The lived experience of certified nursing assistants in a nursing home viewed through a social constructionist lens.

Abstract

Certified nursing assistants (CNAs) are frontline caregivers for the elderly with chronic physical and cognitive disabilities in nursing homes (NHs). The pool of CNAs available to deliver this complex care in NHs is diminishing and is compromised by CNA turnover rates > 100% per year. Little is known about the meaning of CNAs’ experience with elderly NH residents. Seeing and hearing their perspectives may assist in creating and sustaining the pool of available CNAs for future elder care. The purpose of this study was to discover the lived experience of the CNAs in the NH setting as described by their words, actions, experiences and understandings. A phenomenological research method using a social constructionist methodology was used to frame and analyze the meaning of CNAs experiences with elderly residents. The setting was a >100-bed, urban NH in Kansas. Over 3 months, 4 investigators conducted non-participant observations and semi-structured interviews with 4 female CNAs, aged 30-50 years old with 1-15 years experience. Individual and group analysis of data included identifying and coding major ideas and collapsing codes into aggregated themes that emerged from data. Findings: Three main themes emerged: relational worlds, wise woman, and self-protection. Viewing through a social constructionist lens revealed that CNAs’ realities are constructed through language and social relationships. Major conclusions: Relational worlds of CNAs often collide, however, the wise “knowing” women related to their relational worlds seamlessly as they evolved from novice to expert, and developed strategies to protect selves from emotional loss of residents.