"You don't want to get them agitated and you don't want them to think you don't care.": Observational insights into CNA performance in standardized care challenges

Background: Certified Nursing Assistants are indispensable in institutional long-term care, providing comfort and care to frail elderly. High-stress, low wage CNA jobs are generally held by women and increasingly by immigrant women. While immigrant status has been associated with perceptions of poor care, there were no studies examining the source of these perceptions or their validity.   This study used qualitative methods to examine factors that impact immigrant CNA quality of care.

Methods: A convenience sample of 32 immigrant CNAs provided brief responses to videos of nine care challenges involving a simulated nursing home resident in a “talk to the camera” design. CNAs rated the quality of care they provided in the responses in a recorded “think aloud” exercise. CNA experts viewed the CNAs’ responses to the care challenges and provided qualitative ratings of quality. Transcripts of the “think alouds” and CNA experts’ comments were analyzed using grounded theory methodology. Themes related to aspects of immigrant CNA care that impacted quality were identified.

Results: The eight themes that were identified included language use, orientation, giving choice, calling for help, assessing the situation, meeting psychosocial needs, lying/giving false reassurance and building relationships.

Conclusion: The results offer insight into factors associated with CNA care quality and confirm the need for ongoing CNA training opportunities for immigrant CNAs and suggest specific areas to target in CNA training.