"It doesn't require much effort once you get to know them": Certified nursing assistants' views of communication in long-term care

Certified nursing assistants (CNAs) provide the majority of hands-on care and become highly sensitive to residents' communication behaviors. Yet, CNAs feel disempowered when communicating residents' concerns to higher levels of authority. A grounded theory approach using focus group interviews with 23 CNAs was used to describe the communication environment in long-term care (LTC) and explore CNAs' perceptions of the acceptability of communication plans, a recent Canadian intervention to facilitate resident-staff communication. Findings suggest the communication environment in LTC relates to three overlapping constructs: (a) CNA and resident communication style; (b) paradox of context; and (c) dedication to residents. Although CNAs frequently interact with residents, a division between "top and bottom staff" communication was apparent in the findings. The current study suggested that communication plans may improve the communication environment in LTC settings.