A structure-technology contingency analysis of caregiving in nursing facilities

The purpose of this paper is to describe how the work associated with psychosocial and physical caregiving is structured within nursing facilities. Arguing from a contingency perspective, our central hypothesis is that because the technology underlying physical care is less variable and more interpretable and the process-outcome relationships underlying care processes are better understood than for psychosocial care, work in the physical care domain will be comparatively more mechanistically structured even though work in both domains is performed by the same paraprofessional nurse aide staff. Data for this analysis derive from a survey of unit charge nurses (n = 739) in 308 nursing homes in eight states undertaken as part of a large NIA-funded study of the relationship between nursing home organization and resident outcomes. With the exception of centralization, contingency theory correctly predicts how the work associated with physical and psychosocial care is differentiated.