Caring about Care-givers a Study of Child Care Workers in Cape Town

OPSOMMING Die kindersorgwerker, hoewel die primére versorger, word tot 'n groot mate deur die meeste ondersoeke na kindersorg misken. Hierdie studie t' okus op twaair kindersorgwerkers in ses kinderhuise. Hulle motivering, take, die wyse waarop hulle die wcrk hanteer asook die prohleme wat hulle ervaar is ondersoek. Die bevindinge het die van vorige navorsing bevestig, naamlik dat die kin-dersorgwerker aan baie stremminge onderworpe Ls — byvoorbceld lang werksure, 'n lae kindersorgwerker tot kind verhouding, sowel as die uiteenlopende aard van die take waarvoor die werker verantwoordelik is. Die toewyding van die werkers, sowel as hulle vindingrykheid in die handering van hierdie spanninge het na vore gekom.


INTRODUCTION
M ost o f the available reseach on child care has focussed on the child, rather than on the person who is providing the care.However, an understanding o f the stresses facing the sta ff person and the ways in which he or she copes with them, is critical fo r ensuring that that person delivers high-quality care and teaching to the child (Maslach and Pines 1977, 105).
The child care w orker (CCW ) as the person prim arily responsible for the daily care and em otional nurturance of the child, may be seen as the most im portant and influential person in an in stitution (M aier, 1972; W hittaker, 1972, as quoted by W ilters, 1981).T he CCWs are usually responsible for several chil dren, many of whom may be em otion ally deprived, have sustained contact with the children over a substantial time period and may be involved in a diver sity of care-giving tasks (M attingly 1977; F reudenberger 1977).All these factors have been linked to burn-out -a syndrom e of em otional exhaustionthat may occur am ong those who spend a large proportion of their tim e working with other people (Pines and Maslach, 1980).
As psychiatric nurses, specialising in the field of child care, it seem ed appro priate to focus on the CCW as a prim ary care giver.T he aims of this study are thus to identify the CCW s, their reasons for entering and rem aining in the field, the problem s they may experience, and the actual activities they are involved in.In addition, both the stressfullness and m anner of coping with these tasks are examined.

METHODOLOGY Research Design
Nine children's hom es were selected at random from the tw enty-three such homes in the Peninsula.
The principals of three hom es were reluctant to take part in the investiga tion, thus the six rem aining homes were included.Each of the three researchers, all of whom are qualified psychiatric nurses, selected two children's homes.Prior to the investigation they visited these hom es, explained the purpose of the study, and assured confidentiality.Each researcher was assigned two CCWs in each hom e (th at is twelve in all) and tim es for visits w ere then arranged.Each researcher spent one full day ( ± 6 am to ± 8 pm) with each of the CCWs.
The num ber of children per home ranged from forty to eighty, and five hom es involved long term placem ent.Four accom m odated W hite children, while two cared for Coloured children.

Procedure
The investigation consisted of two parts: • an open-ended questionnaire which elicited the following inform ation: dem ographic characteristics of the CCW s, their reasons for entering and rem aining in the field, as well as diffi culties they may have experienced; • an observation of the CCW s as they perform ed their daily activities.
For the purposes of analysis the ob servations w ere grouped into seven meaningful task areas, nam ely m orning activities, meals with children, other duties with children, warm tim es with children, dom estic duties, adm inis tration and private tim e.

Identifying data
A description of the CCW s appears in table 1.
H alf the CCW s were in the 20 to 29 year age group, with only three over the age of 40.Two thirds w ere w om en, and only four were m arried.H alf had lower secondary school education and the o th er half had attended university.

Training and experience
D etails of the CCW s training and ex perience in children's hom es appears in table 2. Only four of the CCW s had had pre vious experience in w orking in chil d ren 's hom es, and seven received inservice training in their respective   hom es.By far the m ajority had been w orking in th e present ch ildren's hom es for betw een one to five years (one person had been in the hom e for about tw enty years).
Five o f the CCws indicated th eir in ten tio n to leave: two to fu rth er their ed u cation, one to an o th er hom e, and two had decided to leave the field of child care altogether.All of these five had been in the hom e betw een one to five years, and four w ere university graduates.

