Setting and participants

The study was conducted at two NH sites in a large urban city in Central Canada, chosen for their mix of residents with varying degrees of care dependency. Differences in environmental factors, such as facility layout, size and structure between the two sites allowed for an exploration of the impact of the physical and organizational environments on the experiences of receipt and delivery of intimate care. Study sites were also selected based on their willingness to grant the PI entrée and staff receptivity. Both sites are privately managed by the same NH company and receive partial public funding. Each site houses approximately 175–200 residents.

At each site, the first author and main study RA conducted a presentation regarding the study at a staff meeting. Handouts with study information were left for those not in attendance. Inclusion criteria for HCP participation consisted of 1) providing direct care to residents; and willingness to: 2) provide informed consent; 3) have research staff “follow them during their shift”; and 4) participate in informal and formal interviews.

Administrative decision-makers such as nurse managers, directors of nursing, chief executive officers, and programme managers were also invited to participate in key informant interviews. Inclusion criteria for administrative staff consisted of 1) having administrative responsibilities for direct patient care activities; and willingness to 2) provide informed consent and 3) participate in a semi-structured interview.

For residents, the process for participation involved two potential options: to be part of the observational portion of the study and/or participate in a semi-structured interview. Inclusion criteria for residents consisted of 1) having an intimate care dependence; 2) being 18 years of age or older; 3) able to understand English; and 4) cognitively competent to participate (based on clinical consensus).

As many residents of NHs have some degree of cognitive impairment, the project obtained clinical consensus from the nursing manager on whether the resident could consent on their own. If consent from the family was required, NH staff contacted family members, provided a brief description of the research, and asked them if they would agree to have their contact information provided to the main study RA. This RA then approached the families, described the research in detail, answered any questions and gained written consent from a family member. Verbal consent was obtained from all cognitively intact resident participants, and verbal assent obtained from residents who were cognitively impaired, but whose families had consented on their behalf.

Family members of residents were also invited to participate through: letters sent from the NH along with regular NH communications; email and telephone contact from staff; or being approached by the main study RA while visiting the facility. Inclusion criteria for participation included: 1) knowing details regarding the resident’s day-to-day care in the facility; and 2) willingness to provide consent and participate in an interview.