UCSF

This dissertation considers how certified nursing assistants (CNAs) construct the bodies of nursing home residents and how they assign meaning to work that is commonly viewed in one way or another as "dirty", tainted, or undesirable. CNAs invoked dignifying discourses to reinterpret meanings of their stigmatized work to mitigate the degrading implications of their labors. Together, body constructions and dignifying discourses shape the hands-on, intimate care aides provide to nursing home residents.

Observations and interviews were conducted with 27 aides in three different types of nursing homes in California. Other data included a content review of texts such as job descriptions and observations of aide training classes. All participants were people of color and, except for three aides, were first generation immigrants. Most were women and reflected U.S. demographics of CNAs working in metropolitan areas.

Nursing assistants constructed three distinct views of residents: resident as fictive kin, resident as commodity, and resident as autonomous person. Related dignifying discourses supported each construct and helped produce enactments of care giving. Caring practices were influenced by institutional forces such as commodifying the physical body while cultural understandings entered the rhetorics of duty and caring. The dominant discourses did not arise from training or other official sources but were generated by aides themselves in the course of their work. These findings extend the concept of "dirty work" to nursing assistants and contest some conventional views that aides accept stigmatized labels of their work.

Implications for practice confirm other studies that recommend changes in the length and content of aide training. These findings also offer possible directions for nursing home policies to enhance worker retention and satisfaction. Areas for future research include taking up the central inquires across several contexts, such as in rural nursing homes and among licensed nurses and residents and their families. Additionally, the increasing globalization of healthcare workers would benefit from a closer look at the way immigrant workers experience and practice carework.