{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T21:01:56Z","timestamp":1777669316477,"version":"3.51.4"},"reference-count":61,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2021,4,28]],"date-time":"2021-04-28T00:00:00Z","timestamp":1619568000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Hum Factors"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The strategies adopted by personal care attendants (PCAs) to deliver quality care when faced with challenges potentially impacting clinical outcomes were assessed using phenomenological methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In Australia, recent outcry of unsatisfactory standards of care in residential facilities has instigated a national public inquiry. This study investigated how PCAs adapted to challenges in stressful and ambiguous everyday work scenarios to deliver quality care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>A phenomenological approach was used to obtain insights into PCAs\u2019 experiences, perceptions, opinions, and decision processes for enacting care. Ten PCAs working in rural-based residential aged care were interviewed using a novel scenario construction task with thematic and co-occurrence network mapping applied to derive insights.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seven themes were identified, revealing that participants formed close relationships with residents, influencing care provision but blurring personal boundaries. Key contextual factors in scenarios highlighted inadequate staffing and procedures, inadequate training, challenging residents, time poverty, and low support. Individually directed adaptive strategies were used to alleviate dissonance and maintain emotional resilience, including dynamic risk assessment involving rule breaking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The findings suggest that in negotiating care delivery, PCAs strive to optimize rule-based compliance with safety, efficiency, and individualized attention to provide \u201cgood enough\u201d care with fluidity. Implications for policy and practice are considered.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Application<\/jats:title>\n                    <jats:p>Findings have implications for workforce development in the context of ever-increasing industry pressures. Findings identified challenging scenarios and role complexity, with decision-making occurring as a fluid and ongoing process across a flexible boundary of risk assessment influencing interactions between PCAs, registered nurses, and clients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00187208211010962","type":"journal-article","created":{"date-parts":[[2021,4,28]],"date-time":"2021-04-28T12:39:23Z","timestamp":1619613563000},"page":"109-125","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["The Essence of Care: Versatility as an Adaptive Response to Challenges in the Delivery of Quality Aged Care by Personal Care Attendants"],"prefix":"10.1177","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5534-4295","authenticated-orcid":false,"given":"Anjum","family":"Naweed","sequence":"first","affiliation":[{"name":"Central Queensland University, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jana","family":"Stahlut","sequence":"additional","affiliation":[{"name":"Central Queensland University, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valerie","family":"O\u2019Keeffe","sequence":"additional","affiliation":[{"name":"Flinders University, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,4,28]]},"reference":[{"key":"bibr1-00187208211010962","unstructured":"Aged and Community Services Australia. (2015).\n                      The aged care workforce in Australia. Position paper\n                      . Retrieved June 15, 2016 from http:\/\/www.agedcare.org.au\/news\/copy_of_2014-news\/acsa-position-paper-the-aged-care-workforce-in-australia"},{"key":"bibr2-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1177\/1049732305280773"},{"key":"bibr3-00187208211010962","unstructured":"Australian Productivity Commission. (2011).\n                      Caring for Older Australians\n                      . Retrieved January 29, 2021 from https:\/\/www.pc.gov.au\/inquiries\/completed\/aged-care\/report"},{"key":"bibr4-00187208211010962","first-page":"1","author":"Baldwin R.","year":"2014","journal-title":"Aged & Community Services Australia"},{"key":"bibr5-00187208211010962","volume-title":"Workplace training practices in the residential aged care sector","author":"Booth R.","year":"2005"},{"key":"bibr6-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/32.3.360"},{"key":"bibr8-00187208211010962","first-page":"33","volume":"50","author":"Cane S.","year":"2010","journal-title":"Journal of Computer Information Systems"},{"key":"bibr7-00187208211010962","unstructured":"Ca\u00f1as A. J., Coffey J. W., Carnot M. J., Feltovich P., Hoffman R. R. (2003).\n                      A summary of literature pertaining to the use of concept mapping techniques and technologies for education and performance support\n                      . Pensacola, FL: Retrieved February 20, 2021 from http:\/\/re-dock.org\/"},{"key":"bibr9-00187208211010962","volume-title":"Systems thinking, systems practice","author":"Checkland P","year":"1980"},{"key":"bibr10-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1177\/1049732310369337"},{"key":"bibr11-00187208211010962","unstructured":"Commonwealth of Australia. (2019).\n                      Royal Commission into Aged Care Quality and Safety. Background Paper 7 Legislative framework for aged care quality and safety regulation\n                      . Retrieved January 20, 2021 from https:\/\/agedcare.royalcommission.gov.au\/publications\/background-paper-7-legislative-framework-aged-care-quality-and-safety-regulation"},{"key":"bibr12-00187208211010962","volume":"15","author":"Corazzini K. N.","year":"2010","journal-title":"Online journal of issues in nursing"},{"key":"bibr13-00187208211010962","volume-title":"Qualitative inquiry and research design: Choosing among five traditions","author":"Creswell J. W","year":"2013","edition":"3"},{"key":"bibr14-00187208211010962","volume-title":"RHD Online Training Intensive (Keynote)","author":"Creswell J. W","year":"2020"},{"key":"bibr15-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.742775"},{"key":"bibr16-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-13-175"},{"key":"bibr17-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1007\/BF00990785"},{"key":"bibr18-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.soc.012809.102612"},{"key":"bibr19-00187208211010962","first-page":"1","volume":"2","author":"Ferroff C.","year":"2012","journal-title":"Aeronautica"},{"key":"bibr20-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1016\/j.apergo.2016.10.009"},{"key":"bibr21-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2014.01.011"},{"key":"bibr22-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaging.2015.08.006"},{"key":"bibr23-00187208211010962","unstructured":"Gibson D., Braun P., Benham C., Mason F. (2001).