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Theses and Dissertations

Resident Aggression and Quality of Care in Long-term Care Open Access


Other title
quality of care
quality indicator
care aide
nursing home
health care aide
long-term care
Type of item
Degree grantor
University of Alberta
Author or creator
Carleton, Heather L.
Supervisor and department
Estabrooks, Carole (Faculty of Nursing)
Examining committee member and department
Schopflocher, Donald (School of Public Health)
Slaughter, Susan (Faculty of Nursing)
Faculty of Nursing
Date accepted
Graduation date
Master of Nursing
Degree level
Purpose: My aim in this thesis was to investigate the relationship between resident aggression towards care aides and quality of care in long-term care (LTC). Design: This is a paper-based thesis comprised of an introduction and overview, a critical review of the literature and an empirical study, which is a secondary analysis. Theoretical Framing: The research model was created following Arnetz and Arnetz’s model (2001) and variable selection was guided by the clinical microsystems literature. Methods: A literature review, found in Appendix 1, and a manuscript in which I report on a project addressing the question: What is the effect of high levels of unit resident aggression on quality of care? prepared for submission to a peer-reviewed journal, comprises this thesis. The project is a secondary analysis of unit level data from the Translating Research In Elder Care (TREC) program using multiple regression models. The existing data included a sample of nursing home care aides (from the TREC survey) and residents (from the Resident Assessment Instrument –Minimum Data Set 2.0 (RAI-MDS) also collected in TREC) aggregated to 103 units from 36 LTC facilities across Alberta, Saskatchewan, and Manitoba. The final analytical sample had 100 units. A total of 1497 care aides’ individual data were aggregated to the 100 units. A cross-sectional sample of 4220 resident assessments that matched the survey data collection were aggregated to the unit level in order to derive risk adjusted quality indicators (QIs) (decline in ADL’s, worsening pain, pressure ulcers, restraint use). In the models, QIs were the dependent variables and resident aggression was the independent variable while we controlled for several unit and care aide characteristics. Results: The literature review showed that resident aggression and quality of care in LTC are not well studied. Much of the research focused on effects of resident aggression on care aides instead of on the residents. The empirical study showed that at the unit level resident aggression was associated with a lower percent of pressure ulcers but was not related to resident declining activities of daily living, worsening pain or restraint use. Owner-operator model (public not for profit vs. private for profit) and urban vs. rural classification in which a unit was located were the most consistent predictors of quality of care. Conclusions: My findings add to our understanding of how resident aggression experienced by care aides may affect quality of care. I discuss the contributions of this thesis to theory, research, knowledge and practice. I offer insight on the contribution of resident aggression to quality of care, suggest additional research opportunities and comment on the need for further research.
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
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