Reality or a Dream: Barriers and Facilitators for Nursing Assistants Pursuing a Nursing Career

Abstract Certified nursing assistants (CNAs) serve a critical role in the care of older adults. However, CNAs often experience significant professional and personal burdens related to caregiving work. Professionally, CNAs experience exorbitant workplace stress (e.g., physical injury, burnout, emotional exhaustion, staffing shortages, turnover). Personally, CNAs may have only a high school education, are subjected to low-paying jobs, and little opportunity for career advancement. Further, CNAs are disproportionately of minority race. Clearly, CNAs are negatively impacted by many social determinants of health. Ultimately, these burdens negatively impact older adults’ care provision and quality of life. Transitioning to a nursing career may alleviate some of these complex problems, but this has scantly been explored. A qualitative descriptive study was designed to 1) identify interest in a nursing career, and 2) explore perceived barriers and facilitators of transitioning into a nursing profession. CNAs from nursing facilities participated in private, semi-structured interviews. Recorded interviews (n = 6) were transcribed verbatim. Preliminary thematic analyses yielded two overarching themes: The Dream and The Reality. Rich subthemes began emerging from both overarching themes. Example subthemes from The Dream were: family legacy in healthcare, and finding purpose. Example subthemes from The Reality were: versus (CNAs vs. nurses; nurses vs. nursing care), and work-life balance. These preliminary findings suggest that CNAs express desire in becoming a nurse, although a range of personal and professional barriers and facilitators exist. Making the nursing dream become reality may improve CNAs’ social determinants, workplace outcomes, and resident outcomes, but further exploration is warranted.

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SOCIAL FRAILTY IN RECENTLY RELOCATED SEMI-INDEPENDENT OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.3285 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S899-S899

Author(s):

Suzanne Dupuis-Blanchard ◽

Catherine Bigonnesse ◽

Danica Maillet ◽

Odette Gould ◽

Melissa Andrews ◽

...

Keyword(s):

Older Adults ◽

Social Determinants ◽

Continuum Of Care ◽

Structured Interviews ◽

Care Community ◽

The Social ◽

Qualitative Descriptive ◽

Demographic Surveys ◽

Study Participants ◽

The Impact

Abstract Although most older adults live outside of care institutions, not all seniors choose to live in traditional family homes. Among those who relocate, some relocate too early while others are pre-frail or frail when they relocate. Social frailty – the interaction between social vulnerability and frailty – could contribute to these untimely relocations. The goal of this study was to inform the concept of social frailty by examining a population of semi-independent older adults who recently relocated to a continuum of care community. The objectives of this study were to: 1) understand the influence of the social determinants of health on the relocation process; 2) explore whether relocation increases or reduces social frailty; and 3) measure the level of post-relocation frailty in study participants. This mixed method study combined semi-structured interviews on the relocation process, the frailty identification tool PRISMA-7, and socio-demographic surveys. Twenty-nine recently relocated seniors were recruited with the assistance of a Citizens' Advisory Committee along with advertisements, presentations, information booths, and word of mouth. Qualitative descriptive thematic analysis and descriptive statistical analyses were used to examine the relationship between frailty, socio-demographic variables and relocation. Findings indicated that several social determinants contributed to frailty and that relocation into a continuum of care community could mitigate some aspects of social frailty. A conceptual framework on the influence of social frailty on relocation is discussed. More research is needed to inform the concept of social frailty and to better understand the impact of social factors on frailty.

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Implementation and Long-Term Outcomes of Organisational Health Literacy Interventions in Ireland and The Netherlands: A Longitudinal Mixed-Methods Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16234812 ◽

2019 ◽

Vol 16 (23) ◽

pp. 4812 ◽

Cited By ~ 2

Author(s):

Marise Kaper ◽

Jane Sixsmith ◽

Louise Meijering ◽

Janine Vervoordeldonk ◽

Priscilla Doyle ◽

...

