Behavioral choices and enabling conditions for implementing independence-supportive care among nursing assistants in residential aged care facilities in Hunan Province, China: a qualitative study

ObjectiveTo explore factors influencing nursing assistants’ implementation of independence-supportive care in nursing homes.MethodsA descriptive qualitative study was conducted using purposive sampling. From November 2025 to February 2026, 12 nursing assistants from five nursing homes in Hunan Province, China, participated in semi-structured interviews. The interview data were analyzed using a practical, codebook-oriented thematic analysis approach and subsequently interpreted using the Capability, Opportunity, Motivation–Behavior model.ResultsFive themes were identified: (1) knowledge and skills related to independence-supportive care remained unstandardized; (2) residents’ functional status, willingness, and expectations of care affected their participation; (3) poor integration between assessment and care planning prevented retained abilities from becoming daily care goals; (4) limited staffing, time, and assistive devices led nursing assistants to take over residents’ tasks; and (5) safety risks and accountability pressures promoted risk-averse care. Although nursing assistants used some independence-supportive practices in daily work, these practices were largely based on personal experience and lacked standardized criteria for assessing task-specific abilities and determining appropriate levels of assistance.ConclusionNursing assistants’ implementation of independence-supportive care is shaped by the interaction of capability, opportunity, and motivation. Residential aged care facilities may consider providing activity-specific training, incorporating retained abilities and graded assistance into care plans, strengthening interdisciplinary collaboration, improving staffing and access to assistive devices, and establishing clear risk-management and shared-accountability mechanisms. Residents and families should also be informed that independence-supportive care is intended to maintain functional abilities rather than reduce the amount or quality of care. The effectiveness of these proposed strategies requires evaluation in future implementation studies.