Consequences of the division of nursing labour for elderly patients in a continuing care setting

Detailed analysis of nursing activity has suggested that unqualified nursing auxiliaries provide most of the direct patient care and one-to-one contact for elderly patients requiring continuing care. In order to investigate the effects of this division of labour on the quality of care received, a comparison of the content of nurses' verbal interaction with patients was made between qualified and unqualified staff. Content analysis of tape-recorded nurse-patient interaction revealed recurring types of nurse verbal behaviour and a framework for examining similarities/differences between qualified and unqualified staff was developed. Frequency counts for individual verbal behaviour types suggest some differences between staff grades, particularly in relation to verbal behaviours which attempt to increase the patients' control over their activities and environment. The difficulty of assessing the implications of the differential use of particular verbal strategies is discussed in relation to the absence of evidence to confirm patient outcomes in relation to different verbal techniques. Further research in this area is required.