Beyond the Medical Model: The Culture Change Revolution in Long-Term Care

White-Chu, E. Foy; Graves, William; Godfrey, Sandra M.; Bonner, Alice; Sloane, Philip D.

doi:10.1016/j.jamda.2009.04.004

Cited by 136 publications

(94 citation statements)

References 31 publications

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“…In recent years, a "culture shift" in care services in NH has taken place from task-based to person-centred care (e.g., Grabowski et al, 2014;Koren, 2010;White-Chu, Graves, Godfrey, Bonner, & Sloane, 2009). Person-centredness is described as an ethical approach to human interaction, grounded in a fundamental understanding of humans as autonomous reflective persons with the capacity and freedom to make their own decisions (Berlin, 1992).…”

Section: Introductionmentioning

confidence: 99%

Associations between job satisfaction, person‐centredness, and ethically difficult situations in nursing homes—A cross‐sectional study

Vassbø¹,

Kirkevold²,

Edvardsson

et al. 2018

Journal of Advanced Nursing

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Aim To explore the associations between job satisfaction and perceived person‐centredness and ethically difficult situations among staff in nursing homes (NHs). Background Previous studies have indicated that person‐centredness and few ethically difficult situations can contribute positively to NH staff's job satisfaction. However, empirical evidence of these associations is lacking. Design Cross‐sectional survey design. Method Nursing home staff (N = 341) in six NHs in Australia, Norway, and Sweden completed the questionnaire measuring job satisfaction, person‐centredness, and ethically difficult situations. Data were collected between April – June 2016. Univariate analysis was used to describe the sample, one‐way analysis of variance examined differences between variables. Bivariate correlation tested the relationships between variables and hierarchical multiple regression explored the extent to which person‐centredness and ethically difficult situations could explain job satisfaction among staff. Results After controlling for socio‐demographic variables in a regression model, three variables of person‐centredness and “ethically difficult situations” were significantly associated with job satisfaction. A “climate of community” contributed the most, followed by the “amount of organizational and environmental support,” “a climate of everydayness,” and few “ethically difficult situations.” Conclusion The results support the theoretical foundation and previous findings suggesting that establishing NHs organizations based on person‐centredness will increase staff job satisfaction. However, this is a cross‐sectional study and the causality may go in both directions and should be further explored.

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Section: Introductionmentioning

confidence: 99%

Associations between job satisfaction, person‐centredness, and ethically difficult situations in nursing homes—A cross‐sectional study

Vassbø¹,

Kirkevold²,

Edvardsson

et al. 2018

Journal of Advanced Nursing

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“…The shift in health care systems towards improved patient- and person-centred approaches [18,19] suggests that resident and family perceptions of NP care in LTC are also important outcomes to consider. Person-centred practice has been defined in various ways, with common elements including trusting relationships, sharing knowledge, and respecting a person’s right to make their own decisions [20-22].…”

Section: Introductionmentioning

confidence: 99%

Resident and family perceptions of the nurse practitioner role in long term care settings: a qualitative descriptive study

et al. 2013

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BackgroundResearch evidence supports the positive impact on resident outcomes of nurse practitioners (NPs) working in long term care (LTC) homes. There are few studies that report the perceptions of residents and family members about the role of the NP in these settings. The purpose of this study was to explore the perceptions of residents and family members regarding the role of the NP in LTC homes.MethodsThe study applied a qualitative descriptive approach. In-depth individual and focus group interviews were conducted with 35 residents and family members from four LTC settings that employed a NP. Conventional content analysis was used to identify themes and sub-themes.ResultsTwo major themes were identified: NPs were seen as providing resident and family-centred care and as providing enhanced quality of care. NPs established caring relationships with residents and families, providing both informational and emotional support, as well as facilitating their participation in decision making. Residents and families perceived the NP as improving availability and timeliness of care and helping to prevent unnecessary hospitalization.ConclusionsThe perceptions of residents and family members of the NP role in LTC are consistent with the concepts of person-centred and relationship-centred care. The relationships NPs develop with residents and families are a central means through which enhanced quality of care occurs. Given the limited use of NPs in LTC settings, there is an opportunity for health care policy and decision makers to address service inadequacies through strategic deployment of NPs in LTC settings. NPs can use their expert knowledge and skill to assist residents and families to make informed choices regarding their health care and maintain a positive care experience.

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“…In the past, nursing homes were mainly organized according to a medical model [6], in which nursing staff focused on taking care of the physical needs of residents. Currently, the autonomy of residents is crucial and more nursing homes strive to provide homelike environments, in which nursing staff encourage residents to continue their previous activities, including functional ones, as much as possible [7].…”

Section: Introductionmentioning

confidence: 99%

Do nursing staff encourage functional activity among nursing home residents? A cross-sectional study of nursing staff perceived behaviors and associated factors

et al. 2017

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BackgroundNursing home residents are mainly inactive. Nursing staff can encourage residents to perform functional activities during daily care activities. This study examines 1) the extent to which nursing staff perceive that they encourage functional activity in nursing home residents and 2) the associations between these nursing behaviors and professional characteristics, contextual factors, and information-seeking behaviors.MethodsIn this cross-sectional study, 368 registered nurses and certified nurse assistants, working in somatic and psychogeriatric wards of forty-one nursing homes throughout the Netherlands participated. Self-reported data were collected with a questionnaire, comprising the MAINtAIN-behaviors, which assesses the extent to which nursing staff encourage functional activities, including different activities of daily living (ADL), household activities, and miscellaneous encouraging activities (e.g., discouraging informal caregivers from taking over activities residents can do themselves). Additional data collected included professional characteristics (e.g., age), contextual factors (e.g., ward type), and information-seeking behaviors (e.g., reading professional journals). Descriptive statistics were used to determine the extent to which functional activities were encouraged. Hierarchical linear regression analyses were performed to determine the associations between the encouragement of functional activities and other factors.ResultsNursing staff perceived that household activities (mean 4.1 (scale range 1–9), SD 1.9) were less often encouraged than ADL (mean 6.9, SD 1.2) or miscellaneous activities (mean 6.7, SD 1.5). The percentage of nursing staff stating that different household activities, ADL, or miscellaneous activities were almost always encouraged ranged from 11 to 45%, 41 to 86%, and 50 to 83% per activity, respectively. The extent to which these activities were encouraged differed for some of the professional characteristics, contextual factors, or information-seeking behaviors, but no consistent pattern in associations emerged.ConclusionsAccording to nursing staff, household activities are not as often encouraged as ADL or miscellaneous activities. Professional characteristics, contextual factors, and information-seeking behaviors are not consistently associated with the encouragement of functional activity. Nursing staff should also focus on improving the encouragement of household activities. Future research could examine the role of other factors in encouraging functional activity, such as experienced barriers, and assess to what extent the perception of nursing staff corresponds with their actual behavior.

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Beyond the Medical Model: The Culture Change Revolution in Long-Term Care

Cited by 136 publications

References 31 publications

Associations between job satisfaction, person‐centredness, and ethically difficult situations in nursing homes—A cross‐sectional study

Associations between job satisfaction, person‐centredness, and ethically difficult situations in nursing homes—A cross‐sectional study

Resident and family perceptions of the nurse practitioner role in long term care settings: a qualitative descriptive study

Do nursing staff encourage functional activity among nursing home residents? A cross-sectional study of nursing staff perceived behaviors and associated factors

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