No abstract

The current study reports on qualitative insights into the working conditions of personal support workers (PSWs) in long-term care (LTC) homes within the context of a person-centered communication training intervention. PSWs ( N = 39) employed at one of four LTC homes in southwestern Ontario, Canada, participated in a series of 1-hour focus groups before, during, and after a 2-week person-centered communication training program for formal caregivers of persons living with dementia (PLWD). Textual data from focus group conversations were coded and organized into themes following an interpretive description research design. Three overarching themes emerged related to the working conditions of PSWs in LTC: (1) dementia care is complex, (2) there is a lack of trained staff to provide person-centered dementia care, and (3) residents' families are not appropriately situated in residents' care circles. Four overarching themes emerged related to the impact of those working conditions: (a) PSW occupational burnout, (b) poor resident care, (c) frustrated and disengaged families, and (d) PSW job attrition. These findings offer LTC employers and administrators opportunities to ameliorate working conditions to better support person-centered dementia care. [ Research in Gerontological Nursing, 14 (5), 245–253.]

Tag questions are imperative, declarative, exclamative or interrogative statements that have been modified to include a question (e.g.., It is hot out, isn’t it?). Tag questions have been characterized as elderspeak because it suggests an expected response from the person with dementia, thus limiting his/her ability to make a decision independently. However, tag questions serve multiple functions in conversation. There is limited research on the multidimensional nature of tag questions in conversations between formal caregivers and their clients with dementia. Accordingly, the purpose of this study was to investigate the functions of tag questions used by formal caregivers in utterances coded as person-centered. Conversations (N= 87) between formal caregivers and a simulated person with dementia were video-recorded during a 5-minute care interaction involving morning care. Caregivers’ utterances were coded for the use of the following types of person-centered communication: recognition, negotiation, facilitation, and validation. During secondary data analysis, the person-centered utterances were analyzed for the use and function of tag questions. Conversational analyses revealed two broad functions of tag questions: gather information and facilitate a desired action. Tag questions used to gather information included the following specific functions: acknowledge response, establish common ground, state fact or opinion, initiate topic, conversational joking, state what is being done and questions. Tag questions that facilitated a desired reaction included the following specific functions: offers, advice and suggestions and requests and commands. Findings from the current study reveal that tag questions are not exclusively elderspeak and can be used to illicit conversation.

The self-efficacy beliefs of home care personal support workers (PSWs) play a crucial role in their professional competence and subsequent provision of quality care. Understanding the factors that influence self-efficacy of PSWs is critical to ensuring their job satisfaction and retention, and ultimately improving the quality of care provided to home care clients. Currently, there is a lack of literature exploring the factors influencing self-efficacy among home care PSWs who care for clients with dementia. Accordingly, the purpose of this study was to investigate the sources of self-efficacy for home care PSWs. Conventional content analysis of interviews with 15 home care PSWs yielded six categories of sources influencing self-efficacy: insufficient client information provided by employers, lack of supportive communication by employers, restriction of PSWs’ discretion and autonomy by employers, insufficient practical dementia-specific training, sufficient work experience with clients with dementia, and feedback from family caregivers. These findings call for a multi-pronged approach to enhance the self-efficacy of PSWs. In particular, these findings offer specific areas of improvement for employers on how to best support their PSWs. They also highlight the significant role of dementia-specific education and training for PSWs regardless of their experience in the field. Finally, the findings emphasize the importance of family caregivers in the home care context. Taken together, the study’s findings offer insights on how to best support PSWs and ensure stability in the dementia care workforce.

The current study assessed the impact of Be EPIC, an innovative, evidence-informed and theoretically-grounded 6-week person-centered communication intervention for personal support workers (PSWs) caring for persons with dementia. Be EPIC focuses on [E]nvironment contexts for using [P]erson-centered communication, while considering client relationships ([I] matter too), and [C]lients’ abilities, life history and preferences during routine care. A pre- post-Be EPIC comparative design included an intervention (n=13) and a 6-week waitlist control group (n=10) who completed the same communication-related questionnaire. A Two-Way Mixed ANOVA showed a significant group by time interaction for perceived communication skill (F(1, 21) = 4.67, p = .042, ηp2= .18). Simple main effects analysis showed that participants who completed Be EPIC reported feeling more confident in communicating with persons with dementia (Mpre = 13.46; SD = .76; Mpost = 16.31, SD = .85). There was no significant change in the control group. Similarly, there was a significant group by time interaction for perceived helpfulness of communication strategies (F(1, 21) = 6.23, p = .021, ηp2 = .23). Simple main effects analysis showed that participants who completed Be EPIC reported significant increases in the helpfulness of effective communication strategies (Mpre = 36.92; SD = 3.42; Mpost = 43.15, SD = 3.21), with no significant change among controls. Findings indicate that Be EPIC enhanced PSWs’ confidence in communicating with persons with dementia and enhanced their perception of the helpfulness of effective communication strategies.