Stress, strength, and respect: Viewing direct care staff experiences through a trauma-informed lens.

Trauma-informed approaches may promote the well-being of CNAs and disrupt organizational practices that perpetuate inequities. There is a dearth of literature addressing evidence-based, trauma-informed training for direct care staff, yet CMS now requires trauma-informed care in nursing homes. Five focus groups exploring trauma and resilience-related concepts were conducted using an expressive-collaborative model with 18 CNAs at four nursing homes. A thematic analysis was conducted and themes were identified related to identity, relationships with residents, organizational values, and personal wellness. CNAs voiced frustration at limited time and support to implement well-being or stress management practices. Relationships with residents were sources of strength and, conversely, sources of emotional injury due to disrespect, disregard, and hostile behavior directed at CNAs. Central to health and well-being, CNAs called for change within facility cultures experienced as disrespectful, inequitable, and contrary to work-life balance. Trauma-informed training can be used to give particular attention to direct care staff. Administrators would benefit from learning about trauma and resilience among CNAs and precipitating organizational factors such as reasonable care ratios, equitable benefits, and peer support that impact CNA well-being, job satisfaction, and quality of care. The development and implementation of a trauma-informed training curriculum for CNAs are warranted.