This study's purpose was to contribute to the development of a theory of turnover by understanding how CNAs employed in long-term care facilities conceptualize the factors that cause them to leave their jobs. Using grounded dimensional analysis, the authors conducted in-depth interviews with CNAs currently and formerly employed by three nursing homes. The CNAs' perception that they are unappreciated and undervalued by the organizations for which they work contributes significantly to turnover. The origins of this perception lie in policies and practices that lead, CNAs to feel personally and professionally dismissed. The authors suggest how long-term care facilities might change their staffing and personnel policies to better demonstrate respect and appreciation, thus reducing turnover and enhancing the quality of work and care.
Research on staffing and quality of care in long-term care facilities confirms that adequate staffing levels are important to ensuring quality but few studies have examined how the two are linked. The research reported in this article used participant observation and indepth interviewing to explore how nurse aides (NAs) understand the link between staffing and quality. The findings show that NAs deem their relationships with residents to be the central determinant of quality of care as well as an important outcome in itself. Adequate staffing is essential to allowing NAs to nurture these relationships.
Primary care settings are the gateway through which the majority of Latinos access care for their physical and mental health concerns. This study explored the perspectives of primary care providers regarding their Latino patients, particularly, issues impacting their patients' access to and utilization of services. Interviews were conducted with eight primary care providers-and analyzed using consensual qualitative research methods. In addition, observations were conducted of the primary care setting to contextualize providers' perspectives. Providers indicated that care for Latinos was impacted by several domains: (a) practical/instrumental factors that influence access to care; (b) cultural and personal factors that shape patients' presentations and views about physical and mental health and treatment practices; (c) provider cultural competence; and (d) institutional factors which highlight the context of care. In addition to recommendations for research and practice, the need for interdisciplinary collaboration between psychology and medicine in reducing ethnic minority disparities was proposed.
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