Working conditions
E ight of the CCW s lived in their respec tive hom es and m ost w orked sixteen hour shifts (6 am to 10 pm ) w ith varying degrees of tim e off duty (tw o to six hours).O nly two had few er than ten children in th eir care, with the m ean n u m b er o f children p er CCW being 9,8.T he age range of the children of four CCW s was 11/12 years (with ages rang ing from 5 to 16 o r 6 to 18).T he age range of the o th e r eight w orkers' chil d ren was 6/8 years (w ith actual ages ranging from 7 to 15 and 11 to 17).

Reasons for entering child care work
E ach C C W was asked to nam e the one m ost im portant reason for entering the field o f child care (see table 3) and, ad ditionally any num ber of factors con tributing to th eir continued stay in this field (see table 4).
T he m ajority o f w orkers en tered the field due to th eir expressed love of chil dren.This ties in with the m ajor factor keeping them in this field of work (like work ing with children).In addition, nine stayed on as they found the w ork re warding.T he finding th a t seven re ported staff su p p o rt as a m ajo r con tributing factor to th eir continued stay is im portant.

Difficulties related to child care work
Problem s related to child care work w ere exam ined in term s of th ree m ajor areas: personal, w ork, factors related to children.E ach w o rk er was asked to state the five m ost serious difficulties in child care w ork.T h e results ap p ear in table 5.
T he m ost im p o rtan t difficulties re lated to personal issues w ere as follows: nine felt th e hours w ere too long, seven that they had no privacy, and six spoke of the lack of social life.G uilt expressed by th ree CCW s at th eir inadequancy in dealing with the children may be related to the low C C W to child ratio.
T hree CCW s expressed difficulty in term s of role confusion, th a t is being surrogate m o th er at th e sam e tim e as being therapist.A lthough specific indi cations of the w ork being too strenuous w ere given, for exam ple, th e long hours, only two regarded this as a m ajor difficulty.

Observations of child care workers
The activities of the CCW s were divided into seven m ajor task areas for example, dom estic duties, m ealtim es with children and warm times.Each of these areas exam ined the num ber of CCW s involved in the activity, as well as the num ber of hours spent on this task.In addition two three-point rating scales were devised: one to assess how dem anding the activity was for the w orker, and the second to assess how each w orker handled the stress of the particular task.T he dem ands of the act ivity were rated as follows: most de manding (3), m oderately dem anding (2), and least dem anding (1).Similarly, the handling of stress was rated as: poorly handled (3), m oderately handled (2), and well handled (1).
Each rating was carefully defined.For exam ple, the m ost dem anding situ ations involved those w here the w orker had to give attention to many children at once, or had to attend to many tasks sim ultaneously.Similarly, a task was as sessed as poorly handled w hen the CCW appeared unable to cope with the situation, such as w hen she becam e angry or withdraw n.All scores were discussed and standardised by the three researchers at subsequent meetings.
M ean scores based on the num ber of CCW s involved w ere calculated.For the dem ands of the situation these scores were calculated as follows: seven CCW s had lunch with the children, and their individual scores on the dem and of this activity w ere 3, 3, 2, 2, 2, 1, 1. T herefore the m ean score was: (2 x 3) + (3 x 2) + (2 x 1) _ 9 7 M ean scores for the handling of stress were similarly calculated.

