Table 4 Types of interactions, major themes, sub-themes, and sample quotes

Worrying about going beyond the boundaries of an NA’s responsibilities

“‘My daily contacts with residents mainly take place during the time that we care for them … doing different nursing procedures … this is our everyday routine in the nursing home…. I am just an NA and have not received any training in handling the residents’ other problems. I am only responsible for conducting basic personal care.” (NA 4)

Boundaries inherent in the nature of an NA’s role as a formal physical caregiver

“There is not much chatting between the NAs and me because, as a resident here, and the NAs are the workers, so we lead different lives…. There is nothing to talk about … I mean, we do not interact like friends; there is not much joking, or chatting.… These things are all on me, and are none of their business…. I wouldn’t force anyone to be my close friend, I’ve never thought about that.... We, residents are those who need to be taken care of … they are care workers…. Our relationships can’t go beyond this…. I mean, there is no way for us to be friends at all.” (RE 11)

Falling under the responsibility of other professionals

“If residents are not in a good mood, or have a family problem that is affecting them, we report the cases to social workers…. We shouldn’t ask much about it because it might trigger their sadness. We are not social workers, and we are afraid of saying something wrong…. So I think it is not my job, and is something beyond my abilities. Developing a closer relationship with residents is not our major duty, based on our role in the nursing home.” (NA 3)

Driven by the residents’ demands relating to their physiological needs

“They care about our (the residents’) health, not our family background, personal issues…. They mostly care about our physiological needs … whether or not we can take care of ourselves…. They offer help when we can’t look after ourselves and do things for us.” (RE8)

“I seldom ask for their help, as I can do things (grooming, dressing, etc.) on my own…. It is really not necessary to talk with them (NAs).” (RE7)

Perception of incompetence and irrelevance

“We wouldn’t dig deep into the residents’ personal issues. Because we wouldn’t know if we were saying something wrong, and we wouldn’t know what to talk about … you don’t know if they (residents) like to talk about something personal, and if we dig too deep…. I am just here as an NA, so it would seem to be not that good to know too much about their personal issues…. Since we are not that clear about their conditions, it could be a big problem if we say something upsetting by mistake.” (NA 3)

Barriers to closer interactions

“It is not the NAs’ responsibility … to relieve your emotions…. What they are responsible for taking care of the residents’ physical health…. The NAs are too busy to listen to you…. I think it is beyond their responsibilities…. They are not supposed to deal with your inner feelings.” (RE 14)

“Feeling unhappy is my own problem and shouldn’t be shared with NAs … to bother them because, firstly, they have no time and, secondly, it is inappropriate to bother them (NAs) as they have no responsibility for your personal problems.” (RE5)

Remaining emotionally detached from residents

“We talk to them in a friendly manner … usually about general topics…. If we were really close, like family (with residents), I think it would make my work tougher. What if they (residents) pass away and I can’t get over it. There are just so many dramatic changes for residents….” (NA 10)

Feeling secure by keeping a distance from NAs

“I seldom chat with the NAs … other than daily greetings. We should be careful about what we say, right? People shouldn’t gossip…. NAs work here, so we shouldn’t talk about anything in depth, right? … to them or to anyone else…. There are no deep relationships here, and it is very hard to get to know each other well…. My need? Ha, ha, I am magnanimous. I don’t think about anger or happiness…. I don’t need to think about anything, just eat whatever I have, sleep whenever I can.” (RE 15)

Refusal by residents to interact socially

“The residents don’t think about building closer relationships with us. They just treat us as workers who offer personal care.… I think that they do not think much about our relationship. I respect their choice to maintain a formal care relationship….” (NA 10)

“I rarely share my personal issues with NAs. We have different thoughts and are not close … it is so hard to be close with each other (NAs)…. Sometimes, … I prefer to share my feelings, my issues, with my kids.” (RE 7)

“Some residents responded coldly to us. We would just smile and walk away…. We learn to bear it; we don’t force them, so as to avoid conflict.” (NA 12)

