Factors impacting nursing assistants to accept a delegation in the acute care settings: A mixed method study.

AIMS: To investigate the experience of nursing assistants being delegated nursing tasks by registered nurses. DESIGN: Mixed method explanatory sequential design. METHODS: A total of 79 nursing assistants working in an acute hospital in Australia completed surveys that aimed to identify their experience of working with nurses and the activities they were delegated. The survey data were analysed using descriptive statistics. Interviews with 11 nursing assistants were conducted and analysed using Braun and Clarke's thematic analysis. Results were triangulated to provide a richer understanding of the phenomena. RESULTS: Most nursing assistants felt supported completing delegated care activities. However, there was confusion around their scope of practice, some felt overworked and believed that they did not have the right to refuse a delegation. Factors impacting the nursing assistant's decision to accept a delegation included the attitude of the nurses, wanting to be part of the team and the culture of the ward. Nursing assistants who were studying to be nurses felt more supported than those who were not. CONCLUSIONS: Delegation is a two-way relationship and both parties need to be cognisant of their roles and responsibilities to ensure safe and effective nursing care is provided. Incorrectly accepting or refusing delegated activities may impact patient safety. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Highlights the need for implementing strategies to support safe delegation practices between the registered and unregulated workforce to promote patient safety. IMPACT: Describes the experiences of nursing assistants working in the acute care environment when accepting delegated care from nurses. Reports a range of factors that inhibit or facilitate effective delegation practices between nurses and nursing assistants. Provides evidence to support the need for stronger education and policy development regarding delegation practices between nurses and unregulated staff. REPORTING METHOD: Complied with the APA Style JARS-MIXED reporting criteria for mixed method research. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Perception, behavior and experience of nursing assistants towards pain of older adults with dementia: A qualitative study.

Nursing assistants are strategically positioned to detect and interpret behavioral alterations indicative of pain in residents suffering from dementia. Despite this, extant literature is scarce regarding their experiences in administering pain care to this demographic. Utilizing a phenomenological approach, this study engaged 17 nursing assistants selected via purposive sampling for semi-structured interviews. Data analysed by the Colaizzi 7-step method. Four emergent themes were discerned: perception of pain; strategies for coping with pain; emotional and psychological responses to pain-related caregiving; challenges and needs in pain-related caregiving. Nursing assistants play a unique and crucial role in the identification of pain, reporting and providing feedback to healthcare professionals, and implementing non-pharmacological interventions. However, these roles have not been fully utilized. Enhancements in pain management could be facilitated by decreasing staff turnover, augmenting educational and training programs, and incorporating empathy-focused situational training. The provision of mental health services is also recommended to ameliorate caregiving-induced stress.

Burnout Among Nursing Home Care Aides and the Effects on Resident Outcomes.

While burnout among health care workers has been well studied, little is known about the extent to which burnout among health care workers impacts the outcomes of their care recipients. To test this, we used a multi-year (2014-2020) survey of care aides working in approximately 90 nursing homes (NHs); the survey focused on work-life measures, including the Maslach Burnout Inventory (MBI) and work-unit identifier. Resident Assessment Instrument Minimum Data Set (RAI-MDS 2.0) data were obtained on all residents in the sampled NHs during this time and included a unit identifier for each resident. We used multi-level models to test associations between the MBI emotional exhaustion and cynicism sub-scales reported by care aides and the resident outcomes of antipsychotics without indication, depressive symptoms, and responsive behaviors among residents on units. In 2019/2020, our sample included 3,547 care aides and 10,117 residents in 282 units. The mean frequency of emotional exhaustion and cynicism across units was 43% and 50%, respectively. While residents frequently experienced antipsychotics without indication 1,852 (18.3%), depressive symptoms 2,089 (20.7%), and responsive behaviors 3,891 (38.5%), none were found to be associated with either emotional exhaustion or cynicism among care aides.

Nursing assistants' perceptions and experiences with the emotional impact of providing palliative care: A qualitative interview study in nursing homes.

