Restricted accessResearch articleFirst published online 2019-11
The Influence of Supportive Supervisory Practices and Health Care Aides’ Self-Determination on the Provision of Person-Centered Care in Long-Term Care Facilities
Person-centred care (PCC) is recognized as best practice in long-term care (LTC). Using a cross-sectional design, we examined the relationship between supportive supervisory practices and health care aides’ (HCAs) self-determination on HCAs’ perceived ability to provide PCC. A total of 131 HCAs from four LTC facilities participated in the study. There were strong, positive associations between HCAs’ self-determination and their perceived ability to provide PCC, r = .59, p < .0001, and how supportive their supervisors were, r = .50, p < .0001. Mediation analysis using structural equation modeling found the direct effect of self-determination on PCC was 73% of its total effect on PCC; its indirect effect mediated through supervisory support was 27% of its total effect on PCC. Improving supportive supervisory relationships that encourage and enable HCAs’ self-determination in LTC settings may be an important and effective means by which to increase the provision of PCC.
AndersonR. A.IsselL. M.McDanielR. R.Jr. (2003). Nursing homes as complex adaptive systems: Relationship between management practice and resident outcomes. Nursing Research, 52, 12-21.
2.
BaardP. P.DeciE. L.RyanR. M. (2004). Intrinsic need satisfaction: A motivational basis of performance and well-being in two work settings. Journal of Applied Social Psychology, 34, 2045-2068.
3.
BaumeisterR. F.LearyM. R. (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117, 497-529.
4.
BenderD.LuiK. Y. G.HolyokeP. (2017). Five opportunities for healthcare leaders to better support person- and family-centred care in long-term care settings. Healthcare Management Forum, 30, 20-25.
5.
BlairC. E.GlaisterJ. A. (2005). Making the most of nursing homes’ number one resource. Health Care Management Review, 30, 110-115.
6.
BowersB. J.EsmondS.JacobsonN. (2000). The relationship between staffing and quality in long-term care facilities: Exploring the views of nurse aides. Journal of Nursing Care Quality, 14(4), 55-64.
7.
BowersB. J.EsmondS.JacobsonN. (2003). Turnover reinterpreted: CNAs talk about why they leave. Journal of Gerontological Nursing, 29(3), 36-43.
CasparS. (2014). The influence of information exchange processes on the provision of person-centred care in residential care facilities (Doctoral thesis). University of British Columbia, Vancouver, Canada.
10.
CasparS.O’RourkeN. (2008). The influence of care provider access to structural empowerment on individualized care in long-term-care facilities. The Journals of Gerontology, Series B: Psychological Sciences & Social Sciences, 63, S255-S265
11.
ChappellN. L.NovakM. (1992). The role of support in alleviating stress among nursing assistants. Gerontologist, 32, 351-359.
12.
ChappellN. L.ReidR. C.GishJ. A. (2007). Staff-based measures of individualized care for persons with dementia in long-term care facilities. Dementia, 6, 527-547.
13.
ColeD. A.MaxwellS. E. (2003). Testing mediational models with longitudinal data: Questions and tips in the use of structural equation modeling. Journal of Abnormal Psychology, 112, 558-577. doi:10.1037/0021-843X.112.4.558
14.
de CharmsR. (2013). Personal causation: The internal affective determinants of behavior. Hoboken, NJ: Routledge.
15.
DeciE. L.ConnellJ. P.RyanR. M. (1989). Self-determination in a work organization. Journal of Applied Psychology, 74, 580-590.
16.
DeutschmanM. (2001). Redefining quality and excellence in the nursing home culture. Journal of Gerontological Nursing, 27(8), 28-36.
17.
DotyM. M.KorenM. J.SturlaE. L. (2008). Culture change in nursing homes: How far have we come? Findings from the Commonwealth Fund 2007 National Survey of nursing homes. New York, NY: The Commonwealth Fund.
18.
EstabrooksC. A.SquiresJ. E.CarletonH. L.CummingsG. G.NortonP. G. (2015). Who is looking after mom and dad? Unregulated workers in Canadian long-term care homes. Canadian Journal on Aging, 34, 47-59. doi:10.1017/S0714980814000506
19.
FazioS. (2008). Person-centered care in residential settings: Taking a look back while continuing to move forward. Alzheimer’s Care Today, 9, 151-161.
20.
GagnéM.DeciE. L. (2005). Self-determination theory and work motivation. Journal of Organizational Behavior, 26, 331-362.
21.
HappM.WilliamsC. C.StrumpfN. E.BurgerS. G. (1996). Individualized care for frail elders: Theory and practice. Journal of Gerontological Nursing, 22(3), 6-9.
22.
HouserJ. (2003). A model for evaluating the context of nursing care delivery. Journal of Nursing Administration, 33, 39-47.
23.
KaneR. A. (1994). Ethics and the frontline care worker: Mapping the subject. Generations, 18(3), 71-74.
24.