Morning activities
The CCW s' m orning activities are pre sented in table 6.
A lm ost all the CCW s were involved in all the m orning activities, with the average tim e spent ranging from eleven to twenty-six m inutes.All these activi ties had a very high dem anding score, ranging from 2,6 to 2,9.However, hand ling of stress scores fell betw een 1,1 to 1,7 that is, tending tow ards m oderate handling.
The results appear in table 7.
Alm ost every CCW was involved in breakfast and supper, with the average tim e ranging from tw enty to twentyseven m inutes, and these were the most dem anding m eals, tending tow ards very dem anding scores (2,1 and 2,5 respec tively).N evertheless, the handling of stress appeared to be fair (1,3 and 1,7).Few CCW s were involved in teatim e and lunch, and the form er appeared to be the least dem anding m ealtim e.

Other duties with children
O ther duties with children included everyday activities such as bath and bedtim es, hom ew ork supervision, and back from school (table 8).
T he largest am ount of tim e was spent on supervising hom ew ork (about onehour), and the least on putting the chil dren to bed (about 1/4 hour).B athtim e, in which almost all the CCW s w ere in volved, was the m ost dem anding.All the activities noted here veered tow ards being very dem anding.H andling of stress ranged from 1,4 (hom ew ork) to 2,3 (back form school).

Warmtimes with children
Special w arm tim es were defined as warm/close tim e spent with the chil dren, in a less structured atm osphere, with no specific duties or tasks involved.
These included tim e spent in cuddling the children, playing, sport activities, reading stories, chatting, and so on.They were divided into morning, after noon or evening w arm tim es, as shown in table 9.A ll CC W s w ere involved in the after noon and evening w arm tim es, with each such w arm tim e ranging around one hour.N evertheless, these tim es w ere found to be m ore than m oderately de m anding (2,1 and 2,2) and w ere less th an m oderately coped with (1,75 and 1,5).O nly th ree CCW s w ere involved in th e m orning w arm tim es, w ith an aver age tim e o f around half an hour.It was th e m ost dem anding o f all the w arm tim es and was only m oderately well handled.

Domestic duties
D om estic duties included duties of the CCW s th a t did not, in the m ain, involve th e children directly, and w ere not ad m inistrative (table 10).
A lm ost all CCW s w ere involved in doing laundry, although only a few (two to four) w ere involved in the o th e r do m estic duties.E xcept fo r laundry, the tim e spent was high w ith, for exam ple, th ree hours spent on cooking, and one and th re e q u arte r hours on driving.Scores on th e dem and of th e situation ranged from 1 to 2,5, and stress was m oderately well handled, ranging from 1 to 2.

Administration
A lm ost all the CCW s w ere involved in various adm inistrative duties such as fil ling in form s, requisitioning stores and stationary and com pleting m erit sheets (table 11).
A dm inistration took a considerable p ro p o rtio n of tim e, with th e least being j u s t u n d e r a n h o u r ( c o u n s e l l i n g p aren ts), and th e m ost, one and three q u arte r hours (m eeting).All the adm i nistrative w ork was found to be m oder ately dem anding, but the stress was well handled (ranging around scores of 1).

Private Time
Private tim e included any tim e spent w ithout children, although it did include tim es sp ent w ith o th e r CCW s and tim e com pletely off duty (table 12).M ost CCW s spent m ealtim es with o th er w orkers w ithout th e presence of children, w ith ju st over an hour being spent on this.T he CCW s did not appear to find it dem anding, and stress was well handled.A lthough the off duty hours vary considerably, each CCW had an average o f th ree hours off duty p er day.This was not found to be dem anding, and stress rating was correspondingly

