Address correspondence to Sienna Caspar, Interdisciplinary Studies Graduate Program, University of British Columbia, Green College, Green Commons, Room 153A, 6201 Cecil Green Park Rd. Vancouver, BC V6T 1Z1. E-mail:
Gerontologist. 2013 Oct;53(5):790-800. doi: 10.1093/geront/gns165. Epub 2013 Jan 4.
Previous research examining improved provision of individualized care (I-Care) in long-term care (LTC) facilities has primarily considered contextual influences. Using Kanter's theory of structural empowerment, this study explored the relationship among contextual-level characteristics, individual-level characteristics, and access to empowerment structures on LTC staffs' perceived ability to provide I-Care.
Multilevel models were used to examine 567 staffs' (registered nurse [RN], licensed practical nurses [LPN], care aides) reported ability to provide I-Care, nested within 41 LTC facilities. I-Care was first modeled as a function of within-person (e.g., age, job classification, experience) and between-context (e.g., facility ownership status, culture change models) variables. Independent of these predictors, we then assessed the influence of staffs' access to empowerment structures (information, support, opportunities, resources, informal power, and formal power) on reported ability to provide I-Care.
The intraclass correlation coefficient indicated that 91.7% of the total variance in perceived ability to provide I-Care reflected within- versus between-person differences, with the 6 empowerment variables accounting for 31% of this within-person variance independent of the other context- and person-level covariates. In the final model, only informal power (i.e., quality of interprofessional relationships) and resources (i.e., adequate time and supplies) uniquely predicted I-Care. Notably, access to resources also attenuated the significant effect of support, suggesting a possible mediating effect.
These findings suggest that both contextual- and individual-level factors exert considerably less influence on I-Care than factors associated to staffs' perceptions of empowerment. Consequently, interventions aimed at increasing I-Care in LTC settings should carefully consider staffs' access to structural empowerment.
之前研究检查了在长期护理（LTC）机构中提供改进的个性化护理（I-Care），主要考虑了环境影响。本研究利用 Kanter 的结构赋权理论，探讨了环境水平特征、个人水平特征与赋权结构之间的关系，以了解 LTC 工作人员对提供 I-Care 的感知能力。
使用多层模型，检验了 567 名工作人员（注册护士[RN]、持照实习护士[LPN]、护理助理）提供 I-Care 的能力，该能力嵌套在 41 个 LTC 设施中。首先，将 I-Care 建模为个体内（例如，年龄、工作分类、经验）和个体间（例如，设施所有权状况、文化变革模型）变量的函数。在这些预测因素之外，我们评估了工作人员获得赋权结构（信息、支持、机会、资源、非正式权力和正式权力）对提供 I-Care 的能力的影响。
组内相关系数表明，感知提供 I-Care 的能力的总方差中有 91.7%反映了个体内与个体间的差异，6 个赋权变量独立于其他环境和个体水平协变量，解释了个体内方差的 31%。在最终模型中，只有非正式权力（即，跨专业关系的质量）和资源（即，充足的时间和用品）独立地预测了 I-Care。值得注意的是，资源的获取也减弱了支持的显著影响，这表明可能存在中介效应。
这些发现表明，在提供 I-Care 方面，环境和个体水平的因素对工作人员赋权感知的影响要小得多。因此，旨在提高 LTC 环境中 I-Care 的干预措施应仔细考虑工作人员对结构赋权的获取。
