Culture Change and Resident Choice Highlighted in Journal

The September 2014 issue of the Journal of Applied Gerontology includes articles describing two studies pertaining to culture change and empowering nursing home residents.

Is Resident Choice Preferable?

In “The Value of Resident Choice During Daily Care: Do Staff and Families Differ?“, researchers present the results of two focus groups conducted at three long-term care facilities — two for-profit facilities and one Veterans Administration facility.

Participants — nursing aides and resident family members — watched a series of short taped vignettes. Each vignette displayed two versions of a common morning-care scenario: In one version, resident choice was emphasized, while in the other, the resident was essentially told what to do.

For example, one of the scenarios pertained to toileting. In the version emphasizing resident choice, an aide asked a resident if she needed use the toilet. In the other version, the aide simply told the resident, “It’s time to use the toilet now.”

Other vignettes focused on getting out of bed, getting dress, eating breakfast, and performing a bed transfer.

By a large margin, focus-group participants — both aides and family members — identified the resident-choice version as preferable in every scenario except the bed transfer. (In the bed-transfer scenario, 60 percent of family members and just 53 percent of aides felt that the resident should have a choice in the matter.)

“The results of this preliminary study showed that both families of residents and nurse aides strongly preferred staff-resident interactions in which choice was offered for specific aspects of morning care,” the study’s authors wrote.

Implementing Culture Change

Another study presented in the same issue, entitled “Why and How Do Nursing Homes Implement Culture Change Practices?“, looked at culture change implementation from the perspective of nursing home administrators.

The study’s authors asked 64 nursing home administrators to describe the way they introduced culture change to their facilities and explain the obstacles they faced along the way. The administrator were also asked whether they felt culture change was a worthwhile journey.

The authors collected all of the administrators’ responses and identified several themes that were present in them. For example, administrators generally agreed that culture change was well worth the effort, and was even less costly then they predicted.

However, they also identified common challenges to implementation, such as resistance on the part of staff. One administrator said, “We have a lot of long-term employees, which is good and bad because they’ve done the same thing the same way all the time…nobody really likes change.”

A different administrator said that culture change implementation was particularly difficult because of the size of their facility. “If you picture a large boat that’s trying to make a turn in the water, you can’t just make a sharp turn,” the administrator said.

Administrators also cited the importance of strong leadership and communication skills as essential to a successful culture change journey.

— by Matthew Ozga