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Despite more than 600,000 teacher aides in American schools today, research provides little information about their classroom activities, their qualifications for carrying out their duties, or their impact on student achievement and behavior. This investigation asked whether the presence of a teacher aide in the classroom has any noticeable impact on pupils’ learning. Three primary questions were addressed: (1) In Grades K through 3, does the presence of a full-time teacher aide in the classroom affect students’ academic achievement? (2) If teacher aides have a positive effect on students’ performance, does the effect depend on the number of years the student attends classes with a teacher aide? (3) Do some functions of aides (i.e., clerical tasks, instructional tasks, noninstructional tasks) have a greater impact on student achievement than others? This investigation showed that the teacher aide movement in the United States has created a state of affairs that requires many aides to perform tasks for which they are ill-prepared. In addition, teacher aide data were analyzed from Tennessee’s Project STAR, a longitudinal experiment in which students were assigned at random to small classes, regular-size classes without an aide, or regular-size classes with a full-time teacher aide. The analyses reported here extend previous investigations, examining the functions and effects of teacher aides in depth. The results showed that teacher aides have little, if any, positive effect on students’ academic achievement. The only positive effect was an improvement in reading scores for students who attended a class with a teacher aide for 2 or 3 years. These results were the only exceptions to a plethora of negative findings. The study also showed that the types of duties aides performed had no bearing on student achievement. Because teacher aides are called upon increasingly to provide instruction to pupils, policies and research must help us select and prepare aides to perform effectively.

In this paper, we present two new communication-efficient methods for distributed minimization of an average of functions. The first algorithm is an inexact variant of the DANE algorithm that allows any local algorithm to return an approximate solution to a local subproblem. We show that such a strategy does not affect the theoretical guarantees of DANE significantly. In fact, our approach can be viewed as a robustification strategy since the method is substantially better behaved than DANE on data partition arising in practice. It is well known that DANE algorithm does not match the communication complexity lower bounds. To bridge this gap, we propose an accelerated variant of the first method, called AIDE, that not only matches the communication lower bounds but can also be implemented using a purely first-order oracle. Our empirical results show that AIDE is superior to other communication efficient algorithms in settings that naturally arise in machine learning applications.

OBJECTIVES: In countries with ageing populations, home care (HC) aides are among the fastest growing jobs. There are few quantitative studies of HC occupational safety and health (OSH) conditions. The objectives of this study were to: (1) assess quantitatively the OSH hazards and benefits for a wide range of HC working conditions, and (2) compare OSH experiences of HC aides who are employed via different medical and social services systems in Massachusetts, USA. METHODS: HC aides were recruited for a survey via agencies that employ aides and schedule their visits with clients, and through a labour union of aides employed directly by clients or their families. The questionnaire included detailed questions about the most recent HC visits, as well as about individual aides' OSH experiences. RESULTS: The study population included 1249 HC aides (634 agency-employed, 615 client-employed) contributing information on 3484 HC visits. Hazards occurring most frequently related to musculoskeletal strain, exposure to potentially infectious agents and cleaning chemicals for infection prevention and experience of violence. Client-hired and agency-hired aides had similar OSH experiences with a few exceptions, including use of sharps and experience of verbal violence. CONCLUSIONS: The OSH experience of HC aides is similar to that of aides in institutional healthcare settings. Despite OSH challenges, HC aides enjoy caring for others and the benefits of HC work should be enhanced. Quantification of HC hazards and benefits is useful to prioritise resources for the development of preventive interventions and to provide an evidence base for policy-setting.

