Next Article in Journal
Respiratory Health and Urinary Trace Metals among Artisanal Stone-Crushers: A Cross-Sectional Study in Lubumbashi, DR Congo
Next Article in Special Issue
Nursing Home Residents Aged over 80—A Cross-Sectional Analysis on Which Activity Traits Correlate to Positive Affect
Previous Article in Journal
An Evacuation Simulation for Hazard Analysis of Isolation at Sea during Passenger Ship Heeling
Previous Article in Special Issue
Assessing Nursing Homes Quality Indicators’ between-Provider Variability and Reliability: A Cross-Sectional Study Using ICCs and Rankability
 
 
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Factors Affecting the Competence of Nursing Assistants in Taiwan Long-Term Care Institutions

1
Department of Health Services Administration, China Medical University, Taichung 40402, Taiwan
2
Department of Public Health, China Medical University, Taichung 40402, Taiwan
3
Department of Nursing, China Medical University Hospital, Taichung 40402, Taiwan
4
Taichung Hospital attached Nursing Home, Head Nurse Ministry of Health and Welfare, Taichung 40343, Taiwan
5
Department of Nursing and Health Care, Ministry of Health and Welfare, Taipei 11558, Taiwan
6
Department of Nursing, Asia University, Taichung 41354, Taiwan
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Int. J. Environ. Res. Public Health 2020, 17(24), 9413; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17249413
Submission received: 20 October 2020 / Revised: 3 December 2020 / Accepted: 10 December 2020 / Published: 15 December 2020
(This article belongs to the Special Issue Enhancing the Quality of Care in Long-Term Care Settings)

Abstract

:
With the increasing number of people with disabilities caused by an aging global population, the need for long-term care is gradually increasing. Nursing assistants (NAs) are the primary providers of direct care services to older adults with disabilities, whose knowledge, skills, and beliefs affect the quality of care provided. This study aimed to investigate the influential factors affecting NAs’ current competences. A total of 255 NAs’ valid questionnaires were collected from 20 long-term care institutions in Taiwan through convenience sampling. The questionnaire comprised dimensions of demographics and care competence. The study results indicated that NAs had the greatest care competence in the domain of recognition of patient rights (4.64 ± 0.54 points). The multiple regression indicated that age, religion, job category, disability care experience, the receiving of performance bonuses, and the receiving of year-end bonuses significantly affected the level of care competence (p < 0.05). With the aforementioned findings, the results of this study serve as references for the government in employing long-term care NAs and developing management policies. Training programs for NAs should be developed to improve the quality of care provided to older adults with disabilities.

1. Introduction

An aging population is a serious problem of global concern. According to statistics from the United Nations, 9% of people worldwide were >65 years old in 2019, and this figure is projected to increase to 16% by 2050 [1]. Taiwan’s society became an aged society in 2018, and it is estimated to become a super-aged society by 2026 [2]. Similar to other developed countries, Taiwan’s low total fertility rate has transformed family structures in Taiwan. Consequently, care functions from familial support have declined, and this has, in turn, increased the long-term care (LTC) needs and social burden in Taiwan. Therefore, the promotion of LTC has become an urgent policy matter in Taiwan and many other countries.
LTC types in Europe and North America involve assisted living facilities, skilled nursing facilities, continuing-care retirement communities, medical foster care, and home health care. However, institutional LTC in Taiwan includes LTC institutions, retirement homes, and nursing homes. Nursing assistants (NAs) account for 66%–70% of care manpower but are engaged in 80–90% of care work [3,4,5]. Therefore, NAs are an indispensable source of manpower for LTC institutions. Low wages, lack of good benefits, heavy workload, and lack of promotion channels are all restrictions on the personal and professional development of NAs [6]. In addition, the care competence of NAs is highly correlated with LTC quality [7,8,9,10].
Studies have indicated the importance of professional health care knowledge, efficient interpersonal communication techniques, and moral responsibility in ensuring that the care services rendered to older adults by NAs are of satisfactory quality [11,12]. NAs’ core care competences comprise knowledge on health care, care plan formulation, communication skills, cross-professional team care, safety, professional responsibilities, and ethics [13]. NAs are assistive personnel without formal academic certificates who must undergo training on body mechanics, nutrition, anatomy and physiology, cognitive impairments, mental health, infection control, and personal care skills [14,15]. A recent study indicated that NAs must possess the following care competences for professional and high-quality care: autonomy, daily functioning prevention of health problems, healthy aging and wellbeing, involvement of informal care, collaboration between professionals, and informal care [16]. However, a study indicated that education and training programs are not the primary determinants of NA care quality [17]. The development of leadership skills and services, including personal improvement, civic engagement, communication, and professionalism are also affecting factors [5]. By contrast, LTC institutional culture and LTC feedback to NAs regarding their work performance are the crucial determinants [18]. A recent study done in Australia reported that NAs did not improve in their care competences with experience; however, NAs with more than 5 years of work experience tended to exhibit a more positive work attitude [19].
As indicated in the aforementioned studies, the demand for NAs has been in increasing. NAs are the primary providers of direct care services to older adults with disabilities, and their knowledge, skills, and beliefs affect the quality of care provided. However, the literature on Asia has rarely explored the occupational competences of NAs. Therefore, the present study in Taiwan investigated (1) which critical care competences NAs must possess in providing care to individuals with disabilities and (2) the main factors affecting these care competences of NAs.

