needs. The extent to which these activities should be performed by RNs has been the subject of much discussion and has not been resolved in the health care literature (Kovner, 2001). Under the primary model of nursing care delivery discussed earlier in this chapter, an RN assigned to a patient provides total care for that patient, including bathing and ambulatory support. Under a team or functional nursing care approach, a mix of RNs and NAs coordinates their skill set in the provision of care to the patient.

Providing Emotional Support

Providing emotional support is recognized by nursing staff and patients as an essential part of nursing practice. Quality hospital nursing care has been described by patients as “accepting, empathetic, compassionate … and respectful,” as well as technically competent (Miller, 1995:31). A survey of individual nurses in clinical practice conducted in 1992 to validate the content of the Nursing Interventions Classification (NIC) system and determine the frequency with which nurses performed each of 336 nursing interventions identified provision of emotional support as one of the six most frequently used nursing interventions and the one reported most often by nurses as being used in their patient care activities (Bulechek et al., 1994). Rather than a vague, intangible attitude, caring—showing kindness, preserving dignity, explaining with empathy, and being patient—is recognized as requiring actions that impose their own time requirements as illustrated in the case of Ana in Box 3-2.

Emotional support is a key feature of the care provided by NAs in a variety of long-term care settings (Stone and Wiener, 2001). Providing such support necessitates establishing, nurturing, and sustaining relationships with residents, as well as responding to and effectively managing disruptive, aggressive, or uncooperative resident behavior. Indeed, responding to aggressive residents has increasingly become an aspect of CNAs’ work. In studies describing the epidemiology of workplace violence, NAs in long-term care facilities have been found to represent the occupation most at risk of workplace assault. NAs frequently are subjected to residents’ hitting, scratching, pinching, biting, pulling hair, twisting wrists, spitting, and throwing objects. Verbal assaults include threats of physical harm, cursing, racial slurs, demeaning remarks, screaming, and yelling. In focus groups with NAs and nursing directors at six nursing homes, NAs reported such physical and verbal incidents as occurring on a daily basis, resulting in their feeling “hurt, angry, frustrated, resentful, sad, … violated … fearful” (Gates et al., 1999:17). Unless a physical attack requires medical attention, most violent incidents are not reported for several reasons, including the acceptance of such violence as part of the job; a lack of receptivity and follow-up on the part of administration; and, in five of the six nursing



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