目标:为了满足美国对直接护理人员(DCW)日益增长的需求,结构,组织,和政策相关的解决方案是必要的。劳动力工会可能是这样一种机制;然而,它对结果的影响仍然知之甚少。为了研究工会对DCW的财务状况和就业态度的影响,以及患者的结果。
方法:对AgeLine的系统搜索,CINAHL,PubMed,Scopus,和WebofScience从数据库开始到2024年6月20日。我们纳入了同行评审的实证研究,这些研究使用了观察性、准实验,和实验设计。
方法:研究涉及在家庭和长期护理环境中提供护理的DCW。我们专注于说明DCW财务结果的研究(工资,补偿,福利),就业结果(工作满意度,营业额),以及DCW及其患者的健康相关结局。
方法:Covidence用于筛选纳入标准的研究。研究特征由预先指定的域手动提取。DownsandBlack工具用于质量评估。遵循系统审查和荟萃分析(PRISMA)指南的首选报告项目。
结果:共有19项研究符合纳入标准;它们主要是观察性的(94%),本地(50%)和国家(50%)样本。三项研究集中在薪酬上,所有研究都发现工会与DCW中较高的工资和福利有关。七项研究侧重于就业,发现工会与更高的工作满意度相关,质量,和保留,特别是在养老院工作人员和家庭健康助手中。工会工作场所报告了更好的护理质量和安全性,包括更少的伤害和更好的设备供应。工会对患者预后的影响显示出好坏参半的结果,特别是在养老院居民中。总的来说,研究的质量各不相同,方法和抽样的限制影响了可靠性。
结论:DCW之间的工会通常与较高的工资有关,好处,和工作满意度,以及减少营业额;然而,其对工作者和患者结局的影响在不同研究中有所不同.这些研究的总体质量是公平的,强调需要在这一领域进行更严格的研究。
OBJECTIVE: To meet a growing demand for direct care workers (DCWs) in the United States, structural, organizational, and policy-related solutions are needed. Unionization of the workforce may be one such mechanism; however, its impact on outcomes remains poorly understood. To examine the impact of unionization on DCWs\' financial well-being and employment attitudes, as well as patient outcomes.
METHODS: A systematic search of AgeLine, CINAHL, PubMed, Scopus, and Web of Science from database inception through June 20, 2024. We included peer-reviewed empirical studies that used observational, quasi-experimental, and experimental designs.
METHODS: Studies pertained to DCWs who provided care in the home and long-term care settings. We focused on studies that illustrated the financial outcomes of DCWs (wages, compensation, benefits), employment outcomes (job satisfaction, turnover), and health-related outcomes of DCWs and their patients.
METHODS: Covidence was used to screen studies for inclusion criteria. Study characteristics were abstracted manually by prespecified domains. The Downs and Black tool was used for quality assessment. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed.
RESULTS: A total of 19 studies met inclusion criteria; they were predominantly observational (94%), with local (50%) and national (50%) samples. Three studies focused on compensation and all found that unionization was associated with higher wages and benefits among DCWs. Seven studies focused on employment, finding that unionization was associated with greater job satisfaction, quality, and retention, particularly among nursing home staff and home health aides. Unionized workplaces reported better care quality and safety, including fewer injuries and better equipment provision. Unionization\'s impact on patient outcomes showed mixed results, particularly among nursing home residents. Overall, the quality of the research studies varied, with limitations in methodology and sampling affecting reliability.
CONCLUSIONS: Unionization among DCWs was generally associated with higher wages, benefits, and job satisfaction, as well as reduced turnover; however, its impact on worker and patient outcomes varied across studies. The overall quality of the studies was fair to poor, highlighting the need for more rigorous research in this area.