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Developing a framework to inform staffing models for long- term care facilities in resource-constrained contexts
Thesis (PhD)--Stellenbosch University, 2024.
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Stellenbosch : Stellenbosch University
2025
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| _version_ | 1867613792056115200 |
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| access_status_str | Open Access |
| author | Nicholson, Emerentia Cynthia |
| author2 | Van der Heever, Mariana |
| author_browse | Nicholson, Emerentia Cynthia Van der Heever, Mariana |
| author_facet | Van der Heever, Mariana Nicholson, Emerentia Cynthia |
| author_sort | Nicholson, Emerentia Cynthia |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description | Thesis (PhD)--Stellenbosch University, 2024. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/131866 |
| institution | Stellenbosch University (South Africa) |
| last_indexed | 2026-06-10T12:41:46.341Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2025 |
| publishDateRange | 2025 |
| publishDateSort | 2025 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/131866 Developing a framework to inform staffing models for long- term care facilities in resource-constrained contexts Nicholson, Emerentia Cynthia Van der Heever, Mariana Young, Cornelle Van der Merwe, Anita Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nursing and Midwifery. Long-term care facilities Nursing homes Old age assistance Older people -- Long-term care UCTD Thesis (PhD)--Stellenbosch University, 2024. ENGLISH SUMMARY: Background: The exponential ageing of the world population and corresponding care needs indicate a need to plan for the long-term care of older people. With residents in long-term care facilities (LTCFs) having higher acuity levels, the health workforce must comprise adequate and suitable staff appropriately allocated to meet residents' needs despite scarce resources. However, LTCFs find it difficult to maintain adequate staffing levels and provide a skill mix to ensure quality resident care while staying within the framework of the nurses' scope of practice and caregivers' scope of work. This study focused on exploring the implementation of nurse and caregiver staffing models in LTCFs. The aim of the study was to develop a framework to inform staffing models for LTCFs in resource-constrained contexts. Methods: The study was conducted in three phases from a critical realism perspective. Phase 1 included the concurrent completion of a scoping review and holistic multiple-case study. In the scoping review, four databases were searched using specific search terms, and the final sample comprised 20 studies. The holistic multiple-case study included a document review and interviews in one state-subsidised and one private for-profit LTCF in the Cape Metropole, South Africa. Purposive sampling was employed to select 45 documents for review and nineteen participants for semi-structured interviews in the two LTCFs. All the data was analysed through an inductive thematic analysis process. The scoping review and holistic multiple-case study findings were triangulated in Phase 2. In Phase 3, the triangulated data were used to develop a framework to inform staffing models for LTCFs in resource-limited contexts. Seven experts were purposefully selected, and they validated the framework. Findings: More caregivers and fewer nurses were employed in the LTCFs. This led to fewer qualified nurses in the skill mix and shifting tasks to less qualified nurse categories and caregivers beyond their scope of practice and work scope. Consequently, caregivers provided most of the resident care, overburdening ths category. Staff allocation practices did not consider residents’ acuity levels. Thus, residents received the same basic care regardless of needing more skilled care. Managers, nurses, and caregivers seemed oblivious to the legal implications of working beyond a designated scope of practice or job scope or of failing to meet legal staffing requirements. Additional barriers to implementing a staffing model that influenced the nurses’ and caregivers’ wellbeing were overly harsh disciplinary measures, a lack of management support, managers’ verbal communication which suggested bullying, and the absence of staff meetings and in-service training. Conclusion: The LTCFs implemented aspects of the prescribed staffing model by seemingly using a low-cost one. By over-employing caregivers but fewer nurses, vulnerable older persons were often deprived of care provided by more qualified staff and potentially higher-quality care than they were entitled to. This framework provides a roadmap for role players in LTCFs to ensure adherence to legal requirements, balance cost-effectiveness with quality resident care, and facilitate staff wellbeing. AFRIKAANSE OPSOMMING: Agtergrond: Die vinnige toename in die veroudering van die wereldpopulasie en ooreenkomstige versorgingsbenodigdhede dui op 'n behoefte om vir die langtermynversorging van ouer mense te beplan. Met inwoners in langtermynsorgfasiliteite wat hoër akuutheidsvlakke het, moet die gesondheidswerkmag uit voldoende en geskikte personeel