2. Materials and Methods

2.1. Study Design

This cross-sectional study identified prospective participants from 20 assisted living residences, retirement homes, and nursing homes through convenience sampling; these institutions were situated in Northern Taiwan (7 institutions), Central Taiwan (7 institutions), Southern Taiwan (4 institutions), and Taiwan’s outlying islands (2 institutions). Questionnaires were distributed in July 2019 to prospective participants. This study protocol was approved by the Institutional Review Board of China Medical University Hospital, Taiwan (CMUH107-REC2-166), with accreditation by the international association accreditation research protection programs (AAHRPP).

2.2. Sample and Setting

Participants had to satisfy the following inclusion criteria: they had to be (a) individuals with NA training qualifications obtained in Taiwan, (b) NAs who had cared for five or more older adults with disabilities, (c) NAs with >6 months of experience in caring for older adults with disabilities, and (d) lucid individuals who could complete the questionnaire and communicate in either Mandarin Chinese or Taiwanese Hokkien. Both Mandarin Chinese and Taiwanese Hokkien are native languages in Taiwan. Thus, there was no need for language translation in the study. In total, 269 NAs completed the questionnaire, and 255 of them provided valid questionnaires, for a response rate of 95%.

2.3. Measures

This study used structured questionnaires to collect data. NAs responded to the questionnaires independently. The demographic variables comprised sex, age, monthly salary, bonus, nationality, marital status, level of education, previous disability care experience, religion, education level, college major, nationality, job category, employment type, years of experience, and average hours worked daily. Care competence-related data were collected using the Perceived Caring Ability Assessment Scale of Nurse-Aides in Long-Term Care Facilities developed by Tsai (2013), who approved this study’s use of the scale [20]. This scale comprises six dimensions and 50 items. All items were scored on a 5-point Likert scale, with 1 representing strongly disagree and 5 representing strongly agree. The dimensions (and the number of items in them) are as follows: assistance in daily activities (13), medical professionalism (14), mental and spiritual care (14), professional ethics acknowledgment (4), health education and literacy (3), and recognition of patient rights (2). The Cronbach’s alpha of each dimension was between 0.81 and 0.96. After an expert validity analysis conducted by 10 experts, the content validity index of the scale was noted to be 0.92–0.95.

2.4. Statistical Analysis

Descriptive statistics were used to summarize distributions of NAs’ characteristics, including demographics, the types and characteristics of their workplaces, and the score of care competence. The differences between NAs’ demographics, the types and characteristics of their workplaces, and care competences were examined using a t test and analysis of variance (ANOVA). According to the sample size and related experts and scholars in Taiwan, the years of experience were categorized into <1, ≥1 and <3, ≥3 and <5, ≥5 and <10, and ≥10 years. The monthly salary of the study was divided into four groups according to the payroll bracket table of the National Health Insurance Administration, Taiwan. Moreover, after all other relevant variables were controlled for, and multiple regression was conducted to determine the crucial factors affecting NAs’ competences in caring for older adults with disabilities. IBM SPSS Statistics for Windows version 22.0 (IBM Corp., Armonk, NY, USA) was used to conduct statistical analysis. Statistical significance in this study was defined as p < 0.05.

