title: The influence of organizational context on best practice use by care aides in residential long-term care settings.
abstract: OBJECTIVE
  This study assessed individual and organizational context (work environment) factors that influence use of best practices by care aides (nursing assistants) in nursing homes. Little scientific attention has been focused on understanding best practice use in nursing homes and almost none on care aides.
  
  
  METHODS
  A total of 1262 care aides in 25 nursing homes in the 3 Canadian prairie provinces. Care aides are unregulated workers who provide 80% of direct care to residents in Canadian nursing homes.
  
  
  METHODS
  We used hierarchical linear modeling to (1) assess the amount of variance in use of best practices, as reported by care aides, that could be attributed to individual or organizational factors, and (2) identify predictors of best practices use by care aides.
  
  
  RESULTS
  At the individual level, statistically significant predictors of instrumental use of best practices included sex, age, shift worked, job efficacy, and belief suspension. At the unit level, significant predictors were social capital, organizational slack (staffing and time), number of informal interactions, and unit type. At the facility level, ownership model and province were significant. Significant predictors of conceptual use of best practices at the individual level included English as a first language, job efficacy, belief suspension, intent to use research, adequate knowledge, and number of information sources used. At the unit level, significant predictors were evaluation (feedback mechanisms), structural resources, and organizational slack (time). At the facility level, province was significant. The R(2) was 18.3% for instrumental use of best practices and 43.4% for conceptual use. Unit level factors added a substantial amount of explained variance whereas facility level factors added relatively little explained variance.
  
  
  CONCLUSIONS
  Our study suggests that context plays an important role in care aides' use of best practices in nursing homes. Individual characteristics played a more prominent role than contextual factors in predicting conceptual use of best practices.
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada. Electronic address: carole.estabrooks@ualberta.ca.
authors.forename: Carole A
authors.initials: CA
authors.lastname: Estabrooks
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Squires
authors.affiliation: Department of Sociology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Leslie
authors.initials: L
authors.lastname: Hayduk
authors.affiliation: Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Debra
authors.initials: D
authors.lastname: Morgan
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Greta G
authors.initials: GG
authors.lastname: Cummings
authors.affiliation: School of Health Policy and Management, York University, Toronto, Ontario, Canada.
authors.forename: Liane
authors.initials: L
authors.lastname: Ginsburg
authors.affiliation: College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Norma
authors.initials: N
authors.lastname: Stewart
authors.affiliation: Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada.
authors.forename: Katherine
authors.initials: K
authors.lastname: McGilton
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Sung Hyun
authors.initials: SH
authors.lastname: Kang
authors.affiliation: Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Norton
mesh_terms: D019985:Benchmarking; D002170:Canada; D005260:Female; D006801:Humans; D008297:Male; D009728:Nursing Assistants / Q000592:standards*; D009735:Nursing Homes / Q000592:standards*; D011787:Quality of Health Care
keywords: Alberta Context Tool; Research use; TREC; aide; best practice; context; nursing home