Nurturing Cultural Change in Care for Older People: Seeing the Cherry Tree Blossom

Abstract

There is a need for person-centred approaches and empowerment of staff within the residential care for older people; a movement called 'culture change'. There is however no single path for achieving culture change. With the aim of increasing understandings about cultural change processes and the promotion of cultural values and norms associated with person-centred practices, this article presents an action research project set on a unit in the Netherlands providing care for older people with dementia. The project is presented as a case study. This study examines what has contributed to the improvement of participation of older people with dementia in daily occupational and leisure activities according to practitioners. Data was collected by participant observation, interviews and focus groups. The results show that simultaneous to the improvement of the older people's involvement in daily activities a cultural transformation took place and that the care became more person-centred. Spontaneous interactions and responses rather than planned interventions, analysis and reflection contributed to this. Furthermore, it proved to be beneficial that the process of change and the facilitation of that process reflected the same values as those underlying the cultural change. It is concluded that changes arise from dynamic, interactive and non-linear processes which are complex in nature and difficult to predict and to control. Nevertheless, managers and facilitators can facilitate such change by generating movement through the introduction of small focused projects that meet the stakeholders' needs, by creating conditions for interaction and sense making, and by promoting the new desired cultural values.

Implementation of the Veder contact method in daily nursing home care for people with dementia: a process analysis according to the RE‐AIM framework

“…Later on in the process they performed a number of actions to maintain the implementation of VCM, such as developing and financing a long-term implementation plan and including VCM in the regular business processes. This process is consistent with Snoeren et al (2014), who concluded that improvement of care and cultural change in nursing homes are dynamic, interactive and non-linear processes that take place at the same time. These are complex processes, making prediction and control difficult, and they require managers with a supportive and flexible attitude.…”

“…On wards where compliance with VCM was higher, the training helped caregivers to reflect, correct and encourage each other. Providing feedback appears to be as important as the intervention itself, because it stimulates 'ongoing learning' (Eggenberger et al 2013, Snoeren 2015. As reported before, the long duration of the training, the followup sessions and coaching-on-the-job are also important 'boosters' to successful implementation of VCM (Lawrence et al 2012, Boersma et al 2015.…”

“…This process is consistent with Snoeren et al . (), who concluded that improvement of care and cultural change in nursing homes are dynamic, interactive and non‐linear processes that take place at the same time. These are complex processes, making prediction and control difficult, and they require managers with a supportive and flexible attitude.…”

“…A hypothesis is that not the organisational problems on the ward as such are barriers to successful implementation, but how a team deals with them is of greater importance. Team culture, the system and the interconnected and interacting individuals determine whether a team is ready to adopt a new care method (Snoeren et al 2014). Caregivers who succeeded in applying elements of VCM became better at tailoring their communication to the individual needs of the residents and the person behind the dementia, which resulted in residents enjoying themselves more, and less resistance to daily caring tasks (implementation-effectiveness).…”

“…Some caregivers reported, in line with the studies of De Lange (2004) on integrated emotionoriented care and Gotell et al (2009) on caregiver singing and music, that VCM does not fit their personality and they feel uncomfortable with it. In retrospect, more 'experiential learning' (Snoeren 2015) in the training might be useful to increase the caregivers' familiarity with the communication tools of VCM. On wards where compliance with VCM was higher, the training helped caregivers to reflect, correct and encourage each other.…”