Pilot testing the knowledgeable nursing assistants as creative caregivers (KNACC) guide

Certified Nursing Assistants (CNAs) are an important part of the daily life of older adults living in long term care (LTC).1, 2, 3 The majority of direct care is provided by CNAs who have the added burden of meeting the unique needs of older adult residents, including addressing issues associated with social isolation.1, 2, 3 However, this requires structural support and training to incorporate specific communication skills within daily direct care tasks.1 Interventions have been shown to enhance engagement leading to positive effects for older adults as well as CNAs.4, 5, 6 Arts-based activities are one approach linked to reduced social isolation, enhanced communication, improved employee satisfaction, and relationship building between patient and staff.4, 5, 6, 7, 8, 9

Empowering CNAs through creative engagement may have positive effects on the work environment. The structural empowerment theory explains that opportunities for development, resources, and support within the work environment will alter individual perspectives on the ability to achieve job success.10 A correlation exists between structural empowerment and job satisfaction;11 with a positive association with job satisfaction for nursing assistants.12 High levels of job satisfaction are linked to one's perception of level of control over the work one does.12 Greater access to resources, sharing information with co-workers in trusting relationships, and collaborating in shared decision making have all been identified by CNAs as empowering.13 Incorporating creativity and the arts as a systematic approach to strengthening direct care provides an opportunity to empower CNAs and increase job satisfaction.

Our previous work explored attitudes, approaches, and values surrounding CNA use of creativity within direct care.14 Using a participatory approach to collaborate with CNAs, the multimedia web-based toolkit, called The Creative Caregiving Guide© (CCG),15 was adapted for use within long term care. This toolkit was originally developed to improve communication between family caregivers and persons living with dementia.15 CNAs communicated that not all arts-based techniques were acceptable. Revisions were adopted to fit within the daily workload and structure of LTC. A guide was developed to train CNAs to apply techniques as a tool of engagement and enhance communication while providing care and support to older adults. This adapted guide is called Knowledgeable Nursing Assistants as Creative Caregivers (KNACC).16 This study describes pilot testing KNACC in the LTC setting. We hypothesized that CNA use of KNACC would lead to improvements in CNA perceptions of structural empowerment and job satisfaction.

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