Commentary on Sung H‐C, Chang S‐M & Tsai C‐S (2005) Working in long‐term care settings for older people with dementia: nurses’ aides. Journal of Clinical Nursing 14, 587–593

Abstract

The intention of the team of the researchers is to explore factors affecting the decision of nursing aides in Taiwan to continue working in long-term care settings for older people with dementia. This paper is interesting because it provides an overview of the Taiwan government's regulations about staffing in long-term care, as well as an overview of the present situation concerning service provisions and challenges faced by health care providers in the local community.A high turnover in nursing aides when demand for longterm care workers is increasing is a major concern for longterm care settings not just in Taiwan, but also in many places of the world. This paper is useful in that it addresses a gap in the literature. Yet, the title needs to be modified as the contents do not seem adequately to reflect the intention of the paper. The paper focuses more generally on why care assistants stay in their jobs, not specifically about why they stayed on in a job looking after nursing homes residents with dementia.A major comment is about the design of the study methods. This study can be improved by identifying either an appropriate study site or the right participants. The study setting was a hospital-based nursing home in which 40% of the residents had been diagnosed with dementia or Alzheimer's disease. No mention was made of whether or not the facility has a specialized dementia unit. The inclusion criteria specified that those recruited to be part of the study sample needed to have been certified as a nursing aide, be taking care of residents with dementia, be working full-time and to have been in their current job for at least 18 months. Again, there was no indication of whether or not the participants were caring only for those with dementia. This poses a major problem for the researchers in ascertaining whether the participants' responses were mainly about the phenomenon of caring for older people with dementia, or about caring for older people in general. For future studies on staffing issues in dementia care, it is crucial to choose a study site that is specific to the population of concern, such as a special care unit in a residential care setting. The trustworthiness of the study's results will be enhanced if a specific setting and appropriate participants can be identified.The adoption of a qualitative approach in exploring a phenomenon entails the use of an open and unstructured or semi-structured questionnaire, which the authors have done.