BACKGROUND: Unregulated health care aides provide the majority of direct health care to residents in long term care homes. Lower job satisfaction as reported by care aides is associated with increased turnover of staff. Turnover leads to inferior job performance and negatively impacts quality of care for residents. This study aimed to determine the individual and organizational variables associated with job satisfaction in care aides. METHODS: We surveyed a sample of 1224 care aides from 30 long term care homes in three Western Canadian provinces. The care aides reported their job satisfaction and their perception of the work environment. We used a hierarchical, mixed-effects ordered logistic regression to model the relative odds of care aide job satisfaction for individual, care unit, and facility factors. RESULTS: Care aide exhaustion, professional efficacy, and cynicism were associated with job satisfaction. Factors in the organizational context that are associated with increased care aide job satisfaction include: leadership, culture, social capital, organizational slack-staff, organizational slack-space, and organizational slack-time. CONCLUSIONS: Our findings suggest that organizational factors account for a greater increase in care aide job satisfaction than do individual factors. These features of the work environment are modifiable and predict care aide job satisfaction. Efforts to improve care aide work environment and quality of care should focus on organizational context.

PURPOSE: To examine demographic characteristics and work conditions of home care aides, nursing home aides, and hospital aides in the late 1980s and late 1990s. DESIGN AND METHODS: This study replicated a previous study which examined the Current Population Survey (CPS) March supplement from 1987 to 1989. The present study examined CPS data from 1997 to 1999 both to obtain a profile of aides in the late 1990s and to compare 1990's work conditions and demographic characteristics with those of aides in the late 1980s. RESULTS: Whereas demographic characteristics and work conditions of hospital and nursing home aides show little change over the decade, home care aides today are generally younger, more educated, more likely to hold full-time positions, and more likely to have health benefits than their counterparts 10 years ago. Yet work conditions are still poorer for home care aides than for the other types of aides. IMPLICATIONS: Work conditions need further improvement, particularly for home care aides. More accurate data to describe paraprofessional care workers are also necessary to address the serious worker shortage problems.

Nurses' aides provide the majority of direct care for nursing facility residents. This study investigated aides' self-reported oral care activities and personal, job, organizational, and resident factors associated with oral care. A 30-item questionnaire was completed by 488 aides, and interviews were conducted with 65 of these aides. Aides were performing oral care activities for residents. Associations between some of the four groups of factors proposed and aides' oral care provision were found. Aides' attitudes toward oral care, lack of time and staff to complete oral care, and behavioral and physical difficulties with residents may have affected the time spent by these aides in providing oral care. The study highlighted the need for further investigation and assessment of (1) aides' CNA training courses and (2) continuing oral health educational interventions in nursing facilities. Personal interview were found to be a useful qualitative instrument for conducting dental research in nursing facilities. Further investigation is needed of interviews and other methodologies, such as observation, to supplement self-report as a measure of aides' oral care activities.

PURPOSE: Using a conceptual framework from the field of care work and the theory of boundary work, we explore the use of family metaphors by nurse's aides to describe their affective care for nursing home residents. We focus on how nurse's aides can express affective care in spite of experiencing racial abuse. METHODS: Using the technique of domain analysis, we present a secondary analysis of semistructured interviews with 30 African American and immigrant aides working in three nursing homes about their experience of racism on the job. RESULTS: Aides used metaphors associated with family, relationships, and attachment to describe their affective care of residents. They expressed the value of their caring by contrasting it with "uncaring" families. Immigrant aides expressed a form of caring culture shock about the uncared-for situation of American elders. IMPLICATIONS: Through their use of metaphors of family and attachment, these aides define family care as their gold standard of affective care and communicate that they are attempting to provide good care. Aides distinguished caring tasks from affective care in that they applied affective care in an elective way, so that the caring task was the minimum, universal form of care and added affective care created an enriched form of care. They held out informal elder care in their cultures of origin as a model that is superior to the system of formal elder care in which they work. We use the theory of boundary work to explain how these aides provided affective care in the face of racial abuse.

