Small Q-methodology study identifies three task-prioritization viewpoints among nursing assistants in three Chinese long-term care homes

A Q-methodology study involving 15 nursing assistants from three long-term care homes in Shandong Province, China, identified three shared viewpoints on the relative importance of selected care activities. The study examined nursing assistants’ subjective judgments rather than measuring which tasks they actually completed, omitted or performed most often, making its small, geographically limited scope important when interpreting the results reported in the article’s abstract.

For the study, each participating nursing assistant ranked 25 care-related statements using a forced distribution that ranged from least important, scored −4, to most important, scored +4. Participants also completed a think-aloud task during each Q-sort, after which the researchers conducted semi-structured interviews. The researchers analyzed the Q-sort data through centroid factor analysis and varimax rotation in PQMethod, then interpreted the resulting factor arrays alongside the think-aloud data, field notes and interview material. All 15 completed Q-sorts were included in the factor analysis.

The retained three-factor solution accounted for 57% of the variance, according to the abstract. Thirteen Q-sorts loaded significantly and uniquely on one of the three factors. The first viewpoint was described as risk prevention and safety oriented, emphasizing rapid response and clinical management. The second was plan execution and accountability oriented, emphasizing planned care, procedural accountability and safety within an institutional framework. The third was basic-care and dignity oriented, emphasizing everyday basic care, comfort, dignity and relational support. These categories represent distinct patterns in participants’ expressed judgments about the relative importance of care activities.

Think-aloud and interview narratives suggested that participants connected their judgments with perceived workload, competing care demands, managerial expectations and role responsibilities. The abstract says the findings may help long-term care organizations recognize differences in how nursing assistants evaluate competing dimensions of care and inform reflection on role expectations, workload and organizational support. It also explicitly cautions that the results reflect subjective judgments of relative importance rather than actual patterns of task completion or omission. As a result, the analysis does not establish how often any care activity was performed, whether staffing levels affected care delivery, or whether the three identified viewpoints generalize beyond the 15 participants and three homes studied.

Subject of Research: Q-methodology study of nursing-assistant task priorities in three Chinese long-term care homes

Article Title: Task prioritization among nursing assistants in long-term care homes in China: A Q-methodology study

Article References: Xu, M., Qi, H., Liu, X., Zúñiga, F., Pan, Y., & Song, Y. (2026). Task prioritization among nursing assistants in long-term care homes in China: A Q-methodology study. BMC Nursing. https://doi.org/10.1186/s12912-026-05354-9

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05354-9

Keywords: Q-methodology, nursing assistants, long-term care, task prioritization, Shandong Province, China, workload, care planning, patient dignity, safety management, Task, prioritization