This thesis includes four papers that address the research aims. The first paper sought to test a multilevel model based in self-determination theory which included both manager-level and care assistant-level variables hypothesised to affect the degree of psychosocial care that care assistants give. The second paper addressed emerging concerns with the measurement of basic need satisfaction, and sought to directly capture levels of satisfaction with each of the three needs, as well as improve the validity of the scale. Due to the significant effect of basic need satisfaction on psychosocial caregiving behaviours found in Paper 1, the third paper sought to develop our understanding of the relationship between basic need satisfaction and a behaviour related to caregiving,
prosocial behaviour. The fourth paper was designed to investigate the underlying processes and patterns of relationships found in professional caregiving in a nursing home environment within an idiographic framework. The basic rationale for each study, the methodology, and the hypotheses are summarised below.
Paper 1 – Using an SDT Framework to Explore the Roles of Nursing Home Managers and Care Assistants in the Provision of Psychosocial Care for the Elderly
A multilevel study was designed to examine the effect of managerial autonomy support on psychosocial caregiving, and its potential to moderate the effects of three care assistant level variables: intrinsic aspirations, basic need satisfaction at work, and autonomous motivation. It was expected that autonomy support in managers would positively predict psychosocial caregiving, in addition to intrinsic aspirations, basic need satisfaction at work, and autonomous motivation among care assistants. Managers from 38 nursing homes and 193 care assistants from those homes completed pen-and- paper questionnaires. Low intraclass correlations (ρs < .10), and design effects smaller than two indicated that multilevel analyses were unnecessary. Therefore the effects of care assistant variables on two measures of psychosocial caregiving were assessed, using complex analyses with latent structural equation modelling. This ensured that parameter estimates were accurate and bias due to measurement error was avoided.
Paper 2 - Measuring Autonomy, Relatedness, and Competence Satisfaction: Development and Validation of the ARC-S Scale
Basic need satisfaction was identified as a significant predictor of professional caregiving in Paper 1. However, Johnston and Finney (2010) demonstrated substantial
problems with local and global misfit in the widely used measure of basic need satisfaction in general (BNS-G; Gagné, 2003), with problems remaining despite a significant reworking of the scale. It also seemed that the BNS-G may measure perceived levels of the three needs, and not necessarily satisfaction with the levels of those needs. The Autonomy, Relatedness, and Competence Satisfaction (ARC-S) scale sought to present a balanced scale that directly captures levels of satisfaction with the basic psychological needs for autonomy, relatedness, and competence rather than perceived levels of the three needs. The study assessed the construct validity of the ARC-S using confirmatory factor analyses and tested the equivalence of the constructs across student and non-student groups using measurement invariance analyses in a large sample (N = 888). The criterion-related validity of the scale was assessed in a
subsample (n = 228) using structural equation modelling to test autonomy, competence, and relatedness satisfaction as predictors of well- and ill-being.
Paper 3 - Basic Need Satisfaction and Prosocial Behaviour: Exploring the Effects of Autonomy, Competence, and Relatedness Satisfaction within an SDT Framework
Paper 1 demonstrated a significant positive effect of overall basic need
satisfaction at work on psychosocial caregiving in nursing homes. However, basic need satisfaction is comprised of three variables, autonomy, competence, and relatedness. Furthermore, care assistants are a difficult to access population, evidenced by the relatively low response rates in Paper 1, and previous research carried out with nursing home care assistants (e.g., L. G. Morgan & Farsides, 2009). Therefore, in order to further clarify the role of basic need satisfaction in caregiving without over-burdening the accessible population of care assistants, a series of three studies sought to ascertain
whether a higher-order basic need satisfaction construct is a better predictor of the caregiving-related construct of prosocial behaviour, or whether autonomy, competence, and relatedness satisfaction have separable effects on prosocial behaviour. Across the studies, structural equation modelling with item parcels was employed in order to account for measurement error and ensure accurate parameter estimates. Study 1 assessed basic need satisfaction as a predictor of prosocial behaviour in general and within the specific domain of a university setting (N = 205). In Study 2 basic need satisfaction was explored as a potential mediator of the effects of intrinsic aspirations on prosocial behaviour (N = 220). In Study 3, basic need satisfaction was explored as a mediator of the effects of impersonal, controlled and autonomous causality orientations on prosocial behaviour (N = 235). In all three studies, basic need satisfaction was included as a higher-order construct, indicated by autonomy, competence, and
relatedness modelled as latent constructs. Potential unique effects of each of the three psychological needs on prosocial behaviour were then assessed via the modification indices.
Paper 4 – Towards an Understanding of Professional Caregiving: Using Grounded Theory to Develop a Multidimensional Model
An extensive review of the literature revealed the interpersonal aspects of professional caregiving to be poorly understood, in particular the potential mediating role of care assistants between structure, process, and outcome. A grounded theory approach (following the methodology of Corbin and Strauss, 2008) was undertaken in order to generate a substantive theory of the processes and mechanisms that underlie high quality professional care. Twenty-one participants, including care assistants, nurses, domestic staff, multidisciplinary staff, managers, and nursing home service-
users, were recruited from two high dependency nursing homes in South East England. Semi-structured interviews were used to ask all participants about what they felt
constituted good and not so good quality care, factors that they felt inhibited and
facilitated good quality care, and what they felt might improve the quality of caregiving. The goal of the research was to gain a clearer picture of the components of good quality care, particularly from the perspective of caregivers, and to gain an understanding of the key relationships and the underlying mechanisms in professional caregiving.
The body of research presented in these four papers provides preliminary evidence for the significant effects of both inter- and intra-personal variables from an SDT framework on care assistants’ ability to provide good care. Furthermore, the findings raise interesting theoretical and applied issues in relations to SDT. Intra- personal factors relating to traits and qualities among caregivers were clearly related to their caregiving and associated behaviours in all three applied papers. However, this thesis argues that contextual factors also play an important role in caregivers’ ability to give good care, with some evidence for the effects of management style.