Job characteristics, personal characteristics and well-being of nursing assistants in long-term care facilities: A mixed methods systematic review and narrative synthesis

Background: Within long-term care facilities, paraprofessional nursing assistants account for the largest proportion of the health care workforce and provide essential direct care to older people with complex care needs. There is a gap in developing a theory-driven, systematic synthesis of the job characteristics and well-being outcomes specific to this occupational group, as most existing studies evaluate either professional health care workers or both professional and nursing assistants. Aim: Develop an occupation-specific conceptual model on the job characteristics and well-being of nursing assistants in long-term care facilities drawing upon the job demands-resources model. Design: Mixed methods systematic review following the Joanna Briggs Institute approach. The review protocol was registered on PROSPERO (2023 CRD42023403654). Methods: The review included qualitative, quantitative, and mixed-method studies meeting these inclusion criteria: (1) peer-reviewed empirical research; (2) involved paraprofessional nursing assistants in long-term care facilities; (3) addressed well-being outcomes; (4) addressed occupation-specific job characteristics. Studies that are (1) not written in English, or (2) published before 1 January 2000 were excluded. A convergent synthesis approach was conducted using the content analysis method. Data sources: Database searches (i.e., MEDLINE, PsycINFO, Embase, CINAHL, Web of Science, Scopus, and Google Scholar) and manual searches were conducted. The last search was conducted on July 31st, 2024. Results: A Nursing Assistants Job Demands-Resources Model was developed based on 21 studies included. Nursing assistants are particularly vulnerable to burnout and mental health conditions, as well as occupational hazards, because of their job characteristics. Working time demands, physical care task stressors, and emotional demands are occupation-relevant job demands, while financial rewards, professional development resources, work environment, and emotional resources are motivational job resources. Strain-related personal characteristics are also relevant to nursing assistants. Findings indicated a spiral of vulnerabilities characterized by the vicious cycle of individual vulnerabilities, poor quality job, and health inequalities among nursing assistants in long-term care facilities. Conclusion: This study finds that empirical evidence on nursing assistants' job characteristics and well-being is underdeveloped compared to research focusing on professional and all health care workers. We adapt a conceptual model and identify job and personal characteristics specific to the occupation group. Occupational-specific macro, meso, and micro-level strategies that mitigate job demands and nurture job resources should be developed to tackle the occupational health disparities that nursing assistants face in long-term care facilities. Registration: The protocol of this study was registered on PROSPERO (2023 CRD42023403654).