3. Results

Table 1 presents the data on the participating NAs’ demographic characteristics and overall care competence level. The majority were female (86.3%) and married (60.8%). For the age variable, most participants were in the 31–40 year old group (28.6%), followed by the 41–50 year old group (25.1%). The ≥61 year old group was the smallest (7.5%). For level of education, 78% of the participants graduated from high school or above. Only 29.4% of the participants graduated in a health-related major. For job category, most of the participants worked in nursing homes (56.9%). Almost all of them were full-time workers (95.3%). The proportion of participants with 5 years of experience or longer reached 45.4%. Most of the participants worked an average of 8–12 h daily (76.9%). Only 39.6% of the participants had previous disability care experience. Among the participants, 69.4% had a monthly salary reaching NT$27,001 or above; 65.5% had been receiving work performance bonuses, and 78.8% had been receiving year-end bonuses. In terms of care competence, the participants with an age of 51–60 years, a native-Taiwanese nationality, 5 years of experience or more, previous disability care experience, work performance bonuses, and year-end bonuses exhibited greater care competences. The results reached statistical significance (p < 0.05).
Table 2 depicts the importance of NAs’ care competence domains to care for individuals with disabilities. The recognition of patient rights was the most important domain, followed by health education and literacy, professional ethics acknowledgment, assistance in daily activities, medical professionalism, and mental and spiritual care.
Table 3 presents the multiple regression results, which indicate the crucial factors affecting NAs’ competences in caring for older adults with disabilities in each domain. Relative to NAs aged 20–30 years, NAs aged 51–60 years had significantly greater care competence in the domains of assistance in daily activities (β = 0.22, p < 0.01), medical professionalism (β = 0.18, p = 0.02), and mental and spiritual care (β = 0.25, p < 0.01). Furthermore, compared with NAs without religion, NAs with the religion of Christianity/Catholicism (β = 0.26, p < 0.001) and Taoism (β = 0.20, p < 0.01) had greater care competence in the domain of recognition of patient rights. In the domain of professional ethics acknowledgment, NAs working in assisted living residences (β = 0.23, p = 0.04) and adult day-care centers (β = 0.20, p = 0.04) exhibited greater care competence compared with NAs working in retirement homes. NAs with ≥5 and <10 years of experience (β = −0.21, p = 0.02) and ≥10 years of experience (β = −0.19, p = 0.04) exhibited lower care competence.
NAs with previous disability care experience exhibited greater care competence levels in the domains of assistance in daily activities (β = 0.18, p < 0.001), medical professionalism (β = 0.18, p < 0.001), mental and spiritual care (β = 0.23, p < 0.001), and recognition of patient rights (β = 0.16, p < 0.01). Relative to those who did, NAs who were not receiving performance bonuses had lower care competence in the domain of professional ethics acknowledgment (β = –0.13, p = 0.04), and NAs who were not receiving year-end bonuses had lower health education and literacy (β = –0.18, p = 0.03).

4. Discussion

With the increasing number of people with disabilities caused by an aging global population, the need for long-term care is gradually increasing. NAs are the primary providers of direct care services to older adults with disabilities, and their knowledge, skills, and beliefs affect the quality of care provided. This study investigated (1) which care competences are crucial for NAs in caring for people with disabilities and (2) the main factors influencing these care competences. The results of the study indicate that NAs’ care competence was greatest in the domain of recognition of patient rights, followed by health education and literacy, but poorest in the domain of mental and spiritual care. The NA’s age, level of education, disability care experience, receiving performance bonuses, and receiving of year-end bonuses were correlated with their care competence.
Among the participating NAs who were taking care of older adults with disabilities, most were married women with a high school education or above. These demographic characteristics are similar to those noted in studies conducted outside of Taiwan [21]. However, this study’s participating NAs were mostly 31–60 years old and were thus older than their overseas counterparts. This is possibly because most of the NAs in Taiwan are those who made a mid-career change from hospital caring to LTC. Compared with hospital caring work, LTC work is more stable [22,23].
NAs had the greatest care competence in recognition of patient rights, followed by health education and literacy, whereas mental and spiritual care was the lowest. This is attributable to the emphasis, by the Taiwanese LTC policies and by assessments of LTC institutions, on 1) care recipients’ perspectives in requirements of older adult care quality and 2) the delaying of disability in care services. However, in Taiwan, patients bear the cost of LTC institutions’ services, which are not covered by public health insurance. The ratio of NAs and care recipients in LTC institutions are on the high side to reduce the cost of long-term care. The daytime care ratio of NAs to care recipients ranges from 1:10 to 1:15, and the night-shift care ratio ranges from 1:25 to 1:30. Considering these labor constraints, the patient rights, daily activities, and health education competence are prioritized to the neglect of mental and spiritual care. Moreover, the education and training of mental and spiritual care among the training programs for NAs in Taiwan should be strengthened. Studies have also suggested that NA education and training should emphasize older adults’ social and health care needs in the domains of autonomy, daily functioning, prevention of health problems, healthy aging, and collaboration with health care professionals [16,24]. The results of this study indicate that there is still room for improvement regarding the training programs of mental and spiritual care for NAs in Taiwan.
The participating NAs who were aged 51–60 years and who had disability care experience tended to have greater care competence in the domains of assistance in daily activities, medical professionalism, and mental and spiritual care. In general, more experienced LTC personnel provide better care [25,26]. A Norwegian study interviewed nurses in a nursing home; it indicated that the hospital admission rate among care recipients was influenced by the nursing home’s human resources, personnel deployment, and workers’ care competence [27]. NA care behavior affects the care recipient’s mental health [28,29,30]. More experienced NAs were found to be more emotionally competent [31]. Compared with their counterparts without care experience, NAs with care experience are more able to provide physiological, psychological, and spiritual care centered on care recipients, thereby improving their care quality. The participating NAs in this study who were receiving performance and year-end bonuses had greater care competence. This result is consistent with those of previous studies demonstrating that incentive policies increase NAs’ work satisfaction and care competence [32].
In Taiwan, there are currently about 30,000 NAs working in retirement centers and nursing home institutions in Taiwan. The nursing care training and qualification requirements of NAs are mostly 90 h (50 h core courses established by the Ministry of Health and Welfare of the Taiwan government, including training on body mechanics, nutrition, anatomy and physiology, cognitive impairments, mental health, infection control, hospice care, and personal care skills, etc.) and a 40 h practice course (10 h of demonstrations and 30 h of clinical practice). Taiwan’s Ministry of Education, following the government’s promotion of its long-term care program 1.0 starting in 2007, has facilitated NA training in colleges and universities. As of 2018, there are about 6530 graduates. However, the salary of NAs in Taiwan is relatively low (32,000 NTD/month or 1150 USD/Month), and institutions have difficulty retaining graduates, with only about 20 to 30% of graduates remaining in the elderly and disability care industry. Of the NAs in Taiwan (about 30,000 in 2019) more than 97% are qualified through the 90 h of training required under the Ministry of Health and Welfare Taiwan (MOHW). NA training courses include lectures, implementation, and clinical practice. Current training courses focus on physical care services. However, NAs simultaneously play the roles of caregiver, companion, and communicator in their provision of comprehensive physical and spiritual care to older adults. The Taiwanese government and related professional organizations should refer to European countries such as Denmark and Finland to nurture NAs or increase the number of theoretical and practical training hours for NAs as done in France, the UK, Australia, and Canada. They can also consider the Netherlands, the UK, and South Korea, where professional grading systems are implemented to enhance the care competence of NAs [33]. In addition to education and training, the professional acknowledgment and welfare of NAs in Taiwan are lower than those in other countries. Therefore, adequate incentives should be provided to increase the care competences of NAs. This study’s limitation lies in its use of convenience sampling, for reasons of limitations in time and resources. Although convenience sampling yields poorly generalizable results, the results are somewhat representative of Taiwan because the participants were from LTC institutions from many parts of Taiwan, specifically, Northern Taiwan, Central Taiwan, Southern Taiwan, and Taiwan’s outlying islands. The results of this study serve as references for the government in the recruitment of NAs for LTC and management policy development. Training programs for NAs should be developed to improve the quality of care provided to older adults with disabilities.

5. Conclusions

NA care competence was greatest in the domain of recognition of patient rights, followed by health education and literacy, but poorest in the domain of mental and spiritual care. The NA’s age, level of education, disability care experience, the receiving of performance bonuses, and the receiving of year-end bonuses were correlated with their care competence. The results of this study serve as references for the government in employing long-term care NAs and developing management policies. Training programs for NAs should be developed to improve the quality of care provided to older adults with disabilities. Future research could possibly seek to explore the difference between NAs receiving formal school education and those receiving the MOHW “Nursing Assistant training program” in the competence of disabled care in order to consider adjusting NA education and training content or duration.