AIM: To gain insight into the perceived emotional impact of providing palliative care among nursing assistants in Dutch nursing homes, their strategies in coping with this impact and associated needs. DESIGN: Exploratory qualitative study. METHODS: In 2022, 17 semistructured interviews with nursing assistants working in Dutch nursing homes were conducted. Participants were recruited via personal networks and social media. Interviews were open-coded by three independent researchers following the thematic analysis approach. RESULTS: Three themes emerged regarding the elements that contribute to the emotional impact of providing palliative care in nursing homes: impactful situations (e.g. witnessing suffering and sudden deaths), interactions (e.g. close relationship and receiving gratitude) and reflection on provided care (e.g. feeling fulfilment or feeling inadequate in caring). Nursing assistants used different strategies to cope, including emotional processing activities, their attitude towards death and work and gaining experience. Participants experienced a need for more education in palliative care and organized peer group meetings. CONCLUSION: Elements that play a role in how the emotional impact of providing palliative care is perceived by nursing assistants can have a positive or negative impact. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nursing assistants should be better supported in coping with the emotional impact of providing palliative care. IMPACT: In nursing homes, nursing assistants are most involved in providing daily care to residents and have a signalling role in recognizing the deteriorating conditions of residents. Despite their prominent role, little is known about the emotional impact of providing palliative care among these professionals. This study shows that although nursing assistants already undertake various activities to reduce the emotional impact, employers should be aware of the unmet needs in this area and the responsibility they have in this regard. REPORTING METHOD: The QOREQ checklist was used for reporting. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

'Sometimes you need an eye-opener': A qualitative study on nursing assistants' experiences of developing communication skills through an educational intervention on person-centred communication.

AIM: To explore nursing assistants' (NAs') experiences of developing communication skills while participating in an educational intervention on person-centred communication. DESIGN: A descriptive qualitative study was conducted. METHODS: Data were collected from interviews and written assignments before, during and after an educational intervention on person-centred communication targeting NAs in home care services. The data were analysed using a phenomenological approach. A total of 25 NAs participated in the study. RESULTS: The findings describe NAs' experiences concerning the communication skills needed for building relationships with older persons and handling emotionally challenging situations. The educational intervention increased their knowledge and awareness of the importance of communication skills and how such skills are developed and refined.

Certified Nursing Assistants' Perspectives on Delirium Care.

The current descriptive qualitative study provides an in-depth understanding of the perspectives of certified nursing assistants (CNAs, N = 7) regarding delirium. Data were collected through interviews with seven CNAs working in a long-term care facility. Five themes emerged: Knowledge About Delirium, Caring for Residents With Delirium, Delirium Education, Psychological Burden, and Quality of Care. CNAs' care of residents with delirium was based on prior experiences and gut feelings, indicating a high need for delirium training. [Journal of Gerontological Nursing, 49(2), 43-51.].

An Online Mindfulness-based Intervention for Certified Nursing Assistants in Long-term Care.

Purpose: Certified nursing assistants (CNAs) make up the largest segment of the long-term care (LTC) setting workforce, however, they are at high risk of job dissatisfaction and burnout. Evidence suggests that mindfulness-based interventions (MBIs) might be particularly relevant and useful for CNAs in reducing psychological distress, improving job satisfaction, and reducing burnout, but little research has investigated this possibility. A feasibility study of an online MBI for CNAs in LTC settings was therefore conducted. Methods: CNAs completed assessments at baseline and posttest. Paired t-tests assessed changes in mindfulness, psychological distress (i.e., depressive and anxiety symptoms, and stress), and professional quality of life. Results: Of the 19 CNAs who started the intervention, N = 13 (68%) completed it and provided postintervention data. Depressive symptoms were significantly decreased postintervention (F = 6.26, p = .036, d = .47). Conclusions: MBIs may have beneficial effects for CNAs in LTC settings. Further research with a larger CNA population will increase the power and relevance of these findings, ultimately contributing to the improvement of patient outcomes in LTC.