Using humor on the residents

“When I saw this old lady, I’d yell at her. And she would probably yell back at me since she knew I was just kidding…. It is just a kind of communication, which may be misunderstood by others, but we were just having fun…. So I could joke with those who were up for it, or just say ‘hi’ to those who disliked joking. We got to know the characteristics of the residents after working here for a while.” (NA 8)

Accepting kidding for the purpose of being sociable

“Sometimes the NAs would joke with me … saying that I am pudgy but have nice skin.… Or they would say things like, ‘You are so pretty, I want you to be my mom.’ So I responded, ‘Then I’ll call you “daughter”.’ … But some residents won’t accept being called a ‘fat lady.’ … If you understand that it is a joke, you will feel okay. So NAs really need to know the residents, in order to know what is acceptable for them (the residents), as it is not okay to say this kind of thing to everyone.” (RE 4)

Receiving attentive concern from residents

“I sometimes had a sudden headache and would say to myself: ‘Ouch! Such a bad headache, so annoying! I should take a Panadol.’ The resident heard that and offered me some herbal massage ointment … which means that the resident also pays attention to us. [Interviewer: How did you feel about it?] Very happy. That resident was also happy when I accepted her offer and asked me later about whether or not my headache had been relieved…. Because this kind of interaction made her (the resident) feel happy, she would continue to care about us (NAs).” (NA 12)

Showing care and concern to the carers

“An NA didn’t feel well, I attempted to comfort her … and I would also ask her if she was feeling better the next day.… We know, you (NA) care about me, and so do I…. She would ask me things like “Do you want some more food? Why are you eating so little?” (RE12)

“Mostly I ask NAs first, things like, “How are you doing today? Tired?” … If you actually worked in a nursing home, you would know that some residents are tough to handle.… I treat the NAs like my friends, which means that we share what has happened here and comfort each other.” (RE 9)

Establishing good relationships through sociable contacts

“Some residents remembered that I had a grandson, and would ask me to show them (residents) his photos (the NA’s grandson)…. They praised my grandson as being very cute and chubby.… Some of them would then show me the photos of their grandchildren…. This was how we started to build up a nice relationship….” (NA1)

Enhancing individuality by being addressed using nicknames or family metaphors

“I really love to hear the NAs calling me ‘teacher’ … because I was a teacher for my whole career.… [Interviewer: How do you feel when the NAs call you that?] Fabulous! … Because at least they know I was a teacher, not someone ordinary, but an intellectual…. The way they call me that, it feels like they are showing respect.” (RE 13)

“Some residents, who are more open, love to share their past with you.… They are happy and even more relaxed when you chat with them as friends. If you only behave like a formal care provider, they won’t talk that much. So it is important for us to be open with them, then they feel much better!” (NA7)

“My surname is same as two NAs…. So they usually call me ‘big sister’ and I call them ‘little sister.’ … I feel happy we call each other ‘sister’ … it seems that they all familiar with me and treat me well.” (RE 6)

Being sensitive to the residents’ need for emotional support

“I saw that the resident couldn’t stop crying in her bed when I was walking around the room, so I asked what had happened.… She told me something about her family history.… I comforted her patiently … she felt a lot better.… Since then, she always tell me that I am the one who really cares about her (the resident).… She gave me fruit occasionally.… This showed me that if you care about the residents, they appreciate that.” (NA 9)

Offering help to NAs to show my appreciation

“You shouldn’t mess things up for the NAs to clean up, right? When I am dining, I pick up the rice myself if it accidentally falls on the floor…. They praise me, ‘Wow, you made it so clean!’ When I see that they are doing things that I can do, I think why not just do it myself? They are working the whole day without breaks. It is not easy.” (RE 12)

Respecting my individuality and preferences

“I feel that the NAs care about me.… Sometimes I say I’d love to have some ginger…. I get a small pack of ginger the next day from the NAs…. They know what I like to eat…. Because they (the NAs) see what I eat daily…. Also, I have to eat something before I go to sleep because our dinner is early. So I eat bread, biscuits, etc. Since they (NA) know this, they always drop some food off for me.… In return, sometimes my friends come and visit me with fruit or biscuits, etc., and I would give the NAs some….” (RE 1)