The child care workers
As this study only exam ined twelve CCW s in six ch ild ren 's hom es, some caution m ust be exercised in generalis ing from these findings.
T hree q u arters of th e CCW s were under forty, tw o thirds w ere w om en, and only a q u arte r w ere m arried.These expected findings resem ble those of R oberts (1981, as q uoted by G annon, 1983).
T heir educational level was a mix ture: half having com pleted low er sec ondary school, and th e o th er half uni versity, although none had less th an a standard six education.T he high p ro portion o f university graduates or stu dents was unexpected, although in a study of CCW s in N ew Y ork, Freudenberger (1977) rep o rted sim ilar findings.
The finding that only four had, had previous experience in a children's hom e, ties in with those of Roberts (1981, quoted by G annon, 1983), who, in a study of 53 W hite children's hom es, found previous experience not to be a requirem ent for appointm ent.Only two CCWs had, had formal child care training, with seven receiving in-service training.These findings concur with those of Niewoudt (in progress) and W ilter (1981).
Eight of the w orkers had been in the present hom e for betw een one to five years and five of these expressed their intention to leave soon.This highlights well-known trends in the field of child care (R oberts, 1981).In fact, Freudenberger (1977) stresses that from the m ental health viewpoint, two years is about the maximum am ount of time that should be spent in this type of work.O u r finding that four of the five who expressed their intention to leave were university graduates w arrants further investigation.
M ost of the CCW s w orked extrem ely long hours (shifts of about sixteen hours), lived in the hom e, and had ap proxim ately ten children with a large age range in their care.
A serious implication both for the CCWs and the children includes the stress of working long hours (Maslach and Pines, 1977;Freudenberger, 1977).The ongoing practices o f double shifts and frequent overnights are emotionally suicidal (Freudenberger, 1977:97).
The fact that most lived in the home and w ere unm arried could heighten the feelings of social isolation and lack of privacy expressed by the m ajority of the CCWs.These too are well-known phenom ena associated with work in this field.F reudenberger (1977) points out the difficulty for the CCW in leaving his job at the office, thus resulting in a severe drain on his energy and intruding into all aspects of his personal life.Simi larly, M attingly (1977) cautions that the merging of the CC W s' total life with the agency may potentiate burn-out and may indicate that the w orker is relying on the hom e to m eet personal needs.The low CCW to child ratio, together with the large age range, could further contribute to the stresses of w orking in this field, as well as to feelings of burn out (Maslach and Pines, 1977).A dditio nally, since the children in these homes come from disturbed backgrounds, they usually have em otional difficulties.
F reudenberger (1977) em phasises that in cases w here the children are distrust ful, em otionally deprived, unable to relate, and hungry, the dem ands on the CCW s are heightened. . . .as day-inand-day-out they psychically feed the needy young person, they day-in-andday-out deplete themselves (F reuden berger, 1977:92).
On the positive side, most CCW s re ported that their main reason for both entering and rem aining in this field was their love for children, as well as the rew ard they found in their work.For exam ple, m ore than one CCW related incidents of children who initially were very withdrawn or frightened and, with time and the encouragem ent of the CCW , were able to relate and respond m ore spontaneously.Both M attingly (1977) and F reudenberger (1977) com ment on the dedication of the CCW s to their jobs -usually the primary reason for entering this field.
A striking finding was the high num ber of CCW s who reported that the m anner in which staff supported them contributed to their rem aining in the field.Both Maslach and Pines (1977) and M attingly (1977) em phasise that staff reliance on fellow w orkers not only helps in evaluating their own w ork, but is seen by them as a m ajor source of support.This has im portant policy im plications, as the m aintenance of staff m orale appears crucial in m aintaining a good, com fortable working atm os phere.In fact, F reudenberger (1977) recom m ends a m utual peer support system as an essential prerequisite in preventing staff burn-out.
A lthough in this investigation role conflict was only m entioned by a few CCW s, this aspect has received much attention by both M attingly (1977) and F reudenberger (1977): He (the CCW) is called upon to be a good role model, parent, a guardian, a brother or a sister -both a real person and entirely selfless F reudenberger (1977:93).

