Article Critique: Alone in Eden: Care Aides Perception of Consistent Assignments

The article is about the Eden Alternative. This refers to a philosophy of care and transformational system that aims at enhancing the quality of life among the nursing home resident. This is achieved by enhancing institutional environments that reconfiguring the delivery care. The restructuring referred to in this article include; ensuring resident care is offered by care aides, the care aides have enhanced responsibilities, ensuring consistency in assigning of aides to the residents.

The purpose of this study was indicated to have an aim of making discoveries on how the organizations and transformations of care using adopting a care model of delivery service. This will mean to discover how the service delivery care model affects the care aides’ experiences and viewpoints on their roles of interactions with the study (Andersen & Spiers, 2015). The article points out that the study focused on the understanding more about the Eden Alternative model since the main type of care that the participants were exposed to.

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The literature review in this article provides an overview of the care delivery models. One of the examples highlighted in the article is the care model adopted by care aides in Canada, where they offer the basic care to nursing home residents. These care aides are categorized at the same level as the American Certified Nurse Assistants (CNAs) (Andersen & Spiers, 2015). The care aides are unregulated in their operations and possess the least amount of training. The legal framework provides that these aides work under the supervision of a licensed practical nurse and registered nurses. The literature analyzed indicate that due to a reduction in the recruitment levels of these professionals, the care aides have turned to be the most central and accessible service providers to the residents in the nursing homes.

The article further indicated that in the United States, the long-term care institutions had been highly promoted. The Eden Alternative has undergone reforms and restructuring making it increase its popularity in Canada, Europe, and Australia. The article indicates that the empirical researches that have been carried outputs focus on the resident and family satisfaction in using the Eden Model. Studies have shown that after the introduction of Eden’s model in a veteran’s home, the residents indicated a reduction in the levels of the boredom, and feelings of helplessness. The adoption of the Eden solution has helped the residents report more on the enhanced quality of life and better levels of satisfaction as compared to other members in the traditional nursing homes.

The literature reviewed indicates the process used by a Canadian organization seeking to implement the Eden Alternative model. The process is initiated by choosing two or three people who travel to Saskatoon Saskatchewan for a 3-day training program at the Sherbrook Community Centre. These trainees are then designated to receive the title of Eden Associate. The specific group of the trainees is charged with the role of implementing changes in the workplace and adjusting the structures in the facility for delivery of care.

The literature review further expounds in on the Eden Model. Under this method, consistent assignments form a family while the cross-trained care aides are referred to as universal or versatile workers. The consistent assignment in this care is expected to enhance companionship between residents and care aides. The model provides an opportunity for the residents and care aides because of the scenario where the same care aides offer the services to the residents over a long period a function that was previously carried out by different personnel. The training allows the care aides to offer spontaneous services with less rigidity in medication administration, unscheduled meal preparation. It also provides an opportunity for the care aides to offer more personalized, unstructured, and unplanned social interactions with the residents. The model includes the having the care aides to take care of animals and plants thereby providing nurturing, home-like habitat. The article observes that care aides get more content in their work as their tasks involve taking care of the resident’s bodies and spirits.

The literature review points out to the knowledge in the researchers surrounding the model. There is a deficit of research conducted on benefits and limitations of the model. Most of the empirical research deals with the outcomes of the model such as a model but fails to offer support on the effectiveness of the model. Another key issue identified in the literature review was on low ability to offer individualized care under the Eden Alternative.

The study is carried out using focused ethnography. This method applies the principles of qualitative inquiry which include emic, cyclical, use of research as equipment, and application of concurrent data collection and analysis. The article offers more details common focused ethnography requires the research to have some prior knowledge of the culture under investigation. The research should also have a clear mental picture of what the research means to achieve. The research, as indicated in the articles need to have the ability create a rapport with the participants considered to be most knowledgeable on the issue (Andersen & Spiers, 2015).  In this type of study, participant observation is not set as a requirement like this in most cases is not feasible dues to challenges caused by sensitivities in and vulnerabilities of the participants and discomfort. The article recommends this research method for nurse researchers with an experience of employing specific skill in ensuring the quick establishment of relationship at personal and close relationships.