PURPOSE: This study examines the moderating effect of staff stability on the relationship between management practices used to empower nurse aides and resident outcomes in a multistate sample of nursing homes. An adaptation of Kanter's theory of structural power in organizations guided the framework for the model used in this study. DESIGN AND METHODS: Management practices and nurse aide staff stability measures were taken from a survey of directors of nursing (n = 156) and day-shift charge nurses (n = 430) in a stratified random sample of nursing facilities in Maine, Mississippi, New York, and Ohio (n = 156). Facility risk-adjusted pressure ulcer incidence rates and social engagement scores, taken from the Minimum Data Set, served as resident outcome measures. A hierarchical linear regression model was used to test the moderating effect of staff stability. RESULTS: The situation in which higher numbers of rewards were given to nurse aide staff was associated with lower incidence of pressure ulcers, whereas the situation in which nurse aides had more influence in resident care decisions was associated with higher aggregate social engagement scores. The inclusion of nurse aide staff stability in the regression model provided additional explanatory information for the relationship between management practices and resident outcomes. Facilities experiencing low turnover and high retention were associated with lower pressure ulcer incidence, whereas facilities with high turnover and high retention were associated with higher social engagement scores. IMPLICATIONS: This study suggests that certain management practices used to empower nurse aides can influence resident outcomes. Further, effects of nurse aide staff stability vary with respect to the physical versus psychosocial nature of the outcome.

IMPORTANCE: In Canada, approximately 81% of residents of nursing homes live with mild to severe cognitive impairment. Care needs of this population are increasingly complex, but resources, such as staffing, for nursing homes continue to be limited. Staff risk missing or rushing care tasks and interfering with quality of care and life. OBJECTIVE: To assess the association of work environment with missing and rushing essential care tasks in nursing homes. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used survey data collected from a random sample of 93 urban nursing homes in Western Canada, stratified by health region, owner-operator model, and facility size, between May and December 2017. All 5411 eligible care aides were invited to participate, and 4016 care aides agreed and completed structured, computer-assisted interviews in person. Analyses were conducted from July 4, 2018, to February 27, 2019. MAIN OUTCOMES AND MEASURES: Self-reported number of essential care tasks missed (range, 0-8) or rushed (range, 0-7) in the most recent shift. Two-level random intercept hurdle regressions controlled for care aide, care unit, and nursing home characteristics. RESULTS: Of 4016 care aides, 2757 (68.7%) were 40 years or older, 3574 (89.1%) were women, and 1353 (66.3%) spoke English as an additional language. For their most recent shift, 2306 care aides (57.4%) reported missing at least 1 essential care task and 2628 care aides (65.4%) reported rushing at least 1 essential care task. Care aides on units with more favorable work environments (eg, more effective leadership, better work culture, higher levels of buffering resources) were less likely to miss any care tasks (odds ratio, 1.59; 95% CI, 1.34-1.90; P < .001) and less likely to rush any care task (odds ratio, 1.66; 95% CI, 1.38-1.99; P < .001). CONCLUSIONS AND RELEVANCE: This study found that rates of missed and rushed essential care in Canadian nursing homes were high and were higher in units with less favorable work environments. This finding suggests that work environment should be added to the list of modifiable factors associated with improving nursing home care, as it may be an important pathway for improving quality of care. Further research is needed to understand associations of missed and rushed care and of improving work environments with outcomes among residents of nursing homes.

BACKGROUND: In workplace health promotion, all potential resources needs to be taken into consideration, not only factors relating to the absence of injury and the physical health of the workers, but also psychological aspects. A dynamic balance between the resources of the individual employees and the demands of work is an important prerequisite. In the home care services, there is a noticeable trend towards increased psychosocial strain on employees at work. There are a high frequency of work-related musculoskeletal disorders and injuries, and a low prevalence of sustainable work ability. The aim of this research was to identify factors promoting work ability and self-efficacy in care aides and assistant nurses within home care services. METHODS: This study is based on cross-sectional data collected in a municipality in northern Sweden. Care aides (n = 58) and assistant nurses (n = 79) replied to a self-administered questionnaire (response rate 46%). Hierarchical multiple regression analyses were performed to assess the influence of several independent variables on self-efficacy (model 1) and work ability (model 2) for care aides and assistant nurses separately. RESULTS: Perceptions of personal safety, self-efficacy and musculoskeletal wellbeing contributed to work ability for assistant nurses (R2adj of 0.36, p < 0.001), while for care aides, the safety climate, seniority and age contributed to work ability (R2adj of 0.29, p = 0.001). Self-efficacy was associated with the safety climate and the physical demands of the job in both professions (R2adj of 0.24, p = 0.003 for care aides), and also by sex and age for the assistant nurses (R2adj of 0.31, p < 0.001). CONCLUSIONS: The intermediate factors contributed differently to work ability in the two professions. Self-efficacy, personal safety and musculoskeletal wellbeing were important for the assistant nurses, while the work ability of the care aides was associated with the safety climate, but also with the non-changeable factors age and seniority. All these factors are important to acknowledge in practice and in further research. Proactive workplace interventions need to focus on potentially modifiable factors such as self-efficacy, safety climate, physical job demands and musculoskeletal wellbeing.

