Background: Certified Nursing Assistant (CNA) are responsible for assisting long-term care (LTC) residents in activities of daily living (ADLs) such as bathing, dressing, mobility, and feeding. When CNAs provide too much ADL assistance, functional decline and disability often result. LTC facilities are mandated to provide quality care that enables residents to maintain their highest level of physical well-being (OBRA, 1987). However, poor CNA job performance and job satisfaction are common obstacles in the LTC industry, influencing the quality of care and care outcomes of LTC residents. Purpose: The purpose of this study was to test a hypothesized model of factors related to CNA job performance and job satisfaction using path analysis procedures. The Core Self-Evaluations (CSE) model and Social Cognitive Theory served as the theoretical framework for the study. Methods: This was a secondary data analysis that utilized baseline data obtained from the 504 CNAs, employed in 12 LTC facilities, who participated in the Res-Care study (Resnick et al., 2007). Results: The majority of CNAs were female (93%) and African American (89%). The average CNA age was 39 (SD=12.1). Path analysis results showed that age and self-efficacy (challenges associated with restorative care) were positively related to CNA job satisfaction. Self-esteem was negatively related to CNA job satisfaction and positively related to self-efficacy. None of the variables in the model were related to CNA job performance. Fit statistics showed a good fit of the model to the data (χ<super>2</super> = 9.3, df= 6, χ<super>2</super>/df ratio = 21.6, RMSEA =.03[.00 - .07], CFI = .99). Conclusions: The findings provided partial support for the hypothesized model and utility of the CSE model and Social Cognitive Theory in CNAs. The negative relationship between CNA self-esteem and job satisfaction could have been due to confounding work-related variables. Future research should examine the mediating and moderating effects of job characteristics and organizational characteristics on CNA self-esteem and job satisfaction.

Purpose: To test the feasibility and efficacy of the Worksite Heart Health Improvement Project (WHHIP) Design: This was a quasi-experimental six-month repeated measures pilot study Setting: Two long-term care (LTC) facilities in the Baltimore area participated in the study Subjects: A total of 39 female nursing assistants (NAs) participated in this study with a mean age of 42.39 (SD= 12.79) years. The majority were married (n=16, 51.6%), non-Latino (n=14, 77.8%) and African-American (n=31, 93.9%). Intervention: The three-month WHHIP intervention included three components: (1) environmental and policy assessment; (2) education; and (3) on-going motivation. The control site received education only. Measures: Measures were collected at baseline, three and six months and included: blood pressure, lipid panel, body mass index, physical activity levels, diet behaviors, depressive symptoms and self-efficacy outcomes. Analysis: Generalized estimating equations were used to assess outcome variables. Results: Subject participation averaged 47% and 58% in exercise and diet related activities, respectively. The treatment group showed significant improvements in depressive symptoms (p.012), systolic blood pressure (p.028), total cholesterol (p.002) and triglycerides (p.011) overtime. In addition, there was a significant improvement in average aerobic steps (p.053) at three-months. This improvement was not sustained at six-months. The treatment group also showed positive trends for improvement in diet behaviors (p.069) and diastolic blood pressure (p.073). Conclusions: This study provided evidence for the feasibility of the WHHIP and preliminary evidence that the WHHIP can improve adherence to heart healthy behaviors and subsequent outcomes among NAs in LTC settings.