Path to Improving Long-Term Care Quality: Formation of Core Competence Among Empowered Care Attendants

PURPOSE: To validate a sequential mediation model in which empowerment influences professional identity and research use. Through this model, the pathways for enhancing the core competencies of care attendants in long-term care institutions can be more clearly understood. METHOD: This cross-sectional study surveyed care attendants employed in long-term care institutions in a county in central Taiwan, with 210 valid responses included in the analysis. RESULTS: Findings supported the proposed sequential mediation via professional identity and research use. For the outcome, research use and professional identity significantly enhanced core competencies, whereas the direct effect of empowerment on core competencies was nonsignificant. The total indirect effect was significant, comprising three significant pathways: via professional identity, via research use, and the sequential mediation of professional identity followed by research use. CONCLUSION: Findings provide empirical support for a sequential mediation mechanism, whereby empowerment enhances care attendants' professional identity. Subsequently, strengthened professional identity facilitates research use, which in turn contributes to the enhancement of core competencies. In long-term care settings, institutions are advised to foster cultures of shared decision-making and self-governance. They are also encouraged to implement structured supervisory systems and evidence-based training programs to enhance care quality.