Abrahamson, K., Pillemer, K., Sechrist, J., & Suitor, J. (2011). Does race influence conflict between nursing home staff and family members of residents? Journals of Gerontology Series B: Psychological Sciences & Social Sciences, 66B(6), 750-755.
Utilizing data acquired in the course of the 2003 Partners in Caregiving (PIC) study,
Abrahamson et al. (2011) sought to examine the influence of race on conflicts between CNAs and residents’ family members. The sample featured 655 respondents of whom 435 (66.7%) were CNAs. The majority reported their race as white (76.2%) and their gender as female (94.8%). The authors’ hypothesis regarding black CNAs reporting more conflict with the family members when compared to white CNAs was not supported. However, their hypothesis regarding care expectations of black versus white CNAs being perceive similarly was supported; race appears to be a factor, with black CNAs reporting dissimilar care expectations on behalf of the residents’ family members. This suggests racism remains a factor.

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Fisher, L., & Wallhagen, M. (2008). Day-to-day care: The interplay of CNAs’ views of residents
and nursing home environments. Journal of Gerontological Nursing, 34(11), 26-33.
This qualitative study of CNAs’ experiences and views featured a sample of 27 CNAs from three different nursing homes. All of the CNAs were people of color; 24 of the individuals were immigrants. Based on interviews and observations, the authors concluded that these CNAs regard the residents of their respective nursing homes as fictive kin, commodities, and autonomous individuals. The literature review included in the study discusses the influence of racism on the power relationships between CNAs and the residents. The authors acknowledge that intercultural dynamics can have an influence on staff-resident relationships but that racism may not necessarily be present; cultural diversity is critical in providing meaningful care for this country’s nursing home residents. The increasing diversity of the American population suggests that there are fewer racial disparities between staff and residents. This is suggestive of the idea that racism is less pervasive in these settings than previously.

Gronningsater, S. (2012). Patient’s right to choose is not always black and white: Long term care
facility discrimination and the color of care. Journal of Civil Rights & Economic Development, 26 (2), 329-362.
Gronningsater (2012) examined the phenomenon of nursing home residents requesting that CNAs of certain races not provide the residents with care. The author examined the legal and ethical implications of such requests and the difficulty of accommodating such requests. On the one hand, care must be person-centered and should employ an individual’s preferences and autonomy. On the other hand, such requests can represent racism and discrimination, two circumstances to be avoided in the workplace. Negotiating the line between employee rights and patient preferences is not easy. Gronningsater uses a real world legal case to demonstrate these difficulties. The author concludes with the importance of cultural competency training and awareness for hostile patients. However, employers have an obligation to prevent workplace hostility and protect the rights of their employees like CNAs.

Massey, M. (2013). Immigrant certified nursing assistants in institutional long-term care
facilities. Retrieved from https://jscholarship.library.jhu.edu/bitstream/handle/1774.2
/37061/MASSEY-DISSERTATION-2014.pdf
In this dissertation, Massey examines immigrant CNAs and certain dimensions of their experiences – language proficiency, communication patterns, and the provision of quality care. Massey indicates that more and more CAN positions are being filled by immigrants raising certain issues regarding the aforementioned dimensions of CNAs’ experiences. One of the identified elements of the experiences of these CNAs is perceived experiences of racism. While these individuals do experience some racism, they appear to experience more xenophobia. This suggests that racism is less pervasive or that it is begun finding its expression in xenophobia.

Ramirez, M., Teresi, J., & Holmes, D. (2006). Demoralization and attitudes toward residents
among certified nurse assistants in relation to job stressors and work resources: Cultural diversity in long term care. Journal of Cultural Diversity, 13(2), 119-125.
The authors longitudinally interviewed a sample of 104 CNAs from 22 nursing in the state of New York with a focus on work-related demands and stressors, workplace support and training, and job-stress outcomes. The authors found that 27% of the participants have been called racially-charged pejorative names, contributing to the CNAs’ demoralization. Nevertheless, the CNAs report decreases in perceived racism and the positive influence of cultural diversity training and in-services about confused residents. There were factors other than racism that contributed more significantly to the CNAs’ demoralization. This suggests that racism is decreasing in long-term care environments.

Ryosho, N. (2011). Experiences of racism by female minority and immigrant nursing assistants.
Affilia: Journal of Women & Social Work, 26(1), 59-. doi:10.1177/0886109910392519
Race, gender, ethnicity, and class intersect in the long-term care system. Using a sample of eight minority and immigrant CNAs, the author qualitatively examines their cultural conflicts and experiences of perceived racism. Increasing cultural diversity within the macro environment of society is reflected in the micro environment of nursing homes. Ryosho (2011) uses a framework of feminism to examine these experiences, arguing the feminist practice is the solution for examining and addressing issues of race and culture in long-term care environments. Like other resources, Ryosho encourages cultural diversity training for residents and CNAs.

    References
  • Abrahamson, K., Pillemer, K., Sechrist, J., & Suitor, J. (2011). Does race influence conflict
    between nursing home staff and family members of residents? Journals of Gerontology Series B: Psychological Sciences & Social Sciences, 66B(6), 750-755.
  • Fisher, L., & Wallhagen, M. (2008). Day-to-day care: the interplay of CNAs’ views of residents
    & nursing home environments. Journal of Gerontological Nursing, 34(11), 26-33.
    Gronningsater, S. (2012). Patient’s right to choose is not always black and white: Long term care
    facility discrimination and the color of care. Journal of Civil Rights & Economic Development, 26 (2), 329-362. Retrieved from http://scholarship.law.stjohns.edu/cgi/viewcontent.cgi?article=1702&context=jcred
  • Massey, M. (2013). Immigrant certified nursing assistants in institutional long-term care
    facilities: Language proficiency, communication patterns and quality care (Doctoral dissertation, Johns Hopkins University). Retrieved from https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/37061/MASSEY-DISSERTATION-2014.pdf
  • Ramirez, M., Teresi, J., & Holmes, D. (2006). Demoralization and attitudes toward residents
    among certified nurse assistants in relation to job stressors and work resources: Cultural diversity in long term care. Journal of Cultural Diversity, 13(2), 119-125
  • Ryosho, N. (2011). Experiences of racism by female minority and immigrant nursing assistants. Affilia: Journal of Women & Social Work, 26(1), 59-. doi:10.1177/0886109910392519