\n                      Projections of older immigrants. People from culturally and linguistically diverse backgrounds, 1996\u20132026\n                      . Australian Institute of Health and Welfare. Retrieved February 20, 2021, from https:\/\/www.aihw.gov.au\/"},{"key":"bibr24-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dev334"},{"key":"bibr25-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1002\/j.1839-4655.2007.tb00047.x"},{"key":"bibr26-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1071\/AH17213"},{"key":"bibr27-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1002\/j.1839-4655.2012.tb00234.x"},{"key":"bibr28-00187208211010962","volume-title":"The aged care workforce 2012 final report","author":"King D.","year":"2013"},{"key":"bibr29-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1080\/08959420.2013.816166"},{"key":"bibr30-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1093\/geronb\/gbq022"},{"key":"bibr31-00187208211010962","volume-title":"The psychology of peace: An introduction","author":"MacNair R. M","year":"2012","edition":"2"},{"key":"bibr60-00187208211010962","unstructured":"Mavromaras K., Knight G., Isherwood L., Crettenden A., Flavel J., Karmel T., Moskos M., Smith L., Walton H., We Z. Canberra. (2017). The aged care workforce census and survey \u2013 the aged care workforce, 2016. Canberra: Commonwealth of Australia Department of Health. 978-1-76007-314-5."},{"key":"bibr32-00187208211010962","doi-asserted-by":"publisher","DOI":"10.4135\/9781412995658"},{"key":"bibr33-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1016\/j.aap.2013.08.022"},{"key":"bibr34-00187208211010962","unstructured":"Naweed A. (2015).\n                      The \u201cScenario Invention Task\u201d (SIT): An innovative method for harnessing natural human creativity\n                      [Paper presentation]. Paper presented at the 9th Triennial Congress of the International Ergonomics Association, Melbourne, Australia."},{"key":"bibr62-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1016\/j.apergo.2019.102976"},{"key":"bibr36-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1177\/1555343418821507"},{"key":"bibr61-00187208211010962","doi-asserted-by":"publisher","DOI":"10.3390\/aerospace7060084"},{"key":"bibr35-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1080\/21577323.2014.989339"},{"key":"bibr37-00187208211010962","unstructured":"O\u2019Keeffe V., Kavanagh P., Tuckey M., Bambacas M. (2016). Designed with care: improving job design in the South Australian aged care industry: final project report to SafeWork SA. Adelaide, South Asia Pacific centre for work health and safety. Retrieved February 20, 2021, from http:\/\/library.safework.sa.gov.au\/"},{"key":"bibr38-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssci.2015.02.024"},{"key":"bibr39-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1080\/13683500.2019.1629579"},{"key":"bibr40-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaging.2015.08.008"},{"key":"bibr41-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1177\/1049732308318031"},{"key":"bibr42-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2008.04600.x"},{"key":"bibr43-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1111\/jonm.12172"},{"key":"bibr44-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1016\/j.annals.2021.103160"},{"key":"bibr45-00187208211010962","first-page":"85","volume-title":"Nursing Research: A Qualitative Perspective","author":"Riemen D. J","year":"1986"},{"key":"bibr46-00187208211010962","first-page":"690","volume-title":"The Oxford handbook of expertise","author":"Roth E. M.","year":"2020"},{"key":"bibr47-00187208211010962","volume-title":"Safety and ethics in healthcare: a guide to getting it right Aldershott, Hampshire","author":"Runciman B.","year":"2007"},{"key":"bibr48-00187208211010962","doi-asserted-by":"crossref","unstructured":"Smith D. W. (2006).\n                      Phenomenology\n                      . Retrieved March 25, 2020, from https:\/\/plato.stanford.edu\/entries\/phenomenology\/","DOI":"10.1002\/0470018860.s00153"},{"key":"bibr49-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1177\/1049732307307031"},{"key":"bibr50-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1097\/00006216-200304000-00010"},{"key":"bibr51-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1111\/spc3.12061"},{"key":"bibr52-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1016\/j.outlook.2011.05.001"},{"key":"bibr54-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2702.2008.02735.x"},{"key":"bibr53-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1177\/1049732306298262"},{"key":"bibr55-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssci.2015.07.031"},{"key":"bibr56-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1071\/AH060100"},{"key":"bibr57-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1201\/9781420005684"},{"key":"bibr58-00187208211010962","doi-asserted-by":"publisher","DOI":"10.1016\/j.nedt.2020.104356"}],"container-title":["Human Factors: The Journal of the Human Factors and Ergonomics Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00187208211010962","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00187208211010962","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00187208211010962","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:52:49Z","timestamp":1777449169000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00187208211010962"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,28]]},"references-count":61,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,2]]}},"alternative-id":["10.1177\/00187208211010962"],"URL":"https:\/\/doi.org\/10.1177\/00187208211010962","relation":{},"ISSN":["0018-7208","1547-8181"],"issn-type":[{"value":"0018-7208","type":"print"},{"value":"1547-8181","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,28]]}}}