Author Contributions

Conceptualization, S.-F.T. and S.-H.S.; Formal analysis, M.-Y.C. and T.-H.T.; Methodology, S.-F.T. and S.-H.S.; Writing—original draft, T.-J.C. and Y.-M.H.; Writing—review and editing, S.-H.S. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by the Ministry of Science and Technology, Taiwan (MOST 108-2410-H-039-007), and China Medical University, Taiwan (CMU109-MF-124).

Acknowledgments

Our special thanks to the Ministry of Science and Technology, Taiwan and China Medical University, Taiwan for providing administrative, technical, and funding support that has contributed to the completion of this study.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. United Nations. World Population Ageing 2019 Highlights. Available online: https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf (accessed on 30 May 2020).
  2. National Development Council Taiwan. Population Projections for Taiwan: 2018–2065. Available online: https://pop-proj.ndc.gov.tw/download.aspx?uid=70&pid=70 (accessed on 30 May 2020).
  3. Ministry of Health and Welfare Taiwan. Number of Workers in Elderly Long-term Care, Nursing and Caring Institutions. Available online: https://dep.mohw.gov.tw/DOS/np-3899-113.html (accessed on 30 May 2020).
  4. Brady, D.M. An Exploration of Nursing Assistants’ Perceptions about Job Satisfaction. Crit. Care Nurs. Q. 2016, 39, 371–386. [Google Scholar] [CrossRef]
  5. Gion, T.; Abitz, T. An Approach to Recruitment and Retention of Certified Nursing Assistants Using Innovation and Collaboration. J. Nurs. Adm. 2019, 49, 354–358. [Google Scholar] [CrossRef]
  6. Head, B.A.; Washington, K.T.; Myers, J. Job satisfaction, intent to stay, and recommended job improvements: The palliative nursing assistant speaks. J. Palliat. Med. 2013, 16, 1356–1361. [Google Scholar] [CrossRef]
  7. Hsieh, P.L.; Chen, C.M. Long term care nursing competence and related factors among Taiwanese nurses: A national survey for those who completed the LTC training course. Geriatr. Nurs. 2017, 38, 192–198. [Google Scholar] [CrossRef]
  8. Kroezen, M.; Schäfer, W.; Sermeus, W.; Hansen, J.; Batenburg, R. Healthcare assistants in EU Member States: An overview. Health Policy 2018, 122, 1109–1117. [Google Scholar] [CrossRef] [Green Version]
  9. Lang, L.; Orton, S.; Sallah, D.; Hewitt-Moran, T.; Zhang, D.; Cullen, S.; Dixon, S.; Bell, B.; Bell, D.; Meeson, L.; et al. A survey of engagement and competence levels in interventions and activities in a community mental health workforce in England. BMC Health Serv. Res. 2011, 11, 352. [Google Scholar] [CrossRef] [Green Version]
  10. Sales, A.E.; Bostrom, A.M.; Bucknall, T.; Draper, K.; Fraser, K.; Schalm, C.; Warren, S. The use of data for process and quality improvement in long term care and home care: A systematic review of the literature. J. Am. Med. Dir. Assoc. 2012, 13, 103–113. [Google Scholar] [CrossRef]
  11. Harahan, M.F.; Stone, R.I. Defining Core Competencies for the Professional Long-Term Care Workforce: A Status Report and Next Steps; American Association of Homes and Services for the Aging: Washington, DC, USA, 2009. [Google Scholar]
  12. Hedman, S.A.; Fuzy, J.L.; Rymer, S.A. Hartman’s Nursing Assistant Care: Long-term Care and Home Care; Hartman: Albuquerque, NM, USA, 2018. [Google Scholar]
  13. Acker, K.; Pletz, A.M.; Katz, A.; Hagopian, A. Foreign-born care givers in Washington State nursing homes: Characteristics, associations with quality of care, and views of administrators. J. Aging Health. 2015, 27, 650–669. [Google Scholar] [CrossRef] [PubMed]
  14. World Health Organization. Classifying Health Workers: Mapping Occupations to the International Standard Classification; World Health Organization: Geneva, Switzerland, 2010. [Google Scholar]
  15. Hoskins, A.B. Occupational Injuries, Illnesses, and Fatalities Among Nursing, Psychiatric, and Home Health Aides, 1995–2004; Bureau of Labor Statistics, U.S. Department of Labor: Washington, DC, USA, 2006.
  16. Oeseburg, B.; Hilberts, R.; Roodbol, P.F. Essential competencies for the education of nursing assistants and care helpers in elderly care. Nurse Educ. Today 2015, 35, e32–e35. [Google Scholar] [CrossRef]
  17. Hamers, J.; Van Rossum, E.; Peeters, J.; Rameckers, V.; Meijs, N. Ouderenzorg in Het Middelbaar Beroepsonderwijs. Een Inventarisatie Bij Zorgopleidingen (Niveau 2 en 3); Maastricht University: Maastricht, The Netherlands, 2012. [Google Scholar]
  18. Bowers, B.J.; Esmond, S.; Jacobson, N. The relationship between staffing and quality in long-term care facilities: Exploring the views of nurse aides. J. Nurs. Care Qual. 2000, 14, 55–75. [Google Scholar] [CrossRef]
  19. Karacsony, S.; Good, A.; Chang, E.; Johnson, A.; Edenborough, M. An instrument to assess the education needs of nursing assistants within a palliative approach in residential aged care facilities. BMC Palliat. Care 2019, 18, 61. [Google Scholar] [CrossRef]
  20. Tsai, S.-C. To Develop a Perceived Caring Ability Assessment Scale of Nurse-Aide in the Long-Term Care Facilities. Master’s Thesis, Department Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan, 2013. [Google Scholar]
  21. Meyer, D.; Raffle, H.; Ware, L.J. The first year: Employment patterns and job perceptions of nursing assistants in a rural setting. J. Nurs. Manag. 2014, 22, 769–778. [Google Scholar] [CrossRef]
  22. Aud, M.A.; Bostick, J.E.; Marek, K.D.; McDaniel, R.W. Introducing baccalaureate student nurses to gerontological nursing. J. Prof. Nurs. 2006, 22, 73–78. [Google Scholar] [CrossRef]
  23. Lee, C.Y.; Hsu, H.C.; Chou, Y.L.; Chen, Y.J. Willingness and attitudes toward elderly care among nurses at a medical center in central Taiwan. J. Nurs. Healthc. Res. 2012, 8, 297–305. [Google Scholar]
  24. Creamer, A.M.; Austin, W. Canadian nurse practitioner core competencies identified: An opportunity to build mental health and illness skills and knowledge. J. Nurs. Pract. 2017, 13, e231–e236. [Google Scholar] [CrossRef]
  25. Larsen, P.; Eldridge, D.; Brinkley, J.; Newton, D.; Goff, D.; Hartzog, T.; Saad, N.D.; Perkin, R. Pediatric peripheral intravenous access: Does nursing experience and competence really make a difference? J. Infus. Nurs. 2010, 33, 226–235. [Google Scholar] [CrossRef]
  26. Aued, G.K.; Bernardino, E.; Peres, A.M.; Lacerda, M.R.; Dallaire, C.; Ribas Edo, N. Clinical competences of nursing assistants: A strategy for people management. Revista Brasileira de Enfermagem 2016, 69, 130–137. [Google Scholar]
  27. Glette, M.K.; Røise, O.; Kringeland, T.; Churruca, K.; Braithwaite, J.; Wiig, S. Nursing home leaders’ and nurses’ experiences of resources, staffing and competence levels and the relation to hospital readmissions—A case study. BMC Health Serv. Res. 2018, 18, 955. [Google Scholar] [CrossRef]
  28. Glaister, J.A.; Blair, C. Improved education and training for nursing assistants: Keys to promoting the mental health of nursing home residents. Issues Ment. Health Nurs. 2008, 29, 863–872. [Google Scholar] [CrossRef]
  29. McGilton, K.S.; Sidani, S.; Boscart, V.M.; Guruge, S.; Brown, M. The relationship between care providers’ relational behaviors and residents mood and behavior in long-term care settings. Aging Ment. Health 2012, 16, 507–515. [Google Scholar] [CrossRef]
  30. Berendonk, C.; Caine, V. Insights into Care Providers’ Understandings of Life Story Work with Persons with Dementia: Findings From a Qualitative Study. Res. Theory Nurs. Pract. 2017, 31, 272–294. [Google Scholar] [CrossRef]
  31. Humpel, N.; Caputi, P. Exploring the relationship between work stress, years of experience and emotional competency using a sample of Australian mental health nurses. J. Psychiatr. Ment. Health Nurs. 2001, 8, 399–403. [Google Scholar] [CrossRef]
  32. Lu, H.; Zhao, Y.; While, A. Job satisfaction among hospital nurses: A literature review. Int. J. Nurs. Stud. 2019, 94, 21–31. [Google Scholar] [CrossRef]
  33. Francesca, C.; Ana, L.N.; Jérôme, M.; Frits, T. OECD Health Policy Studies Help Wanted? Providing and Paying for Long-Term Care; OECD Publishing: Paris, France, 2011; Volume 2011. [Google Scholar]
Table 1. The overall competence level of disability nursing assistants.
Table 1. The overall competence level of disability nursing assistants.
VariablesOverall Competence Level
(N = 255)
N%Scorep-Value
SumMean±SD
Age (year) 0.03
20–304116.1166.5 4.06 ±0.47
31–407328.6287.8 3.94 ±0.49
41–506425.1256.7 4.01 ±0.44
51–605822.7244.0 4.21 ±0.44
≥61197.577.2 4.06 ±0.43
Sex 0.07
Male3513.7137.0 3.91 ±0.54
Female22086.3895.2 4.07 ±0.45
Marital status 0.76
Married15560.8630.0 4.06 ±0.48
Single8232.2329.4 4.02 ±0.47
Divorced/separated18772.7 4.04 ±0.30
Religion 0.25
None5923.1233.5 3.96 ±0.43
Buddhism7629.8309.8 4.08 ±0.42
Christianity/Catholicism5822.7240.1 4.14 ±0.52
Taoism6023.5241.1 4.02 ±0.50
Other20.97.7 3.85 ±0.04
Level of education 0.78
Elementary or lower124.748.5 4.04 ±0.34
Middle school4417.3175.2 3.98 ±0.43
High school9135.7367.0 4.03 ±0.44
Trade/Technical college6023.5245.7 4.09 ±0.55
University or above4818.8195.8 4.08 ±0.45
Graduated with majors 0.36
Healthcare-related7529.4306.7 4.09 ±0.47
Else18070.6725.5 4.03 ±0.46
Nationality 0.03
Native23491.8951.5 4.07 ±0.46
Non-native218.280.7 3.84 ±0.49
Job category 0.87
Retirement home187.172.2 4.01 ±0.48
Assisted living4919.2199.6 4.07 ±0.42
Long-term care114.344.4 4.04 ±0.45
Adult day-care166.365.0 4.07 ±0.44
Nursing home14556.9588.5 4.06 ±0.50
Home care166.262.5 3.90 ±0.29
Employment type 0.06
Full-time24395.3986.5 4.06 ±0.46
Part-time124.745.6 3.80 ±0.44
Average daily work hours 0.54
Less than 4 h31.211.2 3.72 ±0.31
4–7 h5019.6200.7 4.01 ±0.42
8–12 h19676.9795.4 4.06 ±0.48
12 h or more62.324.9 4.15 ±0.42
Years of experience <0.01
<1 yr3112.2121.5 3.92 ±0.47
≥1 and <3 yrs5622.0217.0 3.87 ±0.45
≥3 and <5 yrs5220.4211.3 4.06 ±0.44
≥5 and <10 yrs6324.7259.7 4.12 ±0.48
≥10 yrs5320.7222.6 4.20 ±0.43
Previous disability care experience <0.001
Yes10139.6421.5 4.17 ±0.44
No15460.4610.7 3.97 ±0.47
Monthly salary (NTD) 0.13
22,001–27,0007830.6311.6 3.99 ±0.44
27,001–32,0008432.9336.8 4.01 ±0.48
32,001–37,0007629.8315.7 4.15 ±0.46
≥37,001176.768.1 4.00 ±0.49
Performance bonus <0.01
Yes16765.5686.3 4.11 ±0.47
No8834.5345.9 3.93 ±0.43
Year-end bonus 0.04
Yes20178.8820.0 4.08 ±0.47
No5421.2212.2 3.93 ±0.44
Table 2. Domains of competency level in disability nursing assistants.
Table 2. Domains of competency level in disability nursing assistants.
DomainMeanSDRank
Assistance in daily activities4.30 0.52 4
Medical professionalism4.30 0.55 4
Mental and spiritual care3.91 0.62 6
Professional ethics acknowledgment4.42 0.75 3
Health education and literacy4.62 0.52 2
Recognition of patient rights4.64 0.54 1
Table 3. Factors affecting competency level in different domains in disability nursing assistants.
Table 3. Factors affecting competency level in different domains in disability nursing assistants.
