Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-19T03:00:44.325Z Has data issue: false hasContentIssue false

Lifting the ‘Violence Veil’: Examining Working Conditions in Long-term Care Facilities Using Iterative Mixed Methods*

Published online by Cambridge University Press:  27 June 2011

Tamara Daly*
Affiliation:
York University, Toronto, Canada
Albert Banerjee
Affiliation:
York University, Toronto, Canada
Pat Armstrong
Affiliation:
York University, Toronto, Canada
Hugh Armstrong
Affiliation:
Carleton University, Ottawa, Canada
Marta Szebehely
Affiliation:
Stockholm University, Stockholm, Sweden
*
Correspondence and requests for offprints should be sent to / La correspondance et les demandes de tirés-à-part doivent être adressées à: Tamara Daly, Ph.D. 4700 Keele St. Rm 411 HNES York University Toronto, ON M3J 1P3 ([email protected])

Abstract

We conducted a mixed-methods study – the focus of this article – to understand how workers in long-term care facilities experienced working conditions. We surveyed unionized care workers in Ontario (n = 917); we also surveyed workers in three Canadian provinces (n = 948) and four Scandinavian countries (n = 1,625). In post-survey focus groups, we presented respondents with survey questions and descriptive statistical findings, and asked them: “Does this reflect your experience?” Workers reported time pressures and the frequency of experiences of physical violence and unwanted sexual attention, as we explain. We discuss how iteratively mixing qualitative and quantitative methods to triangulate survey and focus group results led to expected data convergence and to unexpected data divergence that revealed a normalized culture of structural violence in long-term care facilities. We discuss how the finding of structural violence emerged and also the deeper meaning, context, and insights resulting from our combined methods.

Résumé

Le présent document se concentre sur les méthodes mixtes nous avons utilisé pour comprendre conditions de travail de leur travailleurs dans les établissements de soins de longue durée. Nous avons mené une enquête auprès des syndiqués travailleurs de santé en Ontario (n = 917), et une autre enquête dans trois provinces (n = 948) et quatre pays Scandinaves (n = 1625). Neuf groupes de discussion avec les Canadiens ont eu lieu; les répondants ont été présentés avec des questions du sondage et aussi descriptive des résultats statistiques et ont été demandé: “Est-ce le reflet de votre expérience?” Les contraintes de temps pour les travailleurs et la fréquence des expériences des travailleurs de la violence physique et attentions sexuelles non désirées sont signalés. Nous discutons comment de le façon dont nous utilisé des méthodes qualitatives et quantitatives étè itératif. Nous avons trouvé pas seulement la cohérence des données mais aussi la divergence des données qui montrent comment une culture de la violence dans les établissements de soins de longue durée est acceptée par les travailleurs comme d’habitude. Comment le constat de la violence structurelle vu le jour et la signification profonde, le contexte et les idées qui proviennent de la combinaison de nos méthodes itératives sont discutées.

Type
Articles
Copyright
Copyright © Canadian Association on Gerontology 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

This research was funded with a Canadian Institutes of Health International Opportunity Program One Time Collaborative Research Grant (OPC – 74350) and with research assistance funding from Pat Armstrong’s CHSRF/CIHR Chair in Women’s Health and Nursing Research. The Scandinavian Study was led by Marta Szebehely of Stockholm University and was financed by the Swedish Council for Working Life and Social Research. The Canadian Union of Public Employees (CUPE), the Canadian Auto Workers (CAW), the National Union of Public and General Employees (NUPGE), the Service Employees International Union (SEIU), and the Canadian Federation of Nurses Unions (CFNU) partnered in the Canadian arm of the research. The Institute for Social Research at York University was responsible for the Ontario and Canadian survey sample, distribution, collection, and data entry. Thank you to Lynn Spink and Susan Braedley for conducting focus groups, to Stirling LaFrance for research assistance, and to the Scandinavian Research Team for their contributions. The data analysis and content of this article remain the sole responsibility of the authors.

References

Åkerstrom, M. (2002). Slaps, punches, pinches – But not violence: Boundary-work in nursing homes for the elderly. Symbolic Interaction, 25(4), 515–536.Google Scholar
Andrew, C., Armstrong, P., Armstrong, H., Clement, W., & Vosko, L.F. (2003). Studies in Political Economy: Developments in Feminism. Toronto, Ontario, Canada: Women’s Press.Google Scholar
Armstrong, P., Armstrong, H., & Coburn, D. (2001). The political economy of health and care. In Armstrong, P., Armstrong, H., & Coburn, D. (Eds.), Unhealthy Times: Political Economy Perspectives on Health and Care in Canada (pp. vii–x). Don Mills, Ontario, Canada: Oxford University Press.Google Scholar
Armstrong, P., Armstrong, H., & Scott-Dixon, K. (2008). Critical to Care. The Invisible Women in Health Services. Toronto, Ontario, Canada: University of Toronto Press.Google Scholar
Armstrong, P., Banerjee, A., Szebehely, M., Armstrong, H., Daly, T., & LaFrance, S. (2009). They Deserve Better: The Long-term Care Experience in Canada and Scandinavia. Ottawa, Ontario, Canada: Canadian Centre for Policy Alternatives.Google Scholar
Armstrong, P., & Daly, T. (2004). There are not enough hands: Conditions in Ontario’s Long Term Care Facilities. Toronto. Retrieved October 2011 fromhttp://cupe.ca/updir/CUPELTC-ReportEng1.pdf.Google ScholarPubMed
Armstrong, P., & Kits, O. (2001).One Hundred Years of Caregiving. Law Commission of Canada. Retrieved October 2010 fromwww.cewh-cesf.ca/PDF/health_reform/care-giving-100yrs.pdf.Google Scholar
Astrom, S., Bucht, G., Eisemann, M., Norberg, A., & Saveman, B. (2002). Incidence of violence towards staff caring for the elderly. Scandinavian Journal of Caring Sciences, 16(1), 66–72.CrossRefGoogle ScholarPubMed
Baines, D. (2006). Staying with people who slap us around: Gender, juggling responsibilities in paid (and unpaid) care work. Gender, Work & Organization, 13(2), 129–151.Google Scholar
Banerjee, A., Daly, T., Armstrong, H., Armstrong, P., LaFrance, S., & Szebehely, M. (2008). “Out of Control”: Violence Against Personal Support Workers in Long-term Care. Retrieved fromhttp://www.yorku.ca/mediar/special/out_of_control_english.pdf, accessed October 2010.Google Scholar
Berta, W., Laporte, A., Zarnett, D., Valdmanis, V., & Anderson, G. (2006). A pan Canadian perspective on institutional long-term care. Health Policy, 79, 175–194.Google Scholar
Boyd, N. (1995). Violence in the workplace in British Columbia: A preliminary investigation. Canadian Journal of Criminology, 37, 491–519.CrossRefGoogle Scholar
Castle, N.G., Degenholtz, H., & Rosen, J. (2006). Determinants of staff job satisfaction of caregivers in two nursing homes in Pennsylvania. BMC Health Services Research, 6(60doi:10.1186/1472-6963-6-60Google Scholar
Creswell, J. (2009). Research Design. Qualitative, Quantitative, and Mixed Methods Approaches (3rd ed.). Thousand Oaks, CA: Sage Publications.Google Scholar
Creswell, J., & Plano Clark, V.L. (2007). Designing and Conducting Mixed Methods Research. Thousand Oaks, CA: Sage Publications.Google Scholar
Creswell, J.W., Plano Clark, V.L., Gutmann, M.L., & Hanson, W.E. (2003). Advanced mixed methods research designs. In Tashakkori, A., & Teddlie, C. (Eds.), Handbook of Mixed Methods in Social & Behavioural Research. Thousand Oaks, CA: Sage Publications.Google Scholar
Daly, T., & Szebehely, M. (2011). Unheard voices, unmapped terrain: Care work in long-term residential care for older people in Canada and Sweden. International Journal of Social Welfare, Early View 28 April 2011, pp. 1–10. DOI:10.1111/j.1468–2397.2011.00806.x.Google Scholar
