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Qualitative Health Research
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Nurse Assistant Mental Models, Sensemaking, Care Actions, and Consequences for Nursing Home Residents

Ruth A. Anderson

Duke University School of Nursing, Durham, North Carolina

Natalie Ammarell

Duke University School of Nursing, Durham, North Carolina

Donald Bailey, Jr.

Duke University School of Nursing, Durham, North Carolina

Cathleen Colón-Emeric

Duke University School of Medicine, Durham, North Carolina

Kirsten N. Corazzini

Duke University School of Nursing, Durham, North Carolina

Melissa Lillie

VistaMar School, Los Angeles, California

Mary Lynn Scotton Piven

Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina

Queen Utley-Smith

Duke University School of Nursing, Durham, North Carolina

Reuben R. McDaniel, Jr.

College of Business, The University of Texas at Austin

In a nursing home case study using observation and interview data, the authors described two mental models that guided certified nurse assistants (CNAs) in resident care. The Golden Rule guided CNAs to respond to residents as they would want someone to do for them. Mother wit guided CNAs to treat residents as they would treat their own children. These mental models engendered self-control and affection but also led to actions such as infantilization and misinterpretations about potentially undiagnosed conditions such as depression or pain. Furthermore, the authors found that CNAs were isolated from clinicians; little resident information was exchanged. They suggest ways to alter CNA mental models to give them a better basis for action and strategies for connecting CNAs and clinical professionals to improve information flow about residents. Study results highlight a critical need for registered nurses (RNs) to be involved in frontline care.

Key Words: unlicensed assistive personnel • case study research • nursing facilities • nursing • management practices

Qualitative Health Research, Vol. 15, No. 8, 1006-1021 (2005)
DOI: 10.1177/1049732305280773
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