Keyword(s):

Older Adults ◽

Mixed Methods ◽

Health Literacy ◽

The Netherlands ◽

Implementation Fidelity ◽

Barriers And Facilitators ◽

Service Users ◽

Plain Language ◽

Structured Interviews

Organisational Health Literacy (OHL)-interventions are needed to overcome health inequality. OHL-interventions have successfully identified communication barriers at the organisational level, but evidence is limited on the extent to which this leads to sustainable organisational change. This study aims to assess the implementation fidelity, moderators (barriers and facilitators), and long-term impact of OHL-interventions in hospitals in Ireland and The Netherlands. We used a longitudinal mixed-methods approach to assess two similar OHL-interventions in one Irish and three Dutch hospitals. The OHL-interventions concerned the improvement of navigation and implementation of health literacy-friendly communication throughout organisations. Participants were 24 hospital employees and 40 older adults who use hospital services. At six, eight, and eighteen months, we assessed the level of implementation, barriers and facilitators, and impact through questionnaires and in-depth semi-structured interviews. After older adults and professionals had identified a number of communication problems, we found that professionals had successfully implemented OHL-interventions to promote navigation and comprehensible communication. Limited resources and variation in organisational structures and procedures were perceived as barriers to implementation. The participation of service users, leadership support, and a stepwise implementation of interventions were perceived to facilitate implementation. In the long term, the OHL-interventions led to system-wide improvements, as shown by better embedding of health literacy policies, enhanced patient engagement, provision of plain language training and comprehensible information. Findings were similar for the two countries. Embedded OHL-interventions resulted in sustainable and system-wide health literacy changes in all four hospitals. Following implementation, OHL-interventions have the potential to promote health equity and empowerment among health service users.

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0839 Napping Stigma Among Frail Older Adults: Reflections from a Qualitative Study

SLEEP ◽

10.1093/sleep/zsaa056.835 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A319-A320

Author(s):

A S Berkley ◽

P A Carter

Keyword(s):

Older Adults ◽

Memory Consolidation ◽

Early Stage ◽

Qualitative Interviews ◽

Self Report ◽

Structured Interviews ◽

Younger Adults ◽

Daytime Sleep ◽

Qualitative Descriptive ◽

Descriptive Approach

Abstract Introduction Napping and other daytime sleep is often overlooked in insomnia research and poorly defined in many studies. Research has shown some correlations between older adults’ napping habits and increased medical co-morbidities and risks of dementia, but it has also shown that napping enhances memory consolidation and broader aspects of cognition in younger adults. Where along the aging spectrum this line between beneficial napping and potentially risky napping falls is not clear. Methods This study employed a qualitative descriptive approach in which semi-structured interviews (N=18) were supplemented by the widely used self-report instruments and anxiety scales. Results Insomnia in these older adults directly resulted in reduced energy and stamina, poor mood, and reduced functional capacity. Indirect effects included reduced social interaction and increased isolation. Several participants reported napping in qualitative interviews but denied daytime sleep on standard sleep assessments, and associated napping with anxiety and dread of functional and cognitive decline. Planned or intentional napping was viewed with guilt and denial, while dozing off accidentally was considered an acceptable coping strategy. Conclusion While research about the relationships between disordered sleep and cognitive impairment is still at an early stage, it seems ironic that the participants in this study stigmatized planned napping, which could potentially benefit their cognitive functioning, but seemed accepting of accidental napping, which may well indicate some more serious cognitive issues. More education about sleep needs for older adults is needed. Support I am grateful to the Longhorn Village chapter of Texas Exes for their Gerontology Nursing Scholarship, which helped to fund this project.

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Facilitators and barriers to optimizing eating performance among cognitively impaired older adults: A qualitative study of nursing assistants’ perspectives

Dementia ◽

10.1177/1471301218815053 ◽

2018 ◽

Vol 19 (6) ◽

pp. 2090-2113 ◽

Cited By ~ 8

Author(s):

Wen Liu ◽

Toni Tripp-Reimer ◽

Kristine Williams ◽

Claire Shaw

Keyword(s):