Denzin, N. (1978). The Research Act: A Theoretical Introduction to Sociological Methods (2nd ed.). New York: McGraw-Hill.Google Scholar
Diamond, T. (1995). Making Grey Gold. Chicago: University Of Chicago Press.Google Scholar
Doyle, L., Brady, A.-M., & Byrne, G. (2009). An overview of mixed methods research. Journal of Research in Nursing, 14(2), 175–185.CrossRefGoogle Scholar
Doyal, L., & Pennell, I. (1979). The Political Economy of Health. London: Pluto.Google Scholar
Farmer, P. (1996). On suffering and structural violence: A view from below. Daedalus, 125(1), 261–283.Google Scholar
Farmer, P. E., Nizeye, B., Stulac, S., & Keshavjee, S. (2006). Structural violence and clinical medicine. PLoS Medicine, 3(10), e449 1686–91.Google Scholar
Gates, D., Fitzwater, E., & Meyer, U. (1999). Violence against caregivers in nursing homes: Expected, tolerated, and accepted. Journal of Gerontological Nursing, 25(4), 12–22.Google Scholar
Gates, D., Fitzwater, E., & Succop, P. (2005). Reducing assaults against nursing home caregivers. Nursing research, 54(2), 119–127.CrossRefGoogle ScholarPubMed
Gustafsson, , Szebehely, M (2005). Arbetsvillkor och styrning i äldreomsorgens hierarki – en enkätstudie bland personal och politiker [Working conditions and steering in the hierarchy of eldercare. A survey study among employees and politicians]. Stockholm University, Department of Social Work.Google Scholar
Harrington, C., & Pollock, A.M. (1998). Decentralisation and privatisation of long-term care in UK and USA. Lancet, 351(9118), 1805–1808.Google Scholar
Harrington, C., Woolhandler, S., & Mullan, J. (2001). Does investor ownership of nursing homes compromise the quality of care? American Journal of Public Health, 91(9), 1452–1455.Google Scholar
Hellzen, O., Asplund, K., Sandman, P.O., & Norberg, A. (2004). The meaning of caring as described by nurses caring for a person who acts provokingly: An interview study. Scandinavian Journal of Caring Science, 18(1), 3–11.CrossRefGoogle ScholarPubMed
James, N. (1992). Care = organization + physical labour + emotional labour. Sociology of Health and Illness, 14(4), 488–509.Google Scholar
Johnson, B., & Turner, L. (2003). Data collection strategies in mixed methods research. In Tashakkori, A., & Teddlie, C. (Eds.), Handbook of Mixed Methods in Social and Behavioural Research (pp. 297–320). Thousand Oaks, CA: Sage Publications.Google Scholar
Jick, T.D. (1979). Mixing qualitative and quantitative methods: Triangulation in action. Qualitative Methodology, 24(4), 602–611.Google Scholar
Karasek, R., & Theorell, T. (1990). Healthy Work: Stress, Productivity and the Reconstruction of Working Life. New York: Basic Books.Google Scholar
Kolanowski, A., & Whall, A.L. (2000). Toward holistic theory-based intervention for dementia behaviour. Holistic Nursing Practice, 14, 67–76.Google Scholar
Kittay, E.F. (1999). Love’s Labour: Essays on Women, Equality and Dependency. London: Routledge.Google Scholar
Leech, N.L., & Onwuegbuzie, A.J. (2009). A typology of mixed methods research designs. Quality and Quantity, 43(2), 265–275.Google Scholar
Levin, P.F., Hewitt, J.B., Misner, S.T., Reynolds, S. (2003) Assault of long-term care personnel. Journal of Gerontological Nursing, 29(3), 28–35.Google Scholar
Lopez, S.H. (2006). Culture change management in long-term care: A shop-floor view. Politics and Society, 34(1), 55–79.Google Scholar
