Assessment of immigrant certified nursing assistants' communication when responding to standardized care challenges.
OBJECTIVE
Certified nursing assistants (CNAs) provide 80% of the hands-on care in US nursing homes; a significant portion of this work is performed by immigrants with limited English fluency. This study is designed to assess immigrant CNA's communication behavior in response to a series of virtual simulated care challenges.


METHODS
A convenience sample of 31 immigrant CNAs verbally responded to 9 care challenges embedded in an interactive computer platform. The responses were coded with the Roter Interaction Analysis System (RIAS), CNA instructors rated response quality and spoken English was rated.


RESULTS
CNA communication behaviors varied across care challenges and a broad repertoire of communication was used; 69% of response content was characterized as psychosocial. Communication elements (both instrumental and psychosocial) were significant predictors of response quality for 5 of 9 scenarios. Overall these variables explained between 13% and 36% of the adjusted variance in quality ratings.


CONCLUSIONS
Immigrant CNAs responded to common care challenges using a variety of communication strategies despite fluency deficits.


CONCLUSIONS
Virtual simulation-based observation is a feasible, acceptable and low cost method of communication assessment with implications for supervision, training and evaluation of a para-professional workforce.
National Center for Health Statistics, Hyattsville, MD, USA; Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Meredith
M
Massey
Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: droter1@jhu.edu.
Debra L
DL
Roter
D002568:Certification; D003142:Communication; D003198:Computer Simulation; D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D007802:Language; D008297:Male; D009723:Nurse-Patient Relations; D009730:Nursing Assessment / Q000379:methods*; D009728:Nursing Assistants / Q000592:standards*; D009735:Nursing Homes / Q000592:standards*; D011787:Quality of Health Care
Certified nursing assistant; Computer simulation; Immigrant workforce; RIAS