What are staff attitudes, knowledge and behaviours?
Staff attitudes, knowledge and behaviours fundamentally shape how care is provided and the experience of how care is received. Staff attitudes, knowledge and behaviours are shaped by both qualities of the individual providing care and systemic or organisational factors.
Staff attitudes, knowledge and behaviours that adopt rights-based care principles are critical to the quality of life of older people receiving care and fostering a sense of autonomy, dignity, safety and respect.
The Strengthened Aged Care Quality Standards, Standard 2: The organisation, specifies the ways organisations and the aged care workforce must operate to deliver rights-based care.
How are staff attitudes, knowledge and behaviours barriers to rights-based care?
Staff attitudes as barriers to rights-based care
Ageist attitudes, including the use of ageist labels and language, compromises the provision of dignified care. [1, 2]
Care staff may experience a moral dilemma when their cultural or religious beliefs conflict with the rights, needs or identities of people from diverse backgrounds, including people who identify as LGBTIQ+. When not explicitly addressed, this tension can contribute to discriminatory attitudes or behaviours. [3] For more information about bias, discrimination and exclusion see diversity considerations for rights-based care.
Moral or personal beliefs of staff can also influence decisions around sexual expression of older people, including people living with dementia, in residential care. [4, 5]
System and organisational policies and procedures can play a role in shaping staff attitudes. Management can influence how aged care workers feel about and perform their jobs. In situations where workers don’t feel supported to develop their skills, or feel management have no regard for their wellbeing, workers experience increased job stress. [6] Factors such as low wages, understaffing and shift work impact negatively care workers motivation to deliver the best quality care. [7] Read more about staff burnout and aged care workforce retention.
Knowledge gaps as barriers to rights-based care
While care organisations broadly acknowledge and support human-rights based approaches to care, there is often a lack of understanding of how to embed these in practice. [8, 9] There are many acknowledged tensions for staff between allowing autonomy and dignity of risk while also getting through required routines and supporting healthy, safe behaviours. [2, 8, 10, 11]
Staff may lack training in applying communication methods that help older people voice their preferences. [12] Staff may also face moral uncertainty when their own values conflict with care practices intended to uphold dignity for older people with specific conditions, such as dementia. Without appropriate training, staff may interpret dignity in different ways, leading to inconsistent care or disregarding resident preferences. [5, 13, 14] Read more about dementia, cognitive impairment and capacity considerations.
Care planning processes often exclude direct care staff, despite their close knowledge of an older person’s needs and preferences. This exclusion can create knowledge gaps in providing the most appropriate care. [7, 15]
Staff behaviours as barriers to rights-based care
One of the most widely recognised barriers to promoting autonomy and choice is depersonalisation of care through rigid institutional policies and practices, including imposed schedules, routines and general rules that restrict individual decision-making. [2, 16-18] For example, care staff taking over feeding an older person who is eating slowly, rather than allowing them to do it themselves, in the interest of speeding things up. It is important to distinguish between providing desirable assistance and infringing on an older person’s autonomy and dignity. [19, 20]
Task-oriented care can take priority over meeting older people’s emotional needs, even when workers want to provide a more person-centred approach, due to time constraints and heavy workloads. [7, 15]
The autonomy of older people can be compromised when workers defer to family members, rather than the wishes of the older person receiving care. [1, 21] Substitute decision-making can persist due to structural factors like time pressures, limited training and family pressure. [9]
Inconsistent staff approaches and attitudes can shape whether older people feel safe to express their needs and whether those needs are met. This can make care quality dependent on the individual carer. [18]
How are staff attitudes, knowledge and behaviours enablers to rights-based care?
Staff attitudes as enablers to rights-based care
Enabling rights-based care starts with workers understanding older people’s values, beliefs and cultural background, using a person-centred approach. The provision of appropriate, individualised care is fostered by use of communication that is clear, respectful and avoids ageism. [6]
Respectful working conditions influence staff attitudes and their ability to provide dignified care. [22, 23] “Dignified care for the older adults cannot be achieved without ensuring dignified treatment of the staff in older care institutions.” [23 p9] Read more about workers’ rights and issues.