Nursing aides (18 women and six men) at one traditional and one modern geriatric ward, and warehouse workers (16 men) at two different types of warehouse departments were studied during occupational work. The vertical load during manual handling was measured using strain gauges built into wooden shoes. The warehouse workers performed four times as many lifts as the nursing aides and transferred five times as great a mass per unit time. Less than 25% of the lifts were carried out with the load evenly distributed on both feet during both the upward lift and lowering. In the warehouses the lifts were short, while the nursing aides were exposed both to lifts of longer duration and to carrying, as well as a greater frequency of unexpected, sudden and high peak load. The heart rate and oxygen uptake values recorded were relatively low, and both groups utilized approximately 25% of their maximum aerobic power. According to official occupational injury statistics, both warehouse workers and nursing aides belong to risk groups with a high frequency of reported back injuries. However, more injuries are reported by nursing aides than by warehouse workers. Greater muscle strength in male workers may partly explain this difference. Qualitative differences in the design of the lifting work, with more lifts of long duration in awkward work postures, more carrying, more exertion of horizontal forces and a greater frequency of unexpected rapid lifts in the nursing aides may also contribute to the differences in risk of injury between these occupational groups. Considerable differences were found between the two hospital wards as regards lifting frequency, force, duration and the proportion of lifts with an even distribution of load on both feet during upward lift. The lifting work was approximately 50% less in the modern ward, which has easily maneuvered electric overhead hoists, spacious premises and better work organization than in the traditional ward, even though the patient handling needs were equivalent. In the warehouse department at which the wares were stored with easy access, the frequency of lifts with an even distribution of load on both feet was approximately 25%, compared to 7% in the other warehouse department. In conclusion, evaluations of occupational lifting work should include a quantitative assessment of the duration and load distribution of lifting, as well as of postures. Workstation design, technical aids and work organization have a profound effect on the lifting work load even in jobs with equal manual handling demands.

PURPOSE: The relationship between job satisfaction of nurse aides and intent to leave and actual turnover after 1 year is examined. DESIGN AND METHODS: Data came from a random sample of 72 nursing homes from 5 states (Colorado, Florida, Michigan, New York, and Oregon). From these nursing homes, we collected 1,779 surveys from nurse aides (a response rate of 62%). We used a job satisfaction instrument specifically developed for use with nurse aides, as well as previously validated measures of intent to leave and turnover. We used ordered logistic regression and logistic regression to examine the data. RESULTS: High overall job satisfaction was associated with low scores on thinking about leaving, thinking about a job search, searching for a job, and turnover. In examining the association between the job satisfaction subscales and intent to leave and turnover, we found that high Work Schedule subscale scores, high Training subscale scores, and high Rewards subscale scores were associated with low scores on thinking about leaving, thinking about a job search, searching for a job, and turnover. High scores on the Quality of Care subscale were associated with low turnover after 1 year. IMPLICATIONS: These results are important in clearly showing the relationship between job satisfaction and intent to leave and turnover of nurse aides. Training, rewards, and workload are particularly important aspects of nurse aides' jobs.

This article uses data from the 1987, 1988, and 1989 Current Population Surveys (CPS) to compare the characteristics of hospital, nursing home, and home care aides. The different types of aides were identified through cross-tabulations of the detailed industry and occupation codes available in the CPS. The results verify previous findings in the literature that home care workers tend to be older, less likely to be married, and have poorer educations than other types of aides. In addition, the three types of aides fall into a clear economic continuum with hospital aides tending to be the most affluent, followed by nursing home aides, and finally, by home care workers.

Despite an increasing literature on professional nurses' job satisfaction, job satisfaction by nonprofessional nursing care providers and, in particular, in residential long-term care facilities, is sparsely described. The purpose of this study was to systematically review the evidence on which factors (individual and organizational) are associated with job satisfaction among care aides, nurse aides, and nursing assistants, who provide the majority of direct resident care, in residential long-term care facilities. Nine online databases were searched. Two authors independently screened, and extracted data and assessed the included publications for methodological quality. Decision rules were developed a priori to draw conclusions on which factors are important to care aide job satisfaction. Forty-two publications were included. Individual factors found to be important were empowerment and autonomy. Six additional individual factors were found to be not important: age, ethnicity, gender, education level, attending specialized training, and years of experience. Organizational factors found to be important were facility resources and workload. Two additional factors were found to be not important: satisfaction with salary/benefits and job performance. Factors important to care aide job satisfaction differ from those reported among hospital nurses, supporting the need for different strategies to improve care aide job satisfaction in residential long-term care.

BACKGROUND: Nurses' aides (assistant nurses), the main providers of practical patient care in many countries, are doing both emotional and heavy physical work, and are exposed to frequent social encounters in their job. There is scarce knowledge, though, of how working conditions are related to psychological distress in this occupational group. The aim of this study was to identify work factors that predict the level of psychological distress in nurses' aides. METHODS: The sample of this prospective study comprised 5076 Norwegian nurses' aides, not on leave when they completed a mailed questionnaire in 1999. Of these, 4076 (80.3 %) completed a second questionnaire 15 months later. A wide spectrum of physical, psychological, social, and organisational work factors were measured at baseline. Psychological distress (anxiety and depression) was assessed at baseline and follow-up by the SCL-5, a short version of Hopkins Symptom Checklist-25. RESULTS: In a linear regression model of the level of psychological distress at follow-up, with baseline level of psychological distress, work factors, and background factors as independent variables, work factors explained 2 % and baseline psychological distress explained 34 % of the variance. Exposures to role conflicts, exposures to threats and violence, working in apartment units for the aged, and changes in the work situation between baseline and follow-up that were reported to result in less support and encouragement were positively associated with the level of psychological distress. Working in psychiatric departments, and changes in the work situation between baseline and follow-up that gave lower work pace were negatively associated with psychological distress. CONCLUSION: The study suggests that work factors explain only a modest part of the psychological distress in nurses' aides. Exposures to role conflicts and threats and violence at work may contribute to psychological distress in nurses' aides. It is important that protective measures against violent patients are implemented, and that occupational health officers offer victims of violence appropriate support or therapy. It is also important that health service organisations focus on reducing role conflicts, and that leaders listen to and consider the views of the staff.

BACKGROUND: Nursing aides' attitudes condoning elder abuse are a possible risk factor for executing abusive behaviors against elder residents of long-term care facilities but have been studied infrequently. PURPOSE: The purpose of the study was to assess nursing aides' attitudes that condone abusive behaviors toward elderly people, as well as the relationship of these attitudes to demographic variables, work stressors (role conflict, role ambiguity, and work overload), burnout, and perceived control, based on the theory of planned behavior (Ajzen, 1988, Attitudes, personality and behavior. Milton Keynes: Open University Press) DESIGN AND METHODS: Two hundred and eight nursing aides from 18 nursing homes in Israel completed demographic, work stressors, burnout, and perceived control questionnaires and a case vignette questionnaire to test attitudes condoning elder abuse. RESULTS: The mean score of the attitudes condoning abusive behaviors was relatively high at 3.24 (SD = 0.59) on a 1-4 scale. Condoning abusive behaviors were closely associated with higher levels of work stressors, burnout, and low income. Multiple regression analyses revealed that demographic variables, work stressors, burnout, and perceived control explained 12% of the variance of condoning abusive behaviors among the nursing aides. Of these, role ambiguity, role conflict, and burnout were significantly associated with attitudes condoning abusive behaviors. In addition, burnout partially mediated the relationship between work stressors and attitudes condoning elder abuse. CONCLUSIONS: As nursing aides' attitudes condoning elder abuse may influence their actual behaviors, training and supervision programs should be developed to reduce work stressors and burnout and to modify these attitudes.

