U.S. nursing homes (NHs) serve 1.6 million older persons, all of whom have significant physical and/or cognitive impairment, and the majority of whom have Alzheimer's disease or a related cognitive disorder. In these settings the vast majority of hands-on care is provided by an estimated 634,000 certified nursing assistants (CNAs) ? paraprofessional caregivers who are racially diverse, largely female, with a high school or lower education, and an annual income equivalent to the poverty threshold for a family of four. Despite the crucial role of CNAs in providing care for the long-term care population and efforts to recruit and retain a stable workforce, absenteeism rates are high and annual turnover averages 65%, with adverse impact on the quality of care provided to NH residents, making CNA retention a policy priority. CNAs have significant life stressors that affect their ability to work, such as single parenthood, poor physical health, difficulty finding childcare, and transportation problems. They also face emotionally and physically demanding job tasks, particularly when working with persons with Alzheimer's disease and related dementias, and many lack helpful strategies for dealing with stress, negative feelings, and burden. A newly developed, standardized Mindful Self-Compassion (MSC) intervention may have particularly high impact and relevance for the high-stress lives of NH CNAs. MSC training has been shown to increase well- being, compassion for others, and stress-coping skills. However, little is known about the impact, feasibility and acceptability of MSC training in low-educated, stress-burdened paraprofessional populations such as CNAs, or whether it can impact outcomes such as burnout, absenteeism, and turnover. In this R21 we propose to modify, refine and test a MSC training intervention for CNAs within 3 similarly structured community NHs. One NH will be randomly assigned as the field test site for the standardized 8- week MSC training program, to determine the feasibility, acceptability, and necessary adaptations needed to meet the diverse cultural background, limited literacy, and unique job and family challenges of the NH CNA workforce (Aim 1). The remaining two NHs sites will pilot test the modified training, measuring the intervention's fidelity and its impact on perceived stress, job satisfaction, job burnout symptoms, attitudes towards persons with dementia, absenteeism, and turnover, and evaluating on a preliminary basis how the impact of training differs by site and by participant characteristics (Aim 2). If results from this preliminary work are favorable and a subsequent randomized trial demonstrates significant impact on such key outcomes as burnout, absenteeism, and turnover, then MSC could be incorporated into CNA training programs, thereby helping contribute to a more effective and stable long-term care workforce.
Certified nursing assistants (CNAs), who provide the majority of care to persons with chronic disease and/or cognitive impairment from Alzheimer's disease and related dementias, face tremendous job and home stress, and as a result absenteeism and job turnover are high. This preliminary study will tailor Mindful Self- Compassion (MSC) ? a promising new program designed to cultivate greater self-care, and strengthen resilience and coping skills ? for the CNA population and study its effectiveness. If results are favorable, MSC could be incorporated into CNA training programs, thereby helping contribute to a more effective and stable long-term care workforce.