Staff attitudes and practices found to be markers of providing dignified care include:
- Making older people feel valued as a person
- Staff are compassionate in providing care
- Staff do not make care-recipients feel like a burden to others
- Allowing freedom to complain without fear of repercussions. [2]
Staff knowledge as an enabler to rights-based care
Provider organisations must ensure their workers have the required skills and competencies to perform their jobs. Read more about workforce education policies.
Staff knowledge of rights-based care can be increased by providing additional training and education which include:
- Education and training for staff in rights-based care approaches alongside human rights education. This leads to better understanding of the language and reasoning behind the use of rights-based approaches, helping to make implementation of rights-based practices more effective. [20]
- Training to improve skills in communicating with people with dementia or cognitive impairment, which improves implementation of non-pharmacological approaches to care. [7]
- Training in person-centred care in residential care settings. [23]
- Observation of senior staff conducting person-centred, rights-based approaches in practice, which can be more valuable than formal courses. [15]
Tools such a flow-charts, online learning modules and other practical guides are suggested to help aged care organisations practically apply rights-based approaches more consistently. [8]
Staff behaviours as enablers to rights-based care
Staff behaviours that enable rights-based care include:
- Providing care flexibly, that can be adapted based on mood, health or interests to provide a more dignified experience for the person receiving care, supported by organisational policies that allow that flexibility [16, 17]
- Promoting participation in decision-making alongside others, for example voting on activities for the weekend, to foster a sense of inclusion and belonging in residential care settings. [16]
- Engaging in respectful behaviours such as knocking before entering a room, asking permission while carrying out care checks and acknowledging an older person's wishes. [17, 23]
- Providing visible representation of support for diverse groups (e.g., the LGBTIQ+ community) through displays and inclusivity in documentation helps to reinforce a sense of safety and respect. [3, 24]
Communication supports adapted to meet the needs of an older person, especially if they have functional or cognitive impairments, should be put in place to help determine preferences. For example, staff can explain different options for food or activities and allow for choice. [16] Small acts, like making sure food is presented nicely at mealtimes, can make a big difference. [19] Read more about food, nutrition and dining.
Where possible, consistent staff assignment to each older person helps to build relationships and supports collaborative care planning. [15]
What can be done?
Foster positive, respectful attitudes towards older people and care staff
Organisations:
- Ensure respectful working conditions for aged care workers.
Aged care leaders:
- Model positive, respectful attitudes towards older people receiving care.
The evidence:
- Aged care workers have a right to physically and psychologically safe workplaces. This underpins the ability of aged care workers to provide rights-based care. [22]
- Nursing students described supervisors who exhibited positive behaviours towards older people in care settings as role models, and reported that good relationships with their supervisors were important for their learning. [19]
Provide ongoing training, education and guidance for implementing rights-based care practices
Organisations:
- Provide ongoing training on person-centred care approaches.
- Incorporate human rights education as a part of required trainings.
- Use tools and templates for consistent, practical implementation of rights-based care practices.
Aged care leaders:
- Identify training needs based on the specific qualities and context of care setting, clients and worker needs.
The evidence:
- Ongoing training for both managers and care workers is required for improving person-centred practices, with an emphasis on field-based education. [15]
- Human rights education can provide language for staff to articulate and mobilise human rights-based approaches. [20]
- There is a lack of understanding about how to practically apply and implement human rights-based approaches among management and frontline staff. [8]
Encourage staff behaviours that promote choice, dignity and respect for older people
Aged care leaders:
- Use collaborative or co-design approaches to involve older people receiving care in making decisions.
Aged care workers:
- Practice respectful behaviours when engaging with older people receiving care.
- Adapt communication strategies to meet older people’s needs.
The evidence:
- One study finds the use of co-design approaches have led to gradual but meaningful shifts in inclusion of LGBTIQ+ people in a residential care setting. [3]
- Dignity of older people in residential care is closely tied to how staff interact with them and manage their daily care routines. [23]
Want to learn more?
This checklist from Ageing Australia helps people interested in working in the aged care sector assess whether their personal values match what is required for working in aged care.
See these ARIIA resources for more information about organisational and leadership strategies for delivering rights-based care: