This study set out to test the key processes identified by SDT in an applied setting. We anticipated using a multilevel design to explore concurrently the effects of managerial need support upon care assistants’ intrinsic aspirations, basic need
satisfaction at work, autonomous motivation, and the effects of both manager-level and care assistant-level variables on the provision of autonomy and relatedness for elderly nursing home service users. Our hypotheses were partially supported. Both basic need satisfaction at work and community aspirations significantly positively predicted psychosocial caregiving. A significant amount of variance in both relatedness towards residents and autonomy towards residents was explained. In addition, autonomous motivation was positively predicted by both community aspirations and basic need satisfaction, as expected. However, no between nursing home differences were found, and the manager variables were not significantly related to any of the care assistant- level or dependent variables, with the exception of an unexpected negative relationship between manager relatedness and community aspirations. Furthermore, autonomous motivation did not significantly predict psychosocial caregiving.
The findings from this study show that, in terms of the chosen psychosocial caregiving behaviours, care assistants within participating nursing homes were not more alike than care assistants in general. This may suggest that, in nursing home settings, management style has little effect upon care assistants and the care that they provide. However, previous research suggests that this is very unlikely. Studies have shown that management style and organizational climate do have a significant impact on care
assistants’ well-being and provision of care. For example, Sheridan et al. (1992) found that ineffective nursing home management, characterized by a laissez-faire attitude and poor human relations, resulted in poorer quality care and less organization commitment and poorer work attitudes among care staff. Tellis-Nayak & Tellis-Nayak (1989) identified a vicious circle of poor management, staff dissatisfaction, and poor quality care. The preliminary analyses from this study indicated that a relatively homogenous sample of nursing homes agreed to participate in the study, despite a large number of diverse homes being contacted. The participating homes were characterized by high levels of managerial autonomy and relatedness support towards care assistants, which is a probable cause of the lack of between nursing home variations.
The strong positive relationship between basic need satisfaction at work and both caregiving variables provides additional support to research carried out in organizational settings linking basic need satisfaction to job performance, job
satisfaction, and engagement at work (Baard et al., 2004; Gagné, 2003; Van den Broeck et al., 2008; Vansteenkiste et al., 2007). In addition, the significant role of basic need satisfaction at work in the provision of psychosocial care strongly suggests that supporting care assistants to satisfy their needs for autonomy, competence, and
relatedness may enhance their capacity to provide psychosocial care. Previous research would suggest that a need supportive environment within a nursing home is most likely to be fostered by an autonomy supportive management style (e.g., Baard et al., 2004; Van den Broeck et al., 2008; Williams & Deci, 1996) although this was not supported in the current study. It is possible that care assistants also enhance need satisfaction at work through the support of their colleagues. No research has investigated the role of work colleagues and peers upon basic need satisfaction at work. However, Baard
(2004) highlights the role of team-building exercises that, when conducted skilfully, can support employees’ need for relatedness.
The positive relationship between community aspirations and care-related behaviours contributes to current research demonstrating the link between intrinsic aspirations and desirable outcomes such as greater well-being (Sheldon, Ryan, Deci, & Kasser, 2004), and positive job outcomes (Vansteenkiste et al., 2007). Furthermore, this finding adds support to research that has found that people working in caregiving professions need to have certain ‘caring’ qualities in order to perform well in their role (Macleod & Mcpherson, 2007). Community aspirations reflect an individual’s
endorsement of the importance of helping and supporting wider society and being concerned with the well-being of others in general, values that seem synonymous with caring. However, it is notable that whereas community aspirations significantly
predicted psychosocial caregiving, affiliation aspirations, which focus on creating deep and meaningful relationships with others, did not. Thus it seems that good caregivers need to be more concerned with actively helping their wards than with forming close relationships with them.
Three hypothesised relationships informed by previous research were not supported. First, manager need support was not found to predict any caregiver variables, other than an unexpected negative effect of manager relatedness on
community aspirations. These findings are not in line with the predictions of SDT, or other research that has found a significant effect of need support on outcome variables of interest. However, a systematic review of research assessing the efficacy of SDT to explain exercise-related behaviours has also found mixed results for the effects of need support, with need support being a non-significant predictor of exercise-related
Ryan, 2012). This raises the possibility that need support may not consistently have positive effects in other domains, although further systematic reviews would be required to ascertain this. Second, to our knowledge, no previous research has tested whether intrinsic aspirations predict basic need satisfaction at work. These findings provide preliminary evidence that, within a nursing home setting at least, community and affiliation aspirations are not directly related to need satisfaction at work. This may be because the pursuit of intrinsic aspirations satisfy basic need satisfaction in general, as found in previous research (Niemiec et al., 2009), rather than basic need satisfaction within specific domains.
Finally, the results also did not support the hypothesis that autonomous motivation would positively predict psychosocial caregiving. Research has shown that autonomous motivation is positively associated with better performance on more complex tasks, such as conceptual understanding of text material (Benware & Deci, 1984) or deep processing of written material (Vansteenkiste, Simons, Lens, et al., 2004). In contrast, there is some evidence that controlled motivation positively predicts performance on tasks that are not cognitively demanding, such as rote learning
(Grolnick & Ryan, 1987). It is possible, then, that psychosocial caregiving is a behaviour which does not require great conceptual understanding or deep processing, and thus cannot be predicted by autonomous motivation. However, autonomous
motivation is characterized both by intrinsic interest in or enjoyment of the task at hand, and by identification with the task as being instrumentally important, supporting
personal goals and values (Deci & Ryan, 2008a; Ryan & Deci, 2000a). Research has found that an identified style of motivation may have more positive behavioural and psychological outcomes than intrinsic or controlled styles of motivation for tasks that that require sustained discipline and determination, such as pursuing further education,
or reflective and informed action, such as voting (Koestner & Losier, 2004). This study explored autonomous motivation as a single construct, indicated by intrinsic and identified items. It is conceivable that psychosocial caregiving is an activity that requires perseverance, reflection, and dedication to achieve in settings that often value productivity and efficiency over caring and compassion (Tellis-Nayak & Tellis-Nayak, 1989). Therefore, it may be an activity that is significantly positively predicted by identified rather than intrinsic self-regulation, a relationship not tested in the current study.
Limitations and Future Directions
The data from this study were correlational and therefore assumptions about causality cannot be drawn. The hypothesized relationships in this study were grounded in both theory and empirical evidence. Nevertheless, intervention and longitudinal studies could confirm, or otherwise, causal relationships. Future studies could also expand upon this study by using objective records or observations of care assistants’ psychosocial caregiving behaviours. This would overcome the limitations of self- report measures which assume care assistants’ perceptions of the extent to which they exhibit autonomy support and relatedness towards nursing home service users
accurately reflects servicer users’ own perceptions.
Autonomous motivation was assessed by adapting a well validated self-
regulation measure used in populations with learning difficulties, specifically selected in order to minimize the cognitive load on participants. However, this scale has not been validated for use in a care assistant population. Furthermore, the intrinsic and identified items loaded onto a single factor. Although previous studies have successfully explored the effect of autonomous motivation when measured as a single construct indicated by
intrinsic and identified self-regulation items (Ntoumanis & Standage, 2009;
Vansteenkiste, Lens, De Witte, et al., 2004), it would have been useful to explore their separate effects on psychosocial caregiving. In order to establish with greater certainty the relationship between motivation and caregiving, future studies could first seek to improve and fully validate a self-regulation scale for use with care assistants. Subsequently it would be interesting to explore the separate effects of intrinsic and identified self-regulation on psychosocial caregiving, as well as the potential effects of controlled motivation.
This study did not find the expected significant effect of managerial autonomy support and relatedness on these variables. However, the manager sample was very homogenous, with all managers rating themselves as moderately or highly autonomy supportive and high in relatedness towards their staff. Purposive sampling could attempt to target failing and non-failing homes as this might capture a sample with a range of highly autonomy supportive to highly controlling managers, and managers both high and low in relatedness towards care assistants. This could provide more conclusive evidence for the effects of manager-level variables. Research has also highlighted the effect of social support on professional caregivers (Boey, 1998; Chappell & Novak, 1992; Patel, 2008; Revicki & May, 1989). Future studies could therefore explore the role of colleagues and external sources of support, such as family and friends, in relation to caregivers’ need satisfaction and community aspirations.
Conclusion
This study sought to explain factors that may predict psychosocial caregiving among professional caregivers by exploring caregiving within the framework of SDT, which no previous research has attempted to date. Contrary to the predictions of SDT, in this study managerial autonomy support and relatedness, and autonomous motivation among caregivers were not found to significantly predict psychosocial caregiving among professional caregivers. This finding is of theoretical interest, highlighting the need for further research to fully ascertain the ability of certain elements of SDT to predict behaviours related to psychosocial caregiving. Nevertheless, in line with the predictions of SDT, community aspirations and basic need satisfaction at work were found to play a significant role in promoting psychosocial caregiving among
professional caregivers. This is a novel finding that has not been empirically
demonstrated previously. Care assistants who endorse aspirations to help others and better society, and whose needs for autonomy, competence, and relatedness at work are satisfied seem to be more likely to support service users’ autonomy, and seek to form positive, connected relationships with them. These findings could inform recruitment practices, encouraging nursing homes to employ people with a strong desire to help others. In addition, it is hoped that these findings will promote reflection and future research into how best to support basic need satisfaction at work among care assistants and other professional caregivers.