VariablesAssistance in
Daily Activities
Medical
Professionalism
Mental and
Spiritual Care
Professional Ethics
Acknowledgment
Health Education
and Literacy
Recognition
of Patient Rights
βp-Valueβp-Valueβp-Valueβp-Valueβp-Valueβp-Value
Age (year)
20–30 (ref.)
31–400.020.77−0.040.66−0.040.64−0.080.30−0.020.78−0.010.87
41–500.070.390.040.570.020.78−0.080.320.060.420.010.96
51–600.22<0.010.180.020.25<0.010.080.260.150.060.150.06
≥610.020.770.010.920.090.17−0.110.110.080.240.060.37
Religion
None (ref.)
Buddhism0.070.350.100.190.070.430.010.960.030.720.010.99
Christianity/Catholicism0.090.240.010.580.040.640.050.480.090.230.26<0.001
Taoism0.160.050.130.100.150.050.060.430.150.050.20<0.01
Other0.130.050.120.060.16<0.010.080.240.080.230.150.02
Level of education
Elementary or lower (ref.)
Middle school0.060.58−0.050.670.050.65−0.070.78−0.070.52−0.090.44
High school0.050.70−0.030.860.080.55−0.260.24−0.030.81−0.090.50
Trade/Technical college0.030.82−0.130.270.000.990.020.93−0.050.660.020.84
University or above−0.100.45−0.170.18−0.050.72−0.090.69−0.150.24−0.190.14
Graduated with majors
Healthcare-related (ref.)
Else0.040.540.060.350.070.25−0.100.100.020.750.040.48
Nationality
Native (ref.)
Non-native0.020.810.030.640.080.210.040.550.010.940.030.59
Job category
Retirement home (ref.)
Assisted living0.040.710.100.390.130.230.230.040.020.840.100.36
Long-term care−0.050.54−0.060.50−0.010.930.080.36−0.100.25−0.070.44
Adult day-care0.040.700.100.300.010.870.200.040.020.800.090.30
Nursing home0.070.590.140.290.030.800.220.09−0.100.430.110.38
Home care−0.020.810.060.530.100.260.140.11−0.010.910.090.34
Employment type
Full-time (ref.)
Part-time−0.050.43−0.060.380.030.640.030.67−0.030.61−0.020.75
Years of experience
<1 yr (ref.)
≥1 and <3 yrs−0.020.84−0.020.86−0.080.39−0.140.130.100.39−0.080.38
≥3 and <5 yrs0.080.400.100.29−0.020.86−0.090.31−0.040.74−0.120.19
≥5 and <10 yrs0.030.710.030.76−0.090.36−0.210.02−0.090.45−0.110.25
≥10 yrs0.110.170.080.350.020.77−0.190.04−0.070.64−0.080.30
Previous disability care experience
No (ref.)
Yes0.18<0.0010.18<0.0010.23<0.0010.090.170.120.050.16<0.01
Monthly salary (NTD)
22,001–27,000 (ref.)
27,001–32,0000.080.330.120.120.050.56−0.040.63−0.060.47−0.030.74
32,001–37,0000.050.500.090.27−0.020.76−0.100.19−0.030.750.000.98
≥37,0010.030.630.020.75−0.010.92−0.020.73−0.040.59−0.010.87
Performance bonus
Yes (ref.)
No−0.130.19−0.040.660.020.77−0.130.04−0.080.18−0.080.23
Year-end bonus
Yes (ref.)
No−0.080.40−0.020.820.020.81−0.160.05−0.180.03−0.110.08
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Cheng, T.-J.; Hsu, Y.-M.; Tsai, T.-H.; Chen, M.-Y.; Tsay, S.-F.; Shieh, S.-H. Factors Affecting the Competence of Nursing Assistants in Taiwan Long-Term Care Institutions. Int. J. Environ. Res. Public Health 2020, 17, 9413. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17249413

AMA Style

Cheng T-J, Hsu Y-M, Tsai T-H, Chen M-Y, Tsay S-F, Shieh S-H. Factors Affecting the Competence of Nursing Assistants in Taiwan Long-Term Care Institutions. International Journal of Environmental Research and Public Health. 2020; 17(24):9413. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17249413

Chicago/Turabian Style

Cheng, Tsai-Jung, Yi-Min Hsu, Tung-Han Tsai, Ming-Yu Chen, Shwu-Feng Tsay, and Shwn-Huey Shieh. 2020. "Factors Affecting the Competence of Nursing Assistants in Taiwan Long-Term Care Institutions" International Journal of Environmental Research and Public Health 17, no. 24: 9413. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph17249413

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop