Page 559 - Encyclopedia of Nursing Research

526 n UnLIcenSeD ASSISTIve PeRSOnneL

committees, job enhancement opportunities, self-direction, and an enhanced relation-
extent and kind of delegation, and the degree ship with the resident, the absence of fair
U of influence that aides have regarding res- wages and personal growth opportunities
ident care (Barry et al., 2005). Interestingly, could mute the presumed attractiveness of
there is a positive association between the a restructured job in keeping with culture
influence a nurse aide brings to the develop- change principles (Bishop et al., 2008).
ment of a resident’s plan of care and the level Individualized care, a precursor to the
of social engagement of the resident in facil- concept and practice of person-centered care
ity life (Barry et al., 2005). (Pcc)—a hallmark of the culture change
As part of the Better Jobs Better care movement—requires organizational struc-
demonstration project, a survey of almost tures and supports to be realized. nursing
3,500 UAPs working in home care, ALcs, home cnA’s perceptions about facilitators of
and nHs found that the recommendation for individualized care include supervisor sup-
increased compensation was statistically sig- port of cnA suggestions, their interest and
nificant for all three groups (n = 1,091; Kemper willingness to assist a cnA in trying a new
et al., 2008). Recommended improved work approach to care, and their being a resource for
relationships were statistically significant resident care issues (curry, Porter, Michalski,
with regard to communication, apprecia- & Gruman, 2000). Being able to provide indi-
tion, and supervision. When nH cnAs per- vidualized care also means that the cnAs
ceive that their job affords them autonomy, have to have the flexibility to change their
the opportunity to use their knowledge, and assignment or schedule and to fully partic-
work as a team, they are more committed to ipate in the development of the plan of care.
their job. This, in turn, has a positive effect on Barriers to individualized care are similar to
resident well-being and satisfaction (Bishop factors in cnA job dissatisfaction and turn-
et al., 2008). The quality of the relationship over: insufficient staff, inadequate education
between a UAP and his or her supervisor in clinical care, negative attitude, and poor
affects commitment. Having control over team communication.
their work and being able to use their knowl- A researcher-developed instrument to
edge can, however, be mishandled and per- assess the kind and amount of time cnA
ceived by the cnA as job expansion rather students spent providing Pcc—the Patient-
than job enhancement (Bishop et al., 2008). centered Behaviors Inventory (PcBI)—found
empowered cnA work teams—one of no difference between cnA students in the
the operational principles of culture change— intervention group (i.e., received special
can increase individual empowerment, instruction in Pcc) versus those in the con-
improve performance (and cooperation), trol group (i.e., no Pcc instruction; Grosch,
reduce sick calls and turnover, and improve Medvene, & Wolcott, 2008). Using trained
resident care and choices (yeatts & cready, coders and another researcher-developed
2007). cnAs in an empowered team gained instrument—the Global Behavior Scale—
decision-making skills and competence, as intervention cnA students were slightly
well as having the opportunity to provide more likely to be in a Pcc mode, but not sig-
feedback to their colleagues. The influence of nificantly. Residents were more satisfied with
empowered cnA work teams on job attitude their interactions with the intervention cnA
is mixed, however. nurse managers need students than with the control group stu-
education about team empowerment; what dents. The PcBI, drawing on the literature,
it means, what it does, communication and operationalized Pcc to include communica-
feedback, and the nature of accountability for tion that conveyed interest in the resident’s
team decisions. Given the positive potential of comfort, explaining the nursing task to be
culture change that includes empowerment, performed and asking permission to begin,