Barriers and facilitators to implementing staffing models in South African long-term care facilities: a qualitative study.

backgroundSouth Africa has a staffing model with mandatory staffing standards for long-term care facilities for older persons. This article reports on the barriers and facilitators encountered during the implementation of the staffing model in long-term care facilities within resource-constrained contexts.

methodsA multiple-case study design was employed, comprising multi-methods for data collection, including interviews and a document review. This article concerns the findings from the interviews. Nineteen nurses and caregivers were purposefully sampled and interviewed using a semi-structured interview guide. Ethical and principles that were maintained included ethical board clearance, institutional permission, voluntary participation, beneficence, anonymity, and confidentiality. Trustworthiness was ensured through applying principles such as credibility, dependability, and confirmability. The data were analysed following a thematic analysis process and reported in narrative form. The findings are organised according to two themes: Human resource practices influence staff management, and A perceived indifference to and neglect of residents’ acuity.

findingsFacilitators in implementing the staffing model were high caregiver staffing levels and the availability of relief staff for caregivers. Barriers to implementing the staffing model included inadequate nurse staffing levels, the unavailability of relief staff for nurses, facilities’ neglect to provide in-service training, and an inadequate skill mix. The small number of nurses employed seemingly led to fewer nurses with higher educational levels and skills in the total staff mix and the overuse of caregivers.

conclusionsPolicies should inform facilities’ staffing decisions to ensure adequate baseline nursing staffing and include support systems for nurses and caregivers to promote staff well-being.