke Harper Aging Knowledge Exam (M-SHAKE) (Santo-Novak, Duncan, Grissom, & Powers, 2001). Results were that certified nursing assistants were mostly Black, had a high school education or equivalent, lived in poor neighborhoods, experienced high levels of potentially traumatic events, and supported multiple dependents. These factors were not quantifiably related to job outcomes. Specific organizational factors were related to knowledge scores. CNAs who were more satisfied with their organization's patient safety culture in the areas of training, teamwork, overall perceptions of safety, and handoffs scored lower on the knowledge instrument. While the hypotheses tested in this study were not supported, the data collected has implications for future research on nursing home care and certified nursing assistants. Future research should consider other job related impacts of potentially traumatic events on CNAs, organizational characteristics in the context of the caliber of the facility, and caring behaviors specific to CNAs.