Resident Aggression and Quality of Care in Long-term Care

• Author / Creator

  Carleton, Heather L.

• 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.

• Subjects / Keywords

  • RAI-MDS
  • Nursing homes
  • Aggression
  • Long-term care
  • Quality indicator
  • Quality of care
  • Care aide
  • Health care aide

• Graduation date

  Fall 2014

• Type of Item

  Thesis

• Degree

  Master of Nursing

• DOI

  https://doi.org/10.7939/R3HQ3S533

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.