What Direct Care Staff Think about “Good Care”

Direct care workers play a crucial role in the provision of nursing home care, providing the bulk of hands-on care for residents and serving as the front line for identifying and dealing with the emotional and practical issues that arise in the care setting. Thus, direct care providers are crucial for implementing organizational guidelines and values for care. A recent study interviewed a sample of direct care workers from skilled nursing facilities in Southern California to understand how direct care workers conceptualize quality of care.

Previous research on direct care workers has suggested that the development of meaningful care relationships with residents, and the perception that they can provide residents with high quality care, is an important means through which workers find value in their often challenging employment. The concepts and definitions that individual direct care workers have in terms of what constitutes a good care relationship with residents will influence their actual delivery of care. Thus, the researcher asked direct care workers about their definitions of “good care,” conducting open-ended interviews that allowed research participants to talk generally about their views about quality of care and how it influenced their work processes.

Almost all of the participants (each of whom was a full-time certified nursing assistant with at least one year of work experience) began their responses by identifying visible outcomes of care. Good care, according to the participants, leads to residents who are clean and physically comfortable. Resident happiness was also identified by interviewees as an important element of good care. This was due in part due to empathy for residents, but also for practical reasons, as residents who are happy and comfortable are easier to work with. The author notes that the emphasis on outcomes matches the focus of current nursing home regulations, which target the visible outcomes of care activities, and thus may have influenced the perspectives of nursing home employees through inspections and formal regulations.

The participants identified processes, in addition to outcomes, of good care. In particular, being affectionate, respectful, and patient with residents were all identified as important aspects of good care. The author notes that there can be a tension between these relational, process-oriented goals and more visible outcomes, which often may be difficult to achieve with residents in a patient fashion.

Understanding how residents, facility directors, and direct care staff each perceive “good care” is an important way to understand care quality in nursing homes. Employees, directors, and residents each might have different definitions of, and priorities for, good care. The author suggests that directors and managers might consider providing concrete, practice-oriented definitions of organizational goals such as “individualized care,” and establishing working environments conducive to shared understandings of good care.


Chung G. Understanding nursing home worker conceptualizations about good care. The Gerontologist (2013); 53(2): 246–254.

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