Focus Groups ◽

Psychiatric Inpatient ◽

Nursing Assistants ◽

Barriers And Facilitators ◽

Care Staff ◽

Care Practice ◽

Cognitively Impaired ◽

Increased Risk ◽

Wide Range ◽

Qualitative Descriptive

Background and Objectives Cognitively impaired individuals are at increased risk for functional and behavioral difficulties at mealtimes, leading to compromised eating performance, low food and fluid intake, and negative functional and nutritional outcomes. Nursing assistants are the most critical front-line care staff and best positioned to manage the personal and environmental factors that influence resident eating performance. Identifying nursing assistants’ perceptions of barriers and facilitators to engaging residents in eating will provide important experientially based foundation for developing and testing evidence-driven interventions to promote mealtime care. Methods A qualitative descriptive study was conducted in three sites: two nursing homes and one hospital gero-psychiatric inpatient unit. Six focus groups were conducted with a purposive sample of 23 nursing assistants who regularly provided mealtime care to residents with cognitive impairment. Interview questions addressed barriers and facilitators at resident, caregiver, environmental (facility), and policy levels in optimizing mealtime care. Audio recordings of focus groups were transcribed and analyzed using qualitative descriptive content analysis. Both barriers and facilitators were organized into a hierarchical taxonomy based on similarities and differences framed by the Social Ecological Model. Results The majority of barriers and facilitators were at the caregiver level. Caregiver-level barriers included lack of preparation and training, competing work demands, time pressure, and frustration. Caregiver-level facilitators included caregiver preparation and motivational, technical, informational, and instrumental assistance. Environmental-level barriers and facilitators related to the physical, social, and cultural environment and facility practices. Only barriers to optimizing mealtime care were identified at resident and policy levels. Conclusions Nursing assistants identified multilevel barriers as well as a wide range of caregiver and environmental facilitators to optimizing dementia mealtime care. Findings can inform the development and implementation of multifaceted innovative mealtime assistance and staff training programs to promote resident eating performance while fostering person-centered individualized mealtime care practice.

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“You’ve Got to Be Old to Go There”: Psychosocial Barriers and Facilitators to Social Eating in Older Adults

The Gerontologist ◽

10.1093/geront/gnz121 ◽

2019 ◽

Vol 60 (4) ◽

pp. 628-637 ◽

Cited By ~ 2

Author(s):

Anisa Saeed ◽

Jenny Fisher ◽

Zinnia Mitchell-Smith ◽

Laura J E Brown

Keyword(s):

Older Adults ◽

Gender Differences ◽

Barriers And Facilitators ◽

Physical And Mental Health ◽

Structured Interviews ◽

Framework Analysis ◽

Psychosocial Barriers ◽

Social Eating ◽

Design And Methods

Abstract Background and Objectives Social eating is associated with a range of physical and mental health benefits for older adults. Previous research has identified some of the practical barriers that may limit social eating, such as cost and access to public transport. However, little is known about the psychosocial issues that can affect older adults’ engagement with social eating. This study examines psychosocial barriers and facilitators to attending community-based social eating opportunities for older adults. Design and Methods Forty-two older people aged between 59 and 89 years living in Manchester, UK, participated in semi-structured interviews or focus groups about their experiences and perceptions of social eating opportunities. Interview transcripts were analyzed using inductive thematic analyses. As there are known gender differences in relation to attitudes and behaviors relating to food and social activities, a framework analysis was applied to explore how these themes were differentially expressed by gender. Results Four themes were identified that related to the importance of (a) offering more than food; (b) participants’ social identity; (c) taking the first step; and (d) embarrassment and self-consciousness about physical health. Gender differences related to perceptions of the relevance and attractiveness of social eating, and the role of social support. Discussion and Implications This study improves our understanding of older adults’ social eating experiences and highlights clear strategies by which social eating opportunities could be made more attractive, accessible, and acceptable to older adults.

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Barriers to and facilitators of endorsement for scheduled medicines in podiatry: a qualitative descriptive study

Journal of Foot and Ankle Research ◽

10.1186/s13047-021-00457-9 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Kristin Graham ◽

Helen A. Banwell ◽

Ryan S. Causby ◽

Saravana Kumar ◽

Esther Jie Tian ◽

...

Keyword(s):

Role Models ◽

Financial Incentive ◽

Sampling Strategy ◽

Barriers And Facilitators ◽

Training Process ◽

Structured Interviews ◽

Training Requirements ◽

Qualitative Descriptive ◽

Extrinsic Motivators ◽

Training Opportunities

Abstract Background Australian podiatrists and podiatric surgeons who have successfully completed the requirements for endorsement for scheduled medicines, as directed by the Podiatry Board of Australia, are eligible to prescribe a limited amount of schedule 2, 3, 4 or 8 medications. Registration to become endorsed for scheduled medicines has been available to podiatrists for over 10 years, yet the uptake of training has remained low (approximately 2% of registered podiatrists/podiatry surgeons). This study aimed to explore barriers to and facilitators of engagement with endorsement for scheduled medicines by podiatrists. Methods Qualitative descriptive methodology informed this research. A purposive maximum variation sampling strategy was used to recruit 13 registered podiatrists and a podiatric surgeon who were either endorsed for scheduled medicines, in training or not endorsed. Semi-structured interviews were employed to collate the data which were analysed using thematic analysis. Results Three overarching super-ordinate themes were identified which encompassed both barriers and facilitators: (1) competence and autonomy, (2) social and workplace influences, and (3) extrinsic motivators. Within these, several prominent sub-themes emerged of importance to the participants including workplace and social networks role in modelling behaviours, identifying mentors, and access to supervised training opportunities. Stage of life and career often influenced engagement. Additionally, a lack of financial incentive, cost and time involved in training, and lack of knowledge of training requirements were influential barriers. Rural podiatrists encountered a considerable number of barriers in most of the identified areas. Conclusion A multitude of barriers and facilitators exist for podiatrists as part of the endorsement for scheduled medicines. The findings suggest that a lack of engagement with endorsement for scheduled medicines training may be assisted by a more structured training process and increasing the number of podiatrists who are endorsed to increase the numbers of role models, mentors, and supervision opportunities. Recommendations are provided for approaches as means of achieving, and sustaining, these outcomes.

