A view from the front lines: Perspectives of certified nursing assistants promoting autonomy among the elderly in long term care

Abstract

The purpose of this study was to explore the phenomenon of the "lived" experience of promoting choice and autonomy for the elderly in long term care facilities as experienced by Certified Nursing Assistants. Study participants included five CNAs who were employed in three nursing facilities on the Eastern Shore of Virginia. Participants were interviewed in different settings using a guided interview which was audiotaped. The interviews were transcribed and the resulting narratives were analyzed for data that was pertinent to the subject. Units of data were coded and organized, using the qualitative data analysis computer program QSR NUB.IST 3.0.4. Six category themes emerged from the data: (1) motivation, (2) environmental support and non-support, (3) resident characteristics, (4) the nursing process, (5) conflict, and (6) patient's rights. The results of the study indicated that the CNAs brought to their roles the positive attributes of affection and sympathy for the elderly. They described many strategies used for "mutual goal setting," and for ensuring that their clients received responsive, sensitive care. All participants expressed the belief that "there's always a way" to provide for resident's choice, even within the constraints of a regimented institutional setting. The CNAs were concerned about the stresses imposed on their work by environmental factors which included short-staffing, loss of teamwork, and inadequate educational preparation. They also described how resident safety and quality of life could be compromised by Patient's Rights requirements, even while maintaining that the right of elderly residents to autonomy should not be abridged.