KemperP.HeierB.BarryT.BrannonD.AngelelliJ.VaseyJ.Anderson-KnottM. (2008). What do direct care workers say would improve their jobs? Differences across settings. Gerontologist, 48, 17-25.
25.
KimS. K.ParkM. (2017). Effectiveness of person-centered care on people with dementia: A systematic review and meta-analysis. Clinical Intervention in Aging, 12, 381-397.
26.
LeoneD. (1995). The relation of work climate, higher order need satisfaction, need salience, and causality orientations to work engagement, psychological adjustment, and job satisfaction (Unpublished doctoral dissertation). University of Rochester, Monroe County, New York.
27.
MacKinnonD. P.LockwoodC. M.HoffmanJ. M.WestS. G.SheetsV. A. (2002). Comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7, 83-103.
28.
MarklandD.TobinV. J. (2010). Need support and behavioural regulations for exercise among exercise referral scheme clients: The mediating role of psychological need satisfaction. Psychology of Sport and Exercise, 11, 91-99.
29.
McGiltonK. S. (2002). Enhancing relationships between care providers and residents in long-term care: Designing a model of care. Journal of Gerontological Nursing, 28(12), 13-21.
30.
McGiltonK. S. (2010). Development and psychometric testing of the Supportive Supervisory Scale. Journal of Nursing Scholarship, 42, 223-232. doi:10.1111/j.1547-5069.2009.01323.x
31.
McGiltonK. S.ChuC.ShawA. C.WongR.PloegJ. (2016). Outcomes related to effective nurse supervision in long-term care homes: An integrative review. Journal of Nursing Management, 24, 1007-1026.
32.
McGiltonK. S.HallL. M.WodchisW. P.PetrozU. (2007). Supervisory support, job stress, and job satisfaction among long-term care nursing staff. Journal of Nursing Administration, 37, 366-372.
33.
MillerS. C.MillerE. A.JungH. Y.SternsS.ClarkM.MorV. (2010). Nursing home organizational change: The “culture change” movement as viewed by long-term care specialists. Medical Care Research and Review, 67(Issue 4, suppl.), 65S-81S.
34.
ParmeleeP. A.BowenS. E.RossA.BrownH.HuffJ. (2009). “Sometimes people don’t fit in boxes”: Attitudes toward the minimum data set among clinical leadership in VA nursing homes. Journal of the American Medical Directors Association, 10, 98-106. doi:10.1016/j.jamda.2008.08.004
35.
PurityM.McAuliffeE.OgennaU.HonoratiM.HenryM. (2017). The impact of supportive supervision on the implementation of HRM processes; A mixed-methods study in Tanzania. Health Systems and Policy Research, 4, Article 1. doi:10.21767/2254-9137.100066
36.
RayM. (2016). Person-centred care and dementia. In Chew-GrahamC. A.RayM. (Eds.), Mental health and older people (pp. 219-228). Switzerland: Springer.
37.
RyanR. M.DeciE. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55, 68-78.
38.
SchirmV.AlbaneseT.GarlandT. N. (1999). Understanding nursing home quality of care: Incorporating caregivers’ perceptions through structure, process, and outcome. Quality Management in Health Care, 8(1), 55-63.
39.
SPSS. (2013). IBM SPSS statistics for windows (Version 22.0). Armonk, NY: IBM.
40.
StataCorp. (2015). Stata statistical software: Release 14. College Station, TX: StataCorp LP.
41.
StoneR. I. (2001). Research on frontline workers in long-term care. Generations, 25(1), 49-57.
42.
StoneR. I.YamadaY. (1998). Ethics and the frontline long-term-care worker: A challenge for the 21st century. Generations, 22(3), 45-51.
43.
SuhonenR.ValimakiM.KatajistoJ. (2000). Individualized care in a Finnish healthcare organization. Journal of Clinical Nursing, 9, 218-227.
44.
TalericoK. A.O’BrienJ. A.SwaffordK. L. (2003). Person-centered care: An important approach for 21st century health care. Journal of Psychosocial Nursing and Mental Health Services, 41(11), 12-16.
45.
Tellis-NayakV.Tellis-NayakM. (1989). Quality of care and the burden of two cultures: When the world of the nurse’s aide enters the world of the nursing home. Gerontologist, 29, 307-313.
46.
Van den BroeckA.VansteenkisteM.De WitteH.SoenensB.LensW. (2010). Capturing autonomy, competence, and relatedness at work: Construction and initial validation of the Work-Related Basic Need Satisfaction Scale. Journal of Occupational and Organizational Psychology, 83, 981-1002. doi:10.1348/096317909x481382
47.
WagnerA.CollingJ. (1993). Resistance to change: Understanding the aides’ point of view. The Journal of Long Term Care Administration, 21(2), 27-30.
48.
WhiteR. W. (1956). Motivation reconsidered: The concept of competence. Psychological Review, 66, 297-333.
49.
WongC. A.CummingsG. G. (2007). The relationship between nursing leadership and patient outcomes: A systematic review. Journal of Nursing Management, 15, 508-521.
