Behavioral choices and enabling conditions for implementing independence-supportive care among nursing assistants in residential aged care facilities in Hunan Province, China: a qualitative study.
- 1School of Nursing, Hunan Normal University, Changsha, Hunan, China.
- 2Kiang Wu Nursing College of Macau, Macao, China.
Abstract
Objective
To explore factors influencing nursing assistants' implementation of independence-supportive care in nursing homes.Methods
A descriptive qualitative study was conducted using purposive sampling. From November 2025 to February 2026, 12 nursing assistants from five nursing homes in Hunan Province, China, participated in semi-structured interviews. The interview data were analyzed using a practical, codebook-oriented thematic analysis approach and subsequently interpreted using the Capability, Opportunity, Motivation-Behavior model.Results
Five themes were identified: (1) knowledge and skills related to independence-supportive care remained unstandardized; (2) residents' functional status, willingness, and expectations of care affected their participation; (3) poor integration between assessment and care planning prevented retained abilities from becoming daily care goals; (4) limited staffing, time, and assistive devices led nursing assistants to take over residents' tasks; and (5) safety risks and accountability pressures promoted risk-averse care. Although nursing assistants used some independence-supportive practices in daily work, these practices were largely based on personal experience and lacked standardized criteria for assessing task-specific abilities and determining appropriate levels of assistance.Conclusion
Nursing assistants' implementation of independence-supportive care is shaped by the interaction of capability, opportunity, and motivation. Residential aged care facilities may consider providing activity-specific training, incorporating retained abilities and graded assistance into care plans, strengthening interdisciplinary collaboration, improving staffing and access to assistive devices, and establishing clear risk-management and shared-accountability mechanisms. Residents and families should also be informed that independence-supportive care is intended to maintain functional abilities rather than reduce the amount or quality of care. The effectiveness of these proposed strategies requires evaluation in future implementation studies.
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BibTeX
@article{chen2026behavioral,
title = {{Behavioral choices and enabling conditions for implementing independence-supportive care among nursing assistants in residential aged care facilities in Hunan Province, China: a qualitative study.}},
author = {Honghu Chen and Xuan Cheng and Jiayu Hou and Jiayu Liao and Weihong Wang},
journal = {Frontiers in public health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1972560},
url = {https://europepmc.org/article/MED/42904248},
note = {CC BY},
}
RIS
TY - JOUR
TI - Behavioral choices and enabling conditions for implementing independence-supportive care among nursing assistants in residential aged care facilities in Hunan Province, China: a qualitative study.
AU - Honghu Chen
AU - Xuan Cheng
AU - Jiayu Hou
AU - Jiayu Liao
AU - Weihong Wang
PY - 2026
DA - 2026/10/06
JO - Frontiers in public health
DO - 10.3389/fpubh.2026.1972560
UR - https://europepmc.org/article/MED/42904248
AB - Objective To explore factors influencing nursing assistants' implementation of independence-supportive care in nursing homes.Methods A descriptive qualitative study was conducted using purposive sampling. From November 2025 to February 2026, 12 nursing assistants from five nursing homes in Hunan Province, China, participated in semi-structured interviews. The interview data were analyzed using a practical, codebook-oriented thematic analysis approach and subsequently interpreted using the Capability, Opportunity, Motivation-Behavior model.Results Five themes were identified: (1) knowledge and skills related to independence-supportive care remained unstandardized; (2) residents' functional status, willingness, and expectations of care affected their participation; (3) poor integration between assessment and care planning prevented retained abilities from becoming daily care goals; (4) limited staffing, time, and assistive devices led nursing assistants to take over residents' tasks; and (5) safety risks and accountability pressures promoted risk-averse care. Although nursing assistants used some independence-supportive practices in daily work, these practices were largely based on personal experience and lacked standardized criteria for assessing task-specific abilities and determining appropriate levels of assistance.Conclusion Nursing assistants' implementation of independence-supportive care is shaped by the interaction of capability, opportunity, and motivation. Residential aged care facilities may consider providing activity-specific training, incorporating retained abilities and graded assistance into care plans, strengthening interdisciplinary collaboration, improving staffing and access to assistive devices, and establishing clear risk-management and shared-accountability mechanisms. Residents and families should also be informed that independence-supportive care is intended to maintain functional abilities rather than reduce the amount or quality of care. The effectiveness of these proposed strategies requires evaluation in future implementation studies.
SN - 2296-2565
ER -