The language of caring: nurse's aides' use of family metaphors conveys affective care.

PURPOSE Using a conceptual framework from the field of care work and the theory of boundary work, we explore the use of family metaphors by nurse's aides to describe their affective care for nursing home residents. We focus on how nurse's aides can express affective care in spite of experiencing racial abuse. METHODS Using the technique of domain analysis, we present a secondary analysis of semistructured interviews with 30 African American and immigrant aides working in three nursing homes about their experience of racism on the job. RESULTS Aides used metaphors associated with family, relationships, and attachment to describe their affective care of residents. They expressed the value of their caring by contrasting it with "uncaring" families. Immigrant aides expressed a form of caring culture shock about the uncared-for situation of American elders. IMPLICATIONS Through their use of metaphors of family and attachment, these aides define family care as their gold standard of affective care and communicate that they are attempting to provide good care. Aides distinguished caring tasks from affective care in that they applied affective care in an elective way, so that the caring task was the minimum, universal form of care and added affective care created an enriched form of care. They held out informal elder care in their cultures of origin as a model that is superior to the system of formal elder care in which they work. We use the theory of boundary work to explain how these aides provided affective care in the face of racial abuse.