bestaan wat toepaslik toegewys word ten spyte van skaars hulpbronne om in die inwoners se behoeftes te voorsien. Langtermynsorgfasiliteite vind dit moeilik weens personeeltekorte om voldoende personeelgetalle te handhaaf en 'n vaardigheidsmengsel te verskaf om kwaliteit inwonersorg te verseker terwyl hulle binne die raamwerk van die verpleegsters se praktykomvang en versorgers se werkomvang bly. Hierdie studie het gefokus daarop om die implementering van verpleegster- en versorgerspersoneelmodelle in langtermynsorgfasiliteite te verken. Die doelwit was om 'n raamwerk te ontwikkel om personeelmodelle vir langtermynsorgfasiliteite in hulpbronbeperkte kontekste in te lig. Metodes: Die studie is vanuit 'n kritiese realisme-perspektief uitgevoer en het uit drie fases bestaan. Fase 1 het die gelyktydige uitvoering van 'n literatuuromvangsoorsig en meervoudige gevallestudie ingesluit. In die literatuuromvangsoorsig is spesifieke soekterme gebruik om vier databasisse te deursoek, en die finale steekproef het uit 20 studies bestaan. Die meervoudige gevallestudie het 'n dokumentoorsig en onderhoude in een staatsgesubsidieerde en een privaat langtermynsorgfasiliteit met ‘n winsoogmerk in die Kaapse Metropool, Suid-Afrika, ingesluit. Doelgerigte steekproefneming is gebruik om 45 dokumente vir hersiening en negentien deelnemers vir semi-gestruktureerde onderhoude in die twee langtermynsorgfasiliteite te kies. Al die data is deur middel van 'n induktiewe tematiese ontledingsproses ontleed. Die bevindinge wat verkry is uit die literatuuromvangsoorsig en meervoudige gevallestudie is in Fase 2 getrianguleer. In Fase 3 is die getrianguleerde data gebruik om 'n raamwerk te ontwikkel om personeelmodelle vir langtermynsorgfasiliteite in hulpbronbeperkte kontekste uit te lig. Sewe kundiges is doelgerig gekies en het die raamwerk bekragtig. Bevindinge: Meer versorgers en minder verpleegkundiges is in die langtermynsorgfasiliteite in diens geneem. Dit het daartoe gelei dat minder gekwalifiseerde verpleegkundiges in die vaardigheidsverskeidenheid beskikbaar was en take na minder gekwalifiseerde verpleegsterskategoriee en versorgers buite hul praktyk- en werkomvang verskuif was. Gevolglik het versorgers die meeste van die inwonersorg verskaf, wat die versorgers oorlaai het. Personeeltoewysingspraktyke het nie inwoners se akuutheidsvlakke in ag geneem nie. Inwoners het dus dieselfde basiese sorg ontvang, ongeag of hulle meer vaardige sorg nodig gehad het. Bestuurders, verpleegsters en versorgers was skynbaar onbewus van die wetlike implikasies daarvan om buite 'n aangewese praktykomvang of werksomvang te werk of om nie aan die wetlike personeelvereistes te voldoen nie. Bykomende struikelblokke in die implementering van 'n personeelmodel wat die welstand van verpleegsters en versorgers beinvloed het, was dissiplinere maatreels wat te streng was, 'n gebrek aan bestuursondersteuning, bestuurders se verbale kommunikasie wat boelie-gedrag aangewys het, en die afwesigheid van personeelvergaderings en indiensopleiding. Gevolgtrekking: Die langtermynsorgfasiliteite het aspekte van die voorgeskrewe personeelmodel geimplementeer deur oenskynlik 'n laekoste-personeelmodel te gebruik. Deur meer versorgers maar minder verpleegsters in diens te neem, was kwesbare ouer persone dikwels ontneem van sorg vanaf meer gekwalifiseerde personeel en dus potensieel hoer gehalte sorg as wat hulle ontvang het en op geregtig was. Hierdie raamwerk verskaf 'n padkaart vir rolspelers in langtermynsorgfasiliteite om nakoming van wetlike vereistes te verseker, koste-effektiwiteit met kwaliteit inwonersorg te balanseer en personeelwelstand te bevorder. Doctoral 2025-04-04T07:03:33Z 2025-04-04T07:03:33Z 2024-12 Thesis https://scholar.sun.ac.za/handle/10019.1/131866 Stellenbosch University xviii, 319 pages : illustrations, includes annexures application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Long-term care facilities Nursing homes Old age assistance Older people -- Long-term care UCTD Nicholson, Emerentia Cynthia Developing a framework to inform staffing models for long- term care facilities in resource-constrained contexts |
| title | Developing a framework to inform staffing models for long- term care facilities in resource-constrained contexts |
| title_full | Developing a framework to inform staffing models for long- term care facilities in resource-constrained contexts |
| title_fullStr | Developing a framework to inform staffing models for long- term care facilities in resource-constrained contexts |
| title_full_unstemmed | Developing a framework to inform staffing models for long- term care facilities in resource-constrained contexts |
| title_short | Developing a framework to inform staffing models for long- term care facilities in resource-constrained contexts |
| title_sort | developing a framework to inform staffing models for long term care facilities in resource constrained contexts |
| topic | Long-term care facilities Nursing homes Old age assistance Older people -- Long-term care UCTD |
| url | https://scholar.sun.ac.za/handle/10019.1/131866 |
| work_keys_str_mv | AT nicholsonemerentiacynthia developingaframeworktoinformstaffingmodelsforlongtermcarefacilitiesinresourceconstrainedcontexts |