The article applied convenience and purposive sampling to select 22 care aides comprised of 20 female and two males (Andersen & Spiers, 2015). The population was drawn from one privately funded and four publicly held nursing homes. The convenience and purposive method were used for this research. The research was carried out in one western city in Canada. A key requirement in the selection of the sample was they needed to have installed the Eden Alternative Model and rolled out the philosophy of care. The residents from these homes selected for the research had residents between the ranges of 65 to 213 residents (Andersen & Spiers, 2015). For this research, the care aides were not extensively trained, but the general expectation was that they needed to perform light housekeeping. One key thing to note is that these care aides were not allowed to dispense medication. The average assignment per care aide was 11 residents. The care aides were engaged on full-time basis.

The study was conducted while adhering to ethical standards and approved by necessary academic agencies. To ensure the upholding of the anonymity confidentially, each participant was assigned a pseudonym. The data collection process was through an interview that took approximately 70 minutes. At first, this was performed by relying on research question to guide the interview to ensure that the care aides were engaged with t to bring out the issues most important to them. The interview has transcribed a verbatim and qualitative software to manage the data (Andersen & Spiers, 2015). The data analysis process used for this research was dependent on constant comparison the data analysis. The constant comparison method is a cycle that is carried out over and over again up to a point where the researcher feels that any new question to the participants will not yield new information. The research also included a coding process used to recognize and categorize themes, and relationships. Maintenance of rigor was used as the best model for verification. The aspects of investigator responses in this study include careful, conscientious, and attention to decisions. The methodological coherence required a recursive process of checking. Sampling methods for the study were conducted in a manner that allowed adequacy and representativeness of the population. Other components of the verification process include active analytic stance, and saturation (Andersen & Spiers, 2015).

Twenty-two aides engaged in the study indicated their experiences on being consistently assigned to specific residents. Seventeen participants were incorporated into the study as care aides before and after the Eden Alternatives (Andersen & Spiers, 2015). With this, there were able to give their views in the transition where they involved shifts in perspectives, organization, and culture of care. From the analysis of the data collected, the following themes five themes were identified; focusing on my family, along with my family, my family-my burden, my extended family, and coping with my family.

The first theme on “alone with my family” has it that new policies and procedures were introduced in the facilities. This was by ensuring that the care aides could offer care to all the heaviest of residents by themselves, in a manner that eliminated the need to seek assistance from other care aides. One way of achieving this was by introducing new turning sheets as well as policies involving mechanical lifts. The culture was subjected to gradual change in independence and self-reliance. Care aides were said to be working alone with residents were observed to have greatly reduced the avenues for collegial advice and support (Andersen & Spiers, 2015).

Under my family my burden theme, these came to be the care aides took more roles thereby making the whole arrangement stop being ideal and desirable for a registered nurse. Instead, the RN is engaged as visiting professionals who make occasional visits with the aim of offering skilled service. One key thing to note on this is the increased sense of responsibility by the care aides in the absence of RNs for monitoring and reporting any advancements in the health status of residents to the regulated staff.

The study reports on the role of the extended family by observing that the residents and family members’ points of view provided a consistently assigned care to aide became a crucial element and conduit of information. Some families were found to rely a lot on the care aides as a source of information on the issue they wanted to know about their loved ones and be accountable for everything and everything that took place (Andersen & Spiers, 2015). It was also observed that conflict arose with family members when the care aides created a vision of care for the residents but with their visions being appropriate regarding care concerns.

On the theme of coping with my family, the research indicated that to some care aides, coping was a way of ensuring perceptual loads. The participants were very specific about the importance of the shared tasks, interchangeable tasks, and joint decisions and offered a description that there was a need for a strong need for collegial fellowship. They indicated with a lot of fondness that there was teamwork and highlighted the importance of working together to find and fulfill their general purpose together.

The discussion in this article indicated that the services offered to residents in nursing homes have undergone a quite a big change. Residents and their families had hopes for close and caring relationships with the care aides. The care aides were expected to believe in them, play the role of advocates, and offer help needed on a daily basis. The residents and families were found to appreciate sustained contact and confidence acquired for the contact with small numbers of care aides. It was however found out that the relationship between the relationships between care aides and residents between care aides and family members (Andersen & Spiers, 2015).

Most of the care aides indicated that they did not enjoy working in an independent manner nor did them feel completely capable or competent enough with assessments enough to report their assessment and problems to the regulated professionals. Another concern that came from the research was that they felt reluctant to offer ad hoc care to residents consistently assigned to them (Andersen & Spiers, 2015).


Andersen, E., & Spiers, J. (2015). Alone in Eden: Care Aides’ Perceptions of Consistent Assignments. Western Journal of Nursing Research, 394-410.

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