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Quality of care in nursing homes fro...

Chung, Gawon.

Quality of care in nursing homes from the perspective of nursing assistants.

Record Type:	Electronic resources : Monograph/item
Title/Author:	Quality of care in nursing homes from the perspective of nursing assistants./
Author:	Chung, Gawon.
Description:	190 p.
Notes:	Source: Dissertation Abstracts International, Volume: 70-11, Section: A, page: 4453.
Contained By:	Dissertation Abstracts International70-11A.
Subject:	Gerontology. -
Online resource:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3384023
ISBN:	9781109470543

Quality of care in nursing homes from the perspective of nursing assistants.
Chung, Gawon.

Quality of care in nursing homes from the perspective of nursing assistants. - 190 p.

Source: Dissertation Abstracts International, Volume: 70-11, Section: A, page: 4453.

Thesis (Ph.D.)--University of California, Los Angeles, 2009.

The original purpose of this study was to explore nursing assistants' own conceptualizations about quality of care in nursing homes. By using qualitative research methods, I aimed to understand their "lived experiences" working in nursing homes and their attributed meaning to quality of care. The study employed a purposive and convenience sample of 21 nursing assistants working in eight skilled nursing facilities in the greater Los Angeles area. Study participants were recruited through the SEIU Local 434B, a long term care workers' union. In-depth and semi-structured interviews were used to collect data. Both the textual level analysis of open-coding and the conceptual level analysis of axial coding and focused coding were done complementing each other.

ISBN: 9781109470543Subjects--Topical Terms:

168436
Gerontology.

Quality of care in nursing homes from the perspective of nursing assistants.
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040 $a UMI $c UMI{me_controlnum}
100 1 $a Chung, Gawon. $3 1000007040
245 1 0 $a Quality of care in nursing homes from the perspective of nursing assistants.
300 $a 190 p.
500 $a Source: Dissertation Abstracts International, Volume: 70-11, Section: A, page: 4453.
500 $a Adviser: A.E. (Ted) Benjamin.
502 $a Thesis (Ph.D.)--University of California, Los Angeles, 2009.
520 $a The original purpose of this study was to explore nursing assistants' own conceptualizations about quality of care in nursing homes. By using qualitative research methods, I aimed to understand their "lived experiences" working in nursing homes and their attributed meaning to quality of care. The study employed a purposive and convenience sample of 21 nursing assistants working in eight skilled nursing facilities in the greater Los Angeles area. Study participants were recruited through the SEIU Local 434B, a long term care workers' union. In-depth and semi-structured interviews were used to collect data. Both the textual level analysis of open-coding and the conceptual level analysis of axial coding and focused coding were done complementing each other.
520 $a Care had two different meanings for nursing assistants; first, it meant a job comprised of specific care activities to be completed on time; and second, it meant a relationship to build and maintain with residents. Nursing assistants often had to choose care as a job over care as a relationship due to limited time and resources. However, the concept of care needs to be understood holistically because it entails both what nursing assistants do and how they build relationships with residents by what they do.
520 $a Good care was equal to the desirable outcomes of care activities, such as cleanliness, happiness, and comfort of residents. Only after nursing assistants mentioned good care as such outcomes, they talked about good care as a process emphasizing the importance of affection, patience, and respect toward residents. This pattern was found again when nursing assistants described how they perform specific care activities including feeding, bathing, and toileting. The way they described each care activity was rather mechanical and mainly focused on its outcomes.
520 $a Also, nursing assistants mentioned the need for patience the most, hinting that there is not much room for affection and respect toward residents in the actual care delivery. Nursing assistants' interpretation of good care at the organizational level revealed that they are encouraged to keep residents clean and neatly presented and not to get behind their schedule. It is clear that care as a job, in which outcomes are readily observable, is considered more important than care as a relationship, which is rather process oriented and hard to measure quantitatively in nursing homes.
520 $a Nursing assistants' views on good care can be better understood when we consider how nursing home regulation has influenced the organizational characteristics of nursing homes. Since a market mechanism of competition did not work to improve quality of care in nursing homes as expected, the state governments have enforced regulations on nursing homes by conducting annual inspections so that a minimum level of care must be delivered to residents or the government could refuse to reimburse the costs related to nursing home care.
520 $a However, linking reimbursement (financing) with regulation (quality assurance) has generated a dilemma because nursing homes have two clients: state government which directly reimburses the costs for nursing homes (mostly Medicaid eligible); and residents who are the actual consumers of the services provided by nursing homes. This political economy of nursing home industry has led nursing homes to adopt "dual" organizational goals. One is to protect and enhance residents' physical and mental well-being (transitive goal) and the other is to be recertified and maximize profits (reflexive goal). The high ratio of residents to nursing assistants is an example of the reflexive goal taking priority over the transitive goal, in the sense that in order to save costs nursing homes do not hire more nursing assistants.
520 $a Based on nursing assistants' own descriptions about nursing home surveys, it became clear that nursing home regulation shapes the way quality of care is interpreted by nursing homes and communicated to nursing assistants. Nursing home administrations tend to focus more on the achievement of the reflexive goal of passing the annual inspection and covering costs. In the same vein, they emphasize the importance of the outcomes of care activities which are readily observable for outsiders especially state regulators. As a result, nursing home workers would define good care primarily as the cleanliness and nice presentation of residents.
520 $a Thus, nursing home regulation seems to have lost some of its original intention while nursing home administrations interpret regulations into specific guidelines and require nursing home workers to follow them. My dissertation findings reveal that the mechanism of quality assurance in nursing homes has been only partly successful, so that nursing home workers experience clashes between their transitive and reflexive goals and this hinders the quality of care provided to residents. This suggests that there needs to be a better framework to measure quality of care encompassing both the visible outcomes and invisible processes of care activities.
590 $a School code: 0031.
650 4 $a Gerontology. $3 168436
650 4 $a Social Work. $3 182351
650 4 $a Health Sciences, Nursing. $3 1000006001
650 4 $a Sociology, Public and Social Welfare. $3 1000006346
690 $a 0351
690 $a 0452
690 $a 0569
690 $a 0630
710 2 $a University of California, Los Angeles. $3 170968
773 0 $t Dissertation Abstracts International $g 70-11A.
790 1 0 $a Benjamin, A.E. (Ted), $e advisor
790 $a 0031
791 $a Ph.D.
792 $a 2009
856 4 0 $u http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3384023