The Association of Life Events Outside the Workplace and Burnout: A Cross-Sectional Study on Nursing Assistants.

BACKGROUND: Burnout, by definition, is related to adverse chronic workplace stressors. Life events outside the workplace have been associated with an increased risk of psychiatric morbidity. However, it is unknown whether life events outside the workplace increase the severity of burnout. PURPOSE: The aim of the study was to investigate the association between burnout and life events outside the workplace in nursing assistants. METHODS: In an observational, cross-sectional, single-site study of 521 nursing assistants at a university hospital, we assessed burnout with the Maslach Burnout Inventory-Human Services Survey, and life events with the Social Readjustment Rating Scale. We constructed equations of multiple linear regression analyses that included each burnout subscale as the dependent variable and a domain of life events as the independent variable. Results were adjusted for potential confounders, including gender, no religion or faith, years of work, and depression. RESULTS: An increase in the number of life events in the domain of personal changes or difficulties (e.g., personal injury or illness, sexual difficulties, change in recreation, church activities, social activities, sleeping habits, eating habits and revision of personal habits) was associated with increased severity of emotional exhaustion. An increase in the number of life events in the domain of changes in familial situation and in the domains of death of relatives or friends were associated with increased severity of depersonalization. Those associations were independent of work-related life events and other potential confounders. CONCLUSIONS: Life events outside the workplace may increase the levels of burnout in nursing assistants.

Nursing aides' mentalization, expressed emotion, and observed interaction with residents with dementia: A quasi-experimental study.

This study examined the associations between nursing aides' mentalization, expressed emotion, and observed sensitivity towards their residents with dementia. The study also explored whether nursing aides' mentalization and expressed emotion are relational constructs that vary with residents' characteristics and behavior. To assess mentalization and expressed emotion (i.e., criticism and positive comments), twenty nursing aides provided "Three Minutes Speech Samples" regarding two residents, one nominated by the head nurse as "difficult", and one nominated as "easy". Next, nursing aides were videotaped interacting with each of the two residents to assess their sensitivity and residents' engagement. Findings indicated that nursing aides' mentalization and positive comments were associated with their sensitivity. Nursing aides' mentalization and positive comments did not vary with residents' "easy" versus "difficult" nominations, but they were associated with residents' engagement. Results suggest training and supervision programs should involve efforts to improve nursing aides' mentalization skills and their ability to perceive their residents positively.

Perspectives of certified nursing assistants and administrators on staffing the nursing home frontline during the COVID-19 pandemic.

OBJECTIVE: To identify best practices to support and grow the frontline nursing home workforce based on the lived experience of certified nursing assistants (CNAs) and administrators during COVID-19. STUDY SETTING: Primary data collection with CNAs and administrators in six New York metro area nursing homes during fall 2020. STUDY DESIGN: Semi-structured interviews and focus groups exploring staffing challenges during COVID-19, strategies used to address them, and recommendations moving forward. DATA COLLECTION: We conducted interviews with 6 administrators and held 10 focus groups with day and evening shift CNAs (n = 56) at 6 nursing homes. Data were recorded and transcribed verbatim and analyzed through directed content analysis using a combined inductive and deductive approach to compare perceptions across sites and roles. PRINCIPAL FINDINGS: CNAs and administrators identified chronic staffing shortages that affected resident care and staff burnout as a primary concern moving forward. CNAs who felt most supported and confident in their continued ability to manage their work and the pandemic described leadership efforts to support workers' emotional health and work-life balance, teamwork across staff and management, and accessible and responsive leadership. However, not all CNAs felt these strategies were in place. CONCLUSIONS: Based on priorities identified by CNAs and administrators, we recommend several organizational/industry and policy-level practices to support retention for this workforce. Practices to stabilize the workforce should include 1) teamwork and person-centered operational practices including transparent communication; 2) increasing permanent staff to avoid shortages; and 3) evaluating and building on successful COVID-related innovations (self-managed teams and flexible benefits). Policy and regulatory changes to promote these efforts are necessary to developing industry-wide structural practices that target CNA recruitment and retention.

Leadership and Staff Perceptions on Long-term Care Staffing Challenges Related to Certified Nursing Assistant Retention.

OBJECTIVE: This study investigates practices that may help retain certified nursing assistants (CNAs) and address the staffing challenges faced in long-term care. BACKGROUND: CNAs are critical to quality care and retention has never been more challenging. To solve this staffing crisis, understanding the unique perspective of CNAs is imperative. METHODS: In semistructured interviews, 5 nursing assistants, the director of nursing, and the nursing home administrator at 59 long-term care facilities answered 4 questions, providing multiple perspectives about causes and solutions to CNA staffing challenges. RESULTS: Key responses for each stakeholder group were identified. CNAs highlighted the nature of the job as a bigger challenge than leadership recognized. Although pay is a top concern, emotional support, training, relationship-building, communication, and the work culture can be equally important in reducing turnover. CONCLUSION: When organizational leaders understand how to meet the needs and interests of CNAs, they can reduce turnover.

Emotional availability in dyads of nursing aide - resident with dementia: Old tool, new perspective.

OBJECTIVES: This study examined the emotional availability of nursing aide-resident with dementia dyads in a long-term care-facility. Emotional availability refers to the nursing aide's sensitivity toward the resident, structuring their interactions in a non-intrusive and non-hostile manner and the resident's responsiveness to and involvement of the nursing aide. The study evaluated the reciprocity in the emotional availability of nursing aides and the residents and examined whether emotional availability varies with the level of difficulty of taking care of the residents and with the context of the interaction. METHOD: The study was conducted in three wards in one long-term care-facility. Twenty nursing aides and 40 residents took part in the study. Each nursing aide was videotaped during feeding, structured and unstructured interactions, with two residents, one that was nominated by the head nurse as difficult to take care of and one that was nominated as easy to take care of. The interactions were coded using the emotional availability scales. RESULTS: Linear mixed-effect model analyses indicated that higher emotional availability of nursing aides was related to higher emotional availability of the residents. Nursing aides' emotional availability did not vary between "difficult" and "easy" residents or across the three interaction contexts. "Difficult" residents involved their nursing aides less than "easy" residents. DISCUSSION: The study documented the reciprocal nature of the interaction between nursing aides and residents with dementia. It suggests that nursing aides have an important role in promoting residents' responsiveness and involvement.

Rushing Care by Care Aides Associated With Experiences of Responsive Behaviors From Residents in Nursing Homes.

OBJECTIVES: Residents with cognitive impairment favor "slow care," so rushed care may cause additional responsive behaviors (eg, verbal threats, hitting) among residents. We assessed the association of rushed care (physical and social) by care aides with their experiences of responsive behaviors from residents. DESIGN: Cross-sectional analysis of survey data. SETTING AND PARTICIPANTS: A total of 3547 care aides (response rate: 69.97%) in 282 care units in a stratified random sample (health region, nursing home size, owner-operator model) of 87 urban nursing homes in Western Canada. METHODS: Data collection occurred between September 2019 and February 2020. The dependent variables were care aide self-report of 4 types of verbal and physical responsive behavior (yes/no). The independent variables were care aide self-report of rushed physical care (count, range = 0-6) and rushed social care (yes/no). We conducted a 2-level random-intercept logistic regression with each dependent variable, controlling for care aide, care unit, and nursing home characteristics. RESULTS: In their most recent shift, 2182 (61.5%) care aides reported having rushed at least 1 physical care task and 1782 (50.2%) reported having rushed talking with residents (social care task). When care aides rushed an additional physical care task, they had 8% higher odds of reporting having experienced yelling and screaming [odds ratio (OR) 1.08, 95% CI 1.01-1.15; P = .019]. When care aides rushed social care (talking with residents), they had 70% higher odds of reporting having experienced yelling and screaming (OR 1.70, 95% CI 1.28-2.25; P < .001). We observed the same pattern for the other types of responsive behaviors. CONCLUSIONS AND IMPLICATIONS: Rushing of physical or social care tasks by care aides was associated with increased likelihood of responsive behaviors from residents. One approach to reducing both rushed care and resident responsive behaviors may be to improve the care environment for care aides and residents.

Self-care appraisal in nursing assistant students: Adaptation, validation and psychometric properties of the Spanish ASAS.

The core implication of nursing professionals' labor is promoting self-care and foster well-being among healthcare service users. The beginning of the healing process starts with the provider, and self-care habits are needed to positively impact on patients' care outcomes at different spheres. Overall, current literature supports the idea that nurses' personal self-care should be a necessary skill to be expected in their professional role. In this regard, the Appraisal of Self-care Agency Scale (ASAS) is a worldwide known instrument aimed at assessing the ability to engage in self-care. However, it has never been tested in the Spanish context before, and much less in nursing practitioners or apprentices. The aim of this study was to translate, adapt and validate the ASAS for Spanish nursing apprentices, assessing its dimensionality, psychometric properties and convergent validity by means of the Sense of Coherence (SOC-13) questionnaire. METHODS: Data were collected from a random sample of 921 Certificated Nursing Assistant (CNA) Spanish students and was analyzed trough confirmatory factor analyses via structural equation models. The core ASAS construct and its subscales were correlated with the SOC-13 scores. RESULTS: Fair psychometric properties for the questionnaire were set. Also, SEM models endorse the validity and reliability of the four-factor dimensionality of the Spanish adaptation of the ASAS, whose associations to SOC scores were coherent and significant. CONCLUSION: This study allowed to establish that the Spanish version of the ASAS might be a useful tool for addressing self-care-related issues among nursing apprentices, a key population for promoting both their own and patients' health and welfare through healthy and care-related behaviors.

Impact of the COVID-19 Pandemic on the Mental Health of Nurses and Auxiliary Nursing Care Technicians-A Voluntary Online Survey.

Pandemics impose an immense psychological burden on healthcare workers due to a combination of workplace stressors and personal fears. Nurses and auxiliary nursing care technicians (ANCTs) are on the front line of this pandemic and form the largest group in healthcare practice. The aim of this study is to determine the symptoms of depression and/or anxiety among nurses and ANCTs during the periods known as the first wave (March-June) and second wave (September-November) of theCOVID-19 pandemic in Spain. An observational cross-sectional study was carried out using an anonymous, self-administered questionnaire among nurses and ANCTs practising in Spain. During the first period, 68.3% and 49.6% of the subjects presented anxiety and depression, respectively, decreasing in the second period (49.5% for anxiety and 35.1% for depression). There were statistically significant differences between the different categories and periods (p < 0.001). The COVID-19 pandemic has negatively influenced mental health in nurses and ANCTs. Mental health should be monitored and coping strategies promoted to improve the health, productivity and efficiency of these professionals.

Percepções de trabalhadores readaptados sobre o contexto de trabalho e riscos psicossociais organizacionais / Perceptions of readapted workers about work environment and organizational psychosocial risks / Percepciones de trabajadores readaptados sobre el contexto de trabajo y riesgos psicosociales organizacionales

Introdução: Os fatores psicossociais têm sido descritos como importantes agentes relacionados com o retorno ao trabalho, podendo ser facilitadores ou barreiras neste processo. Objetivo: Apreender as representações que trabalhadores readaptados têm das condições, organização e relações socioprofissionais do contexto de trabalho, onde foram alocados após readaptação, a fim de identificar possíveis fatores psicossociais organizacionais favoráveis ou desfavoráveis para eficácia deste processo Método: Trata-se de uma pesquisa de abordagem quantitativa, com natureza descritiva, segundo o tipo de pesquisa de levantamento. Para a coleta de dados, foi utilizada a Escala de Avaliação do Contexto de Trabalho (EACT) que possibilita a análise de três dimensões: Organização, Condições e Relações Socioprofissionais do Trabalho. Participaram deste estudo 23 trabalhadores, sendo 16 técnicos e 7 auxiliares de enfermagem atuantes em diferentes lotações de um hospital de ensino público. Resultados: Os dados da média bruta das três dimensões ficaram entre 2,3 e 3,69, o que indica um contexto crítico, considerado situação-limite. O contexto de trabalho apresenta aspectos que potencializam o mal-estar, colocando os trabalhadores em risco de adoecimento. Conclusão: Mediante a identificação dos elementos estressores, vê-se a necessidade de produzir ações no sentido de modificar aspectos do contexto de trabalho de modo a eliminar situações estressoras.

Introduction: Psychosocial factors, being facilitators or barriers, have been described as important agents related to return-to-work process. Goals: To understand the representations of the condition, organization and socio-professional relations in the work environment that readapted workers have after being re-allocated. In order to identify possible favorable or unfavorable organizational psychosocial factors for the effectiveness of this process. Method: A quantitative research, with descriptive nature, according to the type of survey. For data collection: We used the Work Environment Impact Scale (WEIS), which allows the analysis of three dimensions: Organization, Condition and Socio-professional labor relations. A total of 23 workers took part in this study, 16 technicians and 7 nursing assistants working in different parts of a public teaching hospital. Results: Data from the gross average of the three dimensions were between 2.3 and 3.69, which indicates a critical context, a limit situation.The work environment presents aspects that enhance malaise, creating a risk of illness for the workers. Conclusion: By identifying the stressful elements, it is possible to modify aspects of the work environment in order to eliminate stressful situations.

Introducción: Los factores psicosociales se han descrito como importantes agentes relacionados con el retorno al trabajo, pudiendo ser facilitadores o barreras en este proceso. Objetivo: Apreciar las representaciones que los trabajadores readaptados tienen de las condiciones, organización y relaciones socio profesionales del contexto de trabajo donde fueron asignados después de la readaptación a fin de identificar posibles factores psicosociales organizacionales favorables o desfavorables para la eficacia de este proceso Método: Se trata de una investigación de abordaje cuantitativa, con naturaleza descriptiva, según el tipo de investigación de estudio de caso. Para la recolección de datos se utilizó la Escala de Avaliação do Contexto de Trabalho (Evaluación de Contexto de Trabajo) que posibilita el análisis de tres dimensiones: Organización, Condiciones y Relaciones Socioprofesionales del Trabajo. Participaron de este estudio 23 trabajadores, siendo 16 técnicos y 7 auxiliares de enfermería actuantes en diferentes locales de un hospital de enseñanza pública. Resultados: Los datos del promedio bruto de las tres dimensiones se situaron entre 2,3 y 3,69; estos indicadores revelan un contexto clasificado como crítico, considerado situación límite. El contexto de trabajo posee aspectos que potencian el malestar, colocando a los trabajadores en riesgo de enfermedad. Conclusión: Mediante la identificación de los elementos estresores, se ve la necesidad de producir acciones en el sentido de modificar aspectos del contexto de trabajo para eliminar situaciones estresantes.

Self-compassion training for certified nurse assistants in nursing homes.

BACKGROUND/OBJECTIVES: Certified nursing assistants (CNAs) who work in nursing homes (NHs) face significant work and personal stress. Self-compassion training has been shown to decrease stress postintervention in previous studies among healthcare providers and those in helping professions. This study examines the feasibility, acceptability, and preliminary outcomes of self-compassion training to address CNA stress and well-being. DESIGN: Pre-post intervention. SETTING: Three mid-size, nonprofit NHs in North Carolina. PARTICIPANTS: Thirty CNAs, with a mean age of 49, 96% of whom were female, and 83% black/African American. INTERVENTION: In one NH, participants received an 8-week, 2.5-h/session (20 h total) group intervention. At the time of recruitment for NHs 2 and 3, a briefer format (6-week, 1-h/session; 6 h total) became available and was preferred by CNAs, thus both NHs 2 and 3 participants received a 6-h group intervention. All interventions occurred in meeting rooms within participating NHs during shift changes. MEASUREMENTS: Intervention attendance, retention, and acceptability; self-compassion, stress, burnout, depression, and attitudes toward residents with dementia, and job satisfaction pre-, post-, 3-month post-, and 6-month postintervention were assessed. RESULTS: Attendance and program satisfaction were high, and attrition was low for both training formats. Self-compassion was significantly improved at all time periods (p < 0.001), and stress and depression improved significantly through 3 months (p < 0.05), but not 6 months. No statistically significant change in job satisfaction was noted. CONCLUSION: Self-compassion interventions are feasible and acceptable for CNAs working in NHs and show promise for managing stress and improving well-being and compassion toward residents. The briefer 6-h format may maximize participation, while still providing benefits.

Certified Nursing Assistants' Perceived Workplace Violence in Long-Term Care Facilities: A Qualitative Analysis.

BACKGROUND: Certified nursing assistants (CNAs) provide 80% to 90% of direct care and are 23 times more likely to experience aggressive behavior from residents in long-term care (LTC) facilities than in other health care settings. The purpose of this study was to describe CNAs' perceptions of workplace violence while working in LTC facilities. METHODS: Ten CNAs were recruited from five LTC facilities through snowball sampling. A semi-structured interview was conducted with CNAs currently working in LTC facilities in Alabama. Question domains included (a) demographics, (b) residents' behavior, (c) behavior of residents with dementia, (d) experiences of verbal or physical violence from residents, (e) quality of care delivered, (f) coping strategies, (g) administrative support, and (h) training for dementia-related care challenges. The resulting transcripts were thematically analyzed. FINDINGS: CNAs described workplace violence as part of the job. They expressed a lack of administrative support as inadequate communication and a dismissal of violence against them. They regularly experienced racially charged abuse, but the perception of abuse was moderated by the presence or absence of dementia. They described a lack of training and direction to recognize and de-escalate workplace violence. CONCLUSIONS/APPLICATION TO PRACTICE: Workplace violence from residents residing in LTC facilities is an occupational health risk for CNAs. LTC facilities need a multisystem approach to reduce episodes of resident-on-CNA violence. This approach should include comprehensive training to recognize triggers of violent behavior, especially when working with individuals with dementia, as well as administrative support, and mental health resources to address the cumulative and negative consequences of racism.

Assessing knowledge and skills of maternity care professionals regarding neonatal hyperbilirubinaemia: a nationwide survey.

BACKGROUND: Neonatal hyperbilirubinaemia is a physiologic phenomenon, but, when severe, may cause lifelong disability. Maternity care assistants (MCAs) play an important role in timely recognition of severe neonatal jaundice. We assessed knowledge and skills of MCAs regarding neonatal hyperbilirubinaemia. METHODS: All Dutch MCAs (n = 9065) were invited to fill out a questionnaire assessing knowledge, expertise, and handling of neonatal jaundice. Additionally, we developed an e-learning and provided training sessions to a subgroup of MCAs (n = 99), and assessed their knowledge on neonatal hyperbilirubinaemia before and after the training. RESULTS: One thousand four hundred sixty-five unique online questionnaires were completed (response 16.2%). The median number of correctly answered knowledge questions was 5 (out of six; IQR 1). Knowledge was significantly better when respondents had had in-service training on neonatal hyperbilirubinaemia in the previous year (p = 0.024). Although 82% of respondents felt highly skilled or skilled to assess jaundice, accuracy of estimation of total serum bilirubin levels by assessing skin colour was generally poor and prone to underestimation. Among participants attending a training session, those who completed the e-learning beforehand had higher pre-training scores (5 (IQR 1) vs. 4 (IQR 2); p < 0.001). The median post-training score was higher than pre-training (6 (IQR 1) vs. 5 (IQR 2); p < 0.001). CONCLUSIONS: Background knowledge of MCAs regarding neonatal hyperbilirubinaemia was adequate, but can be improved by further training. Estimation of total serum bilirubin levels based on skin colour was often inadequate. Approaches to improve timely recognition of jaundiced neonates are needed.