Observation of Time
The greatest length of tim e was spent on adm inistrative and dom estic duties, and meal times w ere surprisingly short.B reakfast and supper were the m ost de manding.The form er is probably attri butable to the early m orning rush and the latter to fatigue at the end of the long day.The extrem e dem ands made on the CCW s at this tim e were observed and their fatigue was reflected in their difficulties in handling this stressful situ ation.
It was encouraging to note that warm times involved more than two hours per day.H ow ever, in view of the large num ber of children per CCW , this could be inadequate in term s of the quality of time spent per child.The high dem and ing score for these warm tim es probably reflects this problem , and for this reason again, stress was only coped with moderately.
The early m orning activities, for example waking up the children and dressing them , were the most dem and ing of all the CC W s' duties and this probably relates to the low CCW to children ratio, as well as to the limited time available in the mornings.The least well handled situation was the time the children came back from school.A gain, the low CCW to children ratio, the short span of tim e allotted to this ac tivity, as well as the children's dem ands, probably contributed to the poor coping by the CCW.
O verall, the observations illustrated the high contact time of the CCW s with the children, as well as the varied duties in which they were involved.The finding that the most stressful activities were those w here there was direct contact with the children, are confirm ed by Maslach and Pines (1977).
D ue to the uncom m on observational nature of this aspect of the investiga tion, detailed com parisons with other research is limited.H ow ever, W ilter (1981) confirms our findings overall . . . the child care worker is responsible fo r the everyday life experiences -she ensures the children are fed, she bathes them and puts them to bed, she awakes them in the mornings, and ensures that they get to school on time, she greets them on their return fro m school, she settles their fights and disputes, she disci plines those who need disciplining, tends the sick -in short, she is responsible fo r every aspect o f the child's day-to-day existence.It is thus obvious that she is the person m ost able to influence both the behaviour and em otional state o f the children in her care (W ilter, 1981:32).

SLOTOPMERKINGS
T he overall findings of this investigation concur w ith previous research in this field in highlighting th e inheren t stress fulness o f child care work: th e long hours, lack of privacy w ith resultant iso lation, exposure over long periods of tim e to em otionally hungry children, the low C C W to child ratio, as well as the diversity o f the tasks they are in volved in -all of which are factors know n to contribute to staff exhaustion and possible burn-out.
D espite th e obvious dedication of the CCW s to th e children, as well as their resourcefulness in coping with the work stresses, certain recom m endations are m ade: sh o rter w orking hours, a higher CCW to child ratio, w ith a sm aller age range, as well as strong staff support.T hese are im portant, both for the m ental health of the CCW as well as the subsequent influence on the children in th eir care.

VERWYSINGS 1 .
C illiers, G .(1983) In v e stig a tio n by H S R C C urationis.V o l. 6 n o .4 , D e s e m b e r 1983.p. 51-54.2. C o la v e c c h io , R .(1982) D ire c t p a tie n t care: a v ia b le c a r e e r ch o ic e ?T h e J o u rn a l o f N u rsin g A d m in is tra tio n .V o l. 12, J u ly /A u g u st 1982.p .17-22.3. S ch leb u sch , L ., S ta n le y -C la rk e , G ., Scallan, M .P .S ., Buys, C., Walley, C .M .R .O ., H o llid a y , K .E .& H o d g e n , J .J .(1982).T h e a ttitu d e o f re g iste re d n u rse s a t A d d in g to n H o s p ita l to w a rd s th e ir p ro fe s sio n .C urationis.V o l. 5 , n o .3, S e p te m b e r 1982, p. 12-17.4. S e a rle , C .(1951) T h e p r o b le m o f the shortage o f n u rsin g p e r so n n e l in T ransvaal p u b lic h o spitals.M .A .th esis.P re to ria , P re to ria U n iv e rsity . 5. V e n te r , A .M .(1983) W a a ro m v e rla a t v e rp le e g k u n d ig e s die b e r o e p ? C ura tio n is.V ol.6, n o . 1 M a a rt 1983.p. 33-37.

Table 7
Meals with childrenT hree CCW s com plained of the chil dren 's aggressive and destructive be haviour, and two stated that they were affected by the children's lack of con cern and inability to take responsibility.

Table 9 Warmtime with children ACTIVITY Number of CCWs involved Mean number of minutes Mean demanding score Mean handling of stress score
40 C U R A T IO N IS M A R C H 1985* These varied considerably -depending on the particular hom e and the day of the week.