Lopez, S.H. (2007). Efficiency and the fix revisited: Informal relations and mock routinization in a nonprofit nursing home. Qualitative Sociology, 30, 225–247.Google Scholar
McGregor, M.J., Cohen, M., McGrail, K., Broemeling, A.M., Adler, R.N., Schulzer, M., et al. . (2005). Staffing levels in not-for-profit and for-profit long-term care facilities: Does type of ownership matter? CMAJ Canadian Medical Association Journal, 172(5), 645–649.CrossRefGoogle ScholarPubMed
McGregor, M.J., Tate, R., McGrail, K., Ronald, L., Broemeling, A.-M., & Cohen, M. (2006). Care outcomes in long-term care facilities in British Columbia, Canada – Does ownership matter? Medical Care, 44(10), 929–935.Google Scholar
Menckel, E., & Viitasara, E. (2002). Threats and violence in Swedish care and welfare – Magnitude of the problem and impact on municipal personnel. Scandinavian Journal of Caring Sciences, 16(4), 376–385.Google Scholar
Miller, M.F. (1997). Physically aggressive resident behaviour during hygenic care. Journal of Gerontological Nursing, 23(5), 24–39.Google Scholar
Morgan, D.G., Stewart, N., D’Arcy, C., Forbes, D., & Lawson, J. (2005). Work stress and physical assault of nursing aides in rural nursing homes with and without dementia special care units. Journal of Psychiatric and Mental Health Nursing, 12(3), 347–358.Google Scholar
National Board of Health and Welfare (2010).Management Form for Certain Services to Elderly and to Persons with Impairments, 2009. Stockholm, Sweden: National Board for Health and Welfare.Google Scholar
O’Cathain, A. (2009). Mixed methods research in the health sciences: A quiet revolution. Journal of Mixed Methods Research, 3(3), 3–6.Google Scholar
Ontario Ministry of Health and Long Term Care (2009). Reports on Long-Term Care Homes. Retrieved fromhttp://www.health.gov.on.ca/english/public/program/ltc/26_reporting.html, accessed October 2010.Google Scholar
Robinson, K.M., Tappen, R.M. (2008). Prevention of violence in long term care facilities: Policy recommendations. Journal of Gerontological Nursing, 34(3), 10–14.Google Scholar
Sharipova, M., Borg, V., & Hogh, A. (2008). Prevalence, seriousness and reporting of work-related violence in the Danish elderly care. Scandinavian Journal of Caring Sciences, 22(4), 574–581.Google Scholar
Shaw, M.M. (2004). Aggression toward staff by nursing home residents: Findings from a grounded theory study. Journal of Gerontological Nursing, 30(10), 43–54.CrossRefGoogle ScholarPubMed
Statistics Canada (2010). Residential Care Facilities 2007/08. Ottawa, Ontario, Canada: Minister of Industry.Google Scholar
Stewart, M., Makwarimba, E., Barnfather, A., Letourneau, N., & Neufeld, A. (2008). Researching reducing health disparities: Mixed-methods approaches. Social Science & Medicine, 66(6), 1406–1417.Google Scholar
Szebehely, M. (2009). Are there lessons to learn from Sweden? In Armstrong, P., Boscoe, M., Clow, B., Grant, K., Haworth-Brockman, M., Jackson, B., et al. . (Eds.), A Place to Call Home: Long-Term Care in Canada. Halifax, Nova Scotia, Canada: Fernwood Publishing.Google Scholar
Trottier, H., Martel, L., Houle, C., Berthelot, J.-M., & Legare, J. (2000). Living at home or in an institution: What makes the difference for seniors? Health Reports, 11(4), 49–61.Google Scholar
Watson, E.A., & Mears, J.(1999). Women, Work and Care of the Elderly. Aldershot, UK: Ashgate Publishing Company.Google Scholar