Beyond burnout: cultural maladaptation places immigrant workers at risk for abusing nursing home residents

Background: In the U.S. health care settings, one in five direct-care workers was born abroad. With an increase of immigrant workforce in health care settings, there is growing interest in the influence of immigrants’ cultural adaptation on their job performance.  Adapting to a new culture generates emotional strain and heightened feeling, such as a state of alertness and anxiety, which occurs when immigrants perceive a given cultural adaptation as a threatening situation and believe that they are not able to cope with that threat—this psychological phenomenon is referred to as acculturative stress. Given that immigrants commonly experience acculturative stress—which may influence their interpersonal relationship and job performance—it is imperative that researchers and practitioners examine whether immigrant workers’ acculturative stress is a predictor of work attitude and job performance.  However, few studies have investigated whether immigrant workers’ acculturation factors are related to their work attitude and job performance in health care settings. The aim of this study was to investigate the effect of acculturative stress on abusive attitude toward elderly residents, in a sample of immigrant frontline care workers in the United States. 

Methods: Participants were 154 female immigrant aides from 31 nursing homes in California.  A 7-item abusive attitude scale was developed and validated by factor analyses.  Work-related stressors and experience were assessed using the Burnout Inventory and Nurse Aide Job Satisfaction questionnaire.  Perceived discrimination and acculturative stress were measured by the Social, Attitudinal, Familial, and Environmental Acculturative Stress Scale. Job satisfaction level was measured by the Nurse Aide Job Satisfaction questionnaire. Correlations and multiple regression analyses were conducted by using the SPSS software.

Results: Regression results showed that abusive attitude was significantly predicted by burnout, job satisfaction, and acculturative stress after controlling for demographics, F(7,142)=12.41, p<.001, R²=.38, adjusted R²=.34.  A high level of acculturative stress increased abusive attitude (β=.47, t(142)=5.52, p<.01, sr² =.13), suggesting that immigrant aides who undergo severe acculturative stress are less likely to treat elderly residents patiently and respectfully. A high level of job satisfaction decreased abusive attitude and behavior among immigrant aides. 

Conclusion: Findings suggest that immigrant aides who experience severe acculturative stress are at risk for engaging in abusive attitude toward elderly residents.  Given that many of immigrant workers provide direct care to elderly residents in health care settings, policy makers and practitioners need to make concerted efforts to develop programs and services to mitigate immigrant workers’ acculturative stress. Guidelines for elder maltreatment prevention and counseling for acculturative stress and sociocultural adaptation for immigrant health care aides are discussed in this study.