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Care Aides’ Perceptions and Experiences of their Roles and Relationships with Residents in Long-term Care Settings Open Access


Other title
cultural change
care aides
long-term care
Eden Alternative®
focused ethnography
Type of item
Degree grantor
University of Alberta
Author or creator
Andersen, Elizabeth A
Supervisor and department
Dr. Judith Spiers, Faculty of Nursing
Examining committee member and department
Dr. Pauline Paul, Faculty of Nursing, University of Alberta
Dr. Laurel Strain, Department of Sociology, University of Alberta
Dr. Kathleen Hunter, Faculty of Nursing, University of Alberta
Dr. Katherine McGilton, External Reader, Senior Scientist Toronto Rehab
Dr. Belinda Parke, Faculty of Nursing, University of Alberta
Faculty of Nursing

Date accepted
Graduation date
Doctor of Philosophy
Degree level
The purpose of this study was to explore care aides’ perceptions and experiences of their roles and relationships with residents in long-term care institutions, and how the context, including the organizational philosophy, influenced those perceptions and experiences. The method of exploration was qualitative focused ethnography. Convenience and purposive sampling were used to recruit 22 care aides from five long-term care facilities in a western Canadian city. Data were collected via semi-structured interviews. Data analysis utilized constant comparison to identify themes or patterns within and across participants as well as comparison of new data to data previously analyzed. It emerged that a dominant influence on care aides’ perceptions of their roles and relationships was the way they experienced a model of cultural change called the Eden Alternative®. The Eden Alternative® model aims to increase quality of life for institutionalized persons by restructuring delivery of care and transforming institutional environments into more habitable places to live. However, although the care aides believed in an ideal occupational relational purpose or state, they perceived that the model had been incompletely implemented in their facilities, was incompatible with an existing organizational policy, and had eroded after implementation. Instead of feeling supported and reassured by fellowship, most of the care aides worked with the residents alone and without reference to each other. They emphasized what separated them, rather than what united them. Without a shared purpose and collegial connections they felt a reduced relationship to the larger residential community. Meaningful personal connections with residents no longer assigned to them were lost. They felt overburdened by their expanded responsibilities; they found themselves engaged in conflicts with residents and families; and many felt unsupported by management. As a consequence, they had little time or energy to be compassionate, empathetic partners to the residents permanently assigned to them. This study contributes to the body of knowledge used by registered nurses, nurse educators and nursing home managers/administrators who train and support care aides and may be useful to managers/administrators who make the decisions that shape and affect services provided to residents.
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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File title: Dissertation Final Formated for FGSR
File author: Elizabeth Andersen
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