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GO Revisited: Qualitative Analysis of the Starting and Continuing Factors of GO Activity Among Older Adults

10.21203/rs.3.rs-1063655/v1 ◽

2021 ◽

Author(s):

Ai Iizuka ◽

Mari Yamashita ◽

Chiaki Ura ◽

Tsuyoshi Okamura

Keyword(s):

Older Adults ◽

Brain Activity ◽

Structured Interviews ◽

Community Based ◽

Human Relationships ◽

Peace Of Mind ◽

Board Games ◽

Living Well ◽

Qualitative Descriptive ◽

Descriptive Approach

Abstract Background GO is one of the most popular board games among older adults in Asian countries. Some studies have shown that playing GO helps maintain cognitive function and brain activity. However, the factors that facilitate older adults to start playing GO and their reasons for continuing it remain unclear. This study explored the starting and continuing factors of playing GO among older adults and found concrete methods for social implementation of GO activity aimed at the prevention of and living well with dementia. Methods In the field of large community-based interdisciplinary research, we conducted semi-structured interviews using a qualitative descriptive approach with six amateur GO players who began playing when they were 65 years or older. The contents of the interviews were the starting and continuing factors of playing GO. Results Six categories were generated for exploring the starting and continuing factors of playing GO. The participants felt motivated to start playing GO due to their interest and impression of GO and to cope with their anxieties about aging. The continuing factors represented feelings of pleasure and relaxation and fostering human relationships through GO. Age-friendly staff and user-oriented tasks were of particular importance in both starting and continuing to play GO. Conclusions GO is not just a board game; it is an effective tool in coping with aging issues, cultivating peace of mind, and facilitating interaction among people; therefore it may be useful to the community as a socially prescribed intervention. The keys to its implementation are fostering comfortable relationships between the participants and staff and allowing self-controlled task difficulty.

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Perceived Barriers to and Facilitators of Hypertension Management among Underserved African American Older Adults

Ethnicity & Disease ◽

10.18865/ed.25.3.329 ◽

2015 ◽

Vol 25 (3) ◽

pp. 329 ◽

Cited By ~ 16

Author(s):

Marylen Rimando, PhD

Keyword(s):

Older Adults ◽

Cardiovascular Health ◽

Perceived Barriers ◽

Barriers And Facilitators ◽

Self Management ◽

Health Clinic ◽

Hypertension Management ◽

The Social ◽

Qualitative Descriptive ◽

Diagnosis Of Hypertension

Objective: To understand the perceived barriers to and facilitators of hypertension self-management among underserved African American older adults in a southeastern clinic.Design: Qualitative descriptive.Setting: Urban cardiovascular health clinic in a southeastern state.Participants: 28 African Americans diagnosed with hypertension.Methods: Interview questions were focused on knowledge of hypertension management and barriers and facilitators to hypertension self-management. Thematic content analysis was applied.Results: Patients reported increased hypertension knowledge after attending the clinic. All patients reported knowledge of the severe consequences of uncontrolled hypertension. Perceived barriers to hypertension management included lack of money, lack of motivation to exercise, and fear of injury from exercising. Perceived facilitators of hypertension management included weight loss, unexpected diagnosis of hypertension, family members with hypertension and diabetes, and social support.Conclusions: Findings suggest that perceived barriers and facilitators influence a patient’s decision to manage hypertension. Findings suggest the importance of health literacy and patient-provider communication at this particular clinic. Possible factors in the social environment may influence hypertension management. This study adds to the literature by understanding the perceived barriers to and facilitators of hypertension management of an underserved sample in a southeastern clinic. The results suggest a need for the redesign and transformation of future hypertension education strategies aimed at this clinic sample. Ethn Dis. 2015;25(3):329-336.

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Barriers to and facilitators to endorsement for scheduled medicines in podiatry: a qualitative descriptive study

10.21203/rs.3.rs-129425/v1 ◽

2020 ◽

Author(s):

kristin graham ◽

Helen A Banwell ◽

Ryan S Causby ◽

Saravana Kumar ◽

Esther Jie Tian ◽

...

Keyword(s):

Role Models ◽

Financial Incentive ◽

Sampling Strategy ◽

Barriers And Facilitators ◽

Training Process ◽

Structured Interviews ◽

Training Requirements ◽

Qualitative Descriptive ◽

Extrinsic Motivators ◽

Training Opportunities

Abstract Background Australian podiatrists and podiatric surgeons who have successfully completed the requirements for endorsement for scheduled medicines, as directed by the Podiatry Board of Australia, are eligible to prescribe a limited amount of schedule 2, 3, 4 or 8 medications. Registration to become endorsed for scheduled medicines has been available to podiatrists for over 10 years, yet the uptake of training has remained low (approximately 2% of registered podiatrists/podiatry surgeons). This study aimed to explore barriers to and facilitators for engagement with endorsement for scheduled medicines by podiatrists. Methods Qualitative descriptive methodology informed this research. A purposive maximum variation sampling strategy was used to recruit 13 registered podiatrists and a podiatric surgeon who were either endorsed for scheduled medicines, in training or not endorsed. Semi-structured interviews were employed to collate the data which were analysed using thematic analysis. Results Three overarching super-ordinate themes were identified which encompassed both barriers and facilitators: (1) competence and autonomy, (2) social and workplace influences, and (3) extrinsic motivators. Within these, several prominent sub-themes emerged of importance to the participants including workplace and social networks role in modelling behaviours, identifying mentors, and access to supervised training opportunities. Stage of life and career often influenced engagement. Additionally, a lack of financial incentive, cost and time involved in training, and lack of knowledge of training requirements were influential barriers. Rural podiatrists encountered a considerable number of barriers in most of the identified areas. Conclusion A multitude of barriers and facilitators exist for podiatrists as part of the endorsement for scheduled medicines. The findings suggest that a lack of engagement with endorsement for scheduled medicines training may be assisted by a more structured training process and increasing the number of podiatrists who are endorsed to increase the numbers of role models, mentors and supervision opportunities. Recommendations are provided for approaches as means of achieving, and sustaining, these outcomes.

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Perceptions from Latino and African American Older Adults about Biological Markers in Research

Ethnicity & Disease ◽

10.18865/ed.25.3.355 ◽

2015 ◽

Vol 25 (3) ◽

pp. 355 ◽

Cited By ~ 3

Author(s):

Gerardo Moreno, MD, MSHS ◽

Carol M. Mangione, MD, MSPH ◽

Carlos E. Meza, BS ◽

Ivy Kwon, MPH ◽

Teresa Seeman, PhD ◽

...

Keyword(s):

Older Adults ◽

African American ◽

African Americans ◽

Focus Group ◽

Biological Markers ◽

Community Dwelling ◽

Barriers And Facilitators ◽

Research Approach ◽

Structured Interviews ◽

And Storage

Although older adult minorities face disparities in health and health care, they continue to be underrepresented in health research. Studies with biological markers of health often lack representation of older minority adults. The purpose of this study was to describe perceptions of biomarkers among ethnic minority seniors who might participate in studies of biological markers of health and to document barriers and facilitators to acceptance of biomarkers. Six focus groups (3 of Spanish-speaking Latinos and 3 of African Americans) were conducted in three community senior service organizations (two senior centers and one church). Ten semi-structured interviews were conducted to support and augment focus group data. Seventy-two community-dwelling minority older adults aged 62 years and older and 10 community stakeholders participated. A community-based partnered research approach was used and two community partners participated in the analysis and interpretation of results. Standard qualitative content-analysis methods were used to identify and organize themes in domains. Focus group participants were 49% Latino and 51% African American. Results included barriers: 1) mistrust, 2) fear of specimen collection/storage, 3) perceived harms, 4) competing demands, and 5) costs. Older Latinos cited issues of language as barriers to awareness and acceptance of biomarkers. African Americans had concerns over perceived harms of biomarkers. Facilitators to acceptance of biomarkers were community engagement through church and community leaders. Older Latino and African Americans identified many barriers and facilitators to the collection and storage of biomarkers. Participants identified community-partnered recommendations to overcome barriers to the acceptance, collection, and storage of biomarkers. Ethn Dis.2015;25(3):355-362.

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