Summary

Patient attendants (PABs, for préposes aux bénéficiaires) are responsible for carrying out all activities that involve assisting patients in residential and long-term care centres (CHSLDs) in Québec. They serve a vital function in the CHSLDs, at a time when the aging population is growing, the physical and cognitive problems of residents are worsening, and the task of meeting their needs is becoming increasingly complex. PABs also constitute a vulnerable occupational category in the health and social services sector in Québec, particularly in terms of occupational health and safety (OHS). They represent the occupation at the greatest risk of sustaining occupational injuries in this sector and account for a large number of sick leave days attributable to musculoskeletal disorders (MSDs) or psychological problems.

More specifically, it is often a question of “lack of time” that PABs cite when they are asked about the concrete issues they face in their work. They mention first and foremost their inability to establish quality interpersonal relations with residents. Their difficulty stems from having to meet the hard-to-reconcile objectives of the CHSLDs, namely, administering all the required daily care to residents while also ensuring quality services. Several recent studies mention that, to reconcile these apparently contradictory objectives, PABs try to regulate their work pace by developing and applying specific strategies, so-called “time constraint regulation strategies.” They use these strategies as a means of speeding up their work pace and successfully completing a specific number of tasks within a limited timeframe. According to the literature, far from applying the practices they learned during training in their real work environment, PABs are more likely to collectively create strategies for regulating time constraints that were not taught during their initial training.

However, a training program exists that was developed by the Association paritaire pour la santé et la sécurité du travail du secteur affaires sociales (ASSTSAS) and is designed to pass on to all PABs useful and effective practices for preventing occupational injuries. The name of this training program is Principes de déplacement sécuritaire des bénéficiaires (PDSB) [safe patient handling principles]. The aim of this research project was to determine whether the time constraint regulation strategies created and used by PABs in fact limit their uptake and general application of the principles taught in the PDSB program, particularly among the least experienced PABs. The hypothesis formulated was that these strategies have a major impact on PABs’ work and are largely the result of the time constraints imposed by the care team (nurses, nurses’ aides, etc.) and the other departments of the CHSLD (recreational services, food services, etc.).

This qualitative study involved conducting 22 semi-structured interviews with various stakeholders in CHSLDs (PABs, union representatives, preventionists, nurses’ aides, nurses, unit heads, administrative managers), as well as observation and self-confrontation sessions with inexperienced PABs, in three different CISSS/CIUSSS (integrated health and social service centres/integrated university health and social services centres).

The general finding of this study was that the way the work is organized clearly complicates PABs’ uptake and application of the principles taught in the PDSB program. Several contributing factors were identified. First, workload intensification leads to a tight work routine and has to do with the presence of time constraints, i.e. greater concern with productivity than with OHS in order to reduce the cognitive workload associated with the fact of having to “finish on time.” In this sense, PABs regard OHS more as a psychological health issue associated with needing to be able to meet the workload objectives that have been set; success in doing so is considered a sign of competence. Second, there are insufficient organizational and physical resources available to allow mastery of the PDSB-related issues, namely, inadequate time for integrating recruits, lack of work spaces and equipment, and lack of support from superiors. The third factor identified concerns the low participation of PABs in the work organization process, even though their participation could reduce conflicts between productivity issues, interpersonal relations issues, and OHS issues. The fourth and last factor is the fact that administrative managers delegate the responsibility for PDSB training to PABs via unit heads, nurses, and nurses’ aides. From the managers’ perspective, the PABs become individually responsible for assimilating and applying the principles taught in the PDSB program, regardless of the organizational constraints associated with this responsibility.

PABs’ practices are not totally devoid of the principles taught in the PDSB program. The PABs draw on some of the knowledge acquired in the program to perform their various manoeuvers and activities. However, it appears clear that in the context of their activities, they have little time to think about the instructions given about implementing the principles taught in the program, mainly due to the work pace they say they are obliged to maintain. They also bemoan the fact that there is no time to reflect on the application of the principles taught in the program other than during the integration phase, during PDSB program follow-up, and when follow-up agents are present or a work accident occurs. Otherwise, the workload intensity and the obligation to respect time constraints create a routine that incorporates a variety of time constraint regulation strategies, in turn complicating the uptake and application of the principles taught in the PDSB program.

Two cross-cutting recommendations emerged from the study. First, any proposed enhancement to the PDSB training program must take into account the intensity of the PABs’ workload and the presence of time constraints that result in an organizational routine and the use of time constraint regulation strategies. It should be pointed out that a good fit between the training provided and the organizational reality faced by PABs is key to the success of the PDSB training program. The second recommendation concerns the need to place value on PABs and to have them participate in the CHSLDs’ organizational decisions having direct impact on them. These establishments must give PABs the opportunity to express their viewpoints on issues they may potentially face in their work environment, primarily regarding their difficulties in applying the knowledge acquired during training.