This study assessed a strategy to promote independent engagement in selected activities for children with disabilities in three integrated public school classrooms. A nonconcurrent multiple-baseline design, replicated across two aide-child pairs, was used to evaluate the effectiveness of a sequence of instructions about prompt reduction for integration aides and the use of photographic activity schedules on aides' prompting and children's engagement. During intervention, there was an increase in independent engagement for all children. Instructional sessions, reminders to reduce prompts, and all instruction to use physical prompts only, resulted in low levels of prompts by all integration aides. On a brief questionnaire, all aides expressed their satisfaction with the program. These findings have important implications for staff training in public school settings, and for promoting the independence of children in integrated classrooms.

• Individual and organizational factors precipitate or buffer HCA burnout. • Individual buffers of burnout focus on subjective appraisal of work environment. • Organizational factors that increase time to complete tasks precipitate burnout. • Identified interventions are primarily educational programs of limited utility. • Research should investigate causal relationships between factors affecting burnout. To systematically review the evidence on factors that influence burnout in health care aides working in nursing homes. Systematic literature review. Two search engines (Google and EBSCO Discovery Service) and five databases (MEDLINE, Scopus, CINAHL, PsycINFO and Proquest Dissertations & Theses) through to August 2013. Keywords: nursing home, health care aide and burnout (all synonyms were included). Two authors independently assessed methodological quality, data extraction, analysis and synthesis on the 10 included publications. 100% reliability was found between the first and second authors. Data extracted included precipitating and buffering factors related to burnout, interventions and demographic information for the health care aide population. Data were synthesized according to individual and organizational factors. Our search and screening yielded 2787 titles and abstracts resulting in 83 manuscripts for full manuscript review and 10 included publications. Methodological quality assessments revealed 3 (30%) rated as low quality, 7 (70%) rated as medium quality. Independent variables were categorized as either individual or organizational factors . Methodological problems and heterogeneity in independent and dependant variables yielded few significant results. Only personal life (attributes of provider) was found to significantly buffer burnout (depersonalization, emotional exhaustion and personal accomplishment). Equivocal evidence was found for many of the organizational factors (work environment, workload and facility) supporting the need for further robust studies in this field. Of the two intervention studies, only dementia care mapping, and training in organizational respect buffered burnout. Factors associated with burnout in health care aides are similar to those reported among nurses, although the level of evidence and low methodological rigor of these studies suggest more robust study designs are warranted. Our findings suggest research focused on this important but largely invisible group of care providers could yield important advances in understanding burnout in this group and yield potential interventions to buffer burnout and its consequences. Without mitigating the effects of burnout on nursing home health care aides, vulnerable older adults in residential care are at risk.

AIMS: To identify the work factors that predict sickness absence in nurses' aides. METHODS: The sample comprised 5563 Norwegian nurses' aides, not on leave because of illness or pregnancy when they completed a mailed questionnaire in 1999. Of these, 4931 (88.6%) completed a second questionnaire three months later. The outcome measure was the three month incidence proportion of certified sickness absence (>3 days), as assessed by self reports at follow up. RESULTS: Perceived lack of encouraging and supportive culture in the work unit (odds ratio (OR) 1.73; 95% confidence interval (CI) 1.28 to 2.34), working in psychiatric and paediatric wards, having injured the neck in an accident, and health complaints were associated with higher risk of sickness absence, after adjustments for a series of physical, psychological, and organisational work factors, personal engagement in the work unit, demographic characteristics, and daily consumption of cigarettes. Having untraditional jobs (for nurses' aides) (OR 0.53; 95% CI 0.36 to 0.77), and engaging in aerobics or gym were associated with a lower risk of sickness absence. CONCLUSIONS: The study suggests that the three month effects of work factors on rates of certified sickness absence are modest in nurses' aides. The most important work factor, in terms of predicting sickness absence, seems to be perceived lack of encouraging and supportive culture in the work unit.