Hostname: page-component-848d4c4894-nmvwc Total loading time: 0 Render date: 2024-06-21T15:36:44.816Z Has data issue: false hasContentIssue false
  • English
  • Français

The Differential Influence of Culture Change Models on Long-Term Care Staff Empowerment and Provision of Individualized Care*

Published online by Cambridge University Press:  01 June 2009

Sienna Caspar ,
Norm O’Rourke  and
Gloria M. Gutman
Sienna Caspar
Affiliation:
University of British Columbia
Norm O’Rourke*
Affiliation:
Simon Fraser University—Vancouver Campus
Gloria M. Gutman
Affiliation:
Simon Fraser University—Vancouver Campus
*
†Correspondence to: / Correspondance à : Norm O’Rourke, Ph.D., R.Psych. Department of Gerontology Simon Fraser University—Vancouver Campus #2800– 515 West Hastings Street Vancouver, British Columbia V6B 5K3 Canada (ORourke@sfu.ca)
Get access Rights & Permissions [Opens in a new window]

Abstract

With this study we set out to determine if differences exist across culture change models (CCM) in relation to formal caregivers’ perceived access to empowerment structures and reported provision of individualized care. We recruited staff working in facilities that had implemented the Eden Alternative, GentleCare, Facility Specific Social Models of Care (FSSMOC), or no CCM. Multivariate analyses of variance (MANOVA) compared these constructs by CCM for each of three caregiver groups (Registered Nurses, Licensed Practical Nurses, and care aides). Results suggest that considerable differences exist between formal caregivers and by CCM. The greater caregivers’ day-to-day contact with residents, the more CCMs appear to affect perceived empowerment and reported provision of individualized care. Findings suggest the greatest benefits existed for staff working in facilities with a FSSMOC. Conversely, in only one instance did responses from staff in Eden Alternative facilities differ from those in facilities with no CCM.

Résumé

La présente étude vise à déterminer si des différences existent entre les divers modèles de changement de culture (MCC) relativement à la perception du personnel soignant agréé à l’égard de l’accès aux structures d’habilitation et des prestations connues de soins individualisés. Nous avons embauché des employés qui travaillent dans des établissements ayant mis en œuvre les modèles sociaux de soins Eden Alternative, GentleCare ou Facility Specific ou n’ayant pas implanté de MCC. Nous avons effectué des analyses de variance multidimensionnelles de chacun des trois groupes de personnel soignant (infirmières autorisées, infirmières auxiliaires autorisées et aides-soignants) en fonction de chaque CCM. Les résultats indiquent qu’il existe des différences considérables entre le personnel soignant agréé et entre chacun des MCC. Plus le personnel soignant côtoie quotidiennement les patients, plus l’influence des MCC semble affecter l’autonomisation perçue et les prestations connues de soins individualisés. Des recherches suggèrent que les employés travaillant dans des établissements ayant mis en œuvre un des modèles sociaux de soins mentionnés ci-dessus profitent des meilleures conditions de travail. Inversement, parmi les établissements ayant implanté un de ces modèles, seul le personnel d’un établissement a fourni des réponses différentes de celles des employés travaillant dans des établissements sans MCC.

Keywords

modèles de changement de culturede l’autonomisation des structuresdes soins individualisésde soins de longue duréecomportement organisationnell’amélioration de la qualitéculture change modelsempowerment structuresindividualized carelong-term careorganizational behaviourquality improvement
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 28 , Issue 2 , June 2009 , pp. 165 - 175
Copyright
Copyright © Canadian Association on Gerontology 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Support for this study was received by Sienna Caspar from the Social Sciences and Humanities Research Council of Canada (SSHRC Masters Fellowship) and the Michael Smith Foundation for Health Research (MSFHR Trainee Award).

References

Anderson, R., Issel, L.M., & McDaniel, R.R. (2003). Nursing homes as complex adaptive systems: Relationship between management practice and resident outcomes. Nursing Research, 52, 12–21.Google Scholar
Angelelli, J. (2004). Comparing the characteristics of Eden Alternative early adopters with those who discontinue. Gerontologist, 44, 34.Google Scholar
Barry, T., Brannon, D., & Mor, V. (2005). Nurse aide empowerment strategies and staff stability: Effects on nursing home resident outcomes. Gerontologist, 45, 309.Google Scholar
Bergman-Evans, B. (2004). Beyond the basics: Effects of the Eden Alternative Model on quality of life issues. Journal of Gerontological Nursing, 30, 27–34.Google Scholar
Blair, C.E., & Glaister, J.A. (2005). Making the most of nursing homes’ number one resource. Health Care Management Review, 30, 110–115.Google Scholar
Boise, L., & White, D. (2004). Aging matters. The family’s role in person-centred care: Practice considerations. Journal of Psychosocial Nursing and Mental Health Services, 42, 12–20.CrossRefGoogle Scholar
Caspar, S., & O’Rourke, N. (2008). The influence of care provider access to structural empowerment on individualized care in long-term care facilities. Journals of Gerontology, 63, S255–S265.CrossRefGoogle ScholarPubMed
Brooke, V., & Drew, J.C. (1999). The Eden Alternative Evaluation Research Program: Residents, Staff, Family and Quality Indicators, June 1997–June 1999. Galveston, TX: University of Texas Medical Branch.Google Scholar
Brooker, D. (2007). Person-centred dementia care. London and Philadelphia: Jessica Kingsley Publishers.Google Scholar
Chappell, N.L., Reid, C., & Gish, J. (2006). Staff measures of individualized care for persons with dementia in long-term care facilities. Dementia: The International Journal of Social Research and Practice, 6, 527–547.CrossRefGoogle Scholar
Coleman, M., Looney, S., O’Brien, J., Ziegler, C., Pastorino, C., & Turner, C. (2002). The Eden Alternative: Findings after 1-year of implementation. Journals of Gerontology: Medical Sciences, 57A, M422–M427.Google Scholar
Crow, J. (2004). Consultation and diagnostic skills: Holistic care and concordance. Prescribing Nurse, 28, 22–26.Google Scholar
Doty, M.M., Koren, M.J., & Sturla, E.L. (2008) Culture change in nursing homes: How far have we come? Findings from the Commonwealth Fund 2007 national survey of nursing homes. Retrieved June 10, 2008 from http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=684709&#doc684709Google Scholar
Gibson, D.E., & Barsade, S.G. (2003). Managing organizational culture change: The case of long-term care. Journal of Social Work in Long-Term Care, 2, 11–34.CrossRefGoogle Scholar
Gnaedinger, N. (2003). Changes in long-term care for elderly people with dementia: A report from the front lines in British Columbia, Canada. Journal of Social Work in Long-Term Care, 2, 355–371.CrossRefGoogle Scholar
Hagenow, N.R. (2003). Why not person-centred care? The challenges of implementation. Nursing Administration Quarterly, 27, 203–207.CrossRefGoogle ScholarPubMed
Halbert, R.J. (2000). Lessons from the original “Eden”. Provider, 26, 49–51.Google ScholarPubMed
Happ, M., Williams, C.C., Strumpf, N.E., & Burger, S.G. (1996). Individualized care for frail elders: Theory and practice. Journal of Gerontological Nursing, 22, 6–14.Google Scholar
Jones, M. (1996). GENTLECARE services and resources. Retrieved June 10, 2008 from http://www.gentlecare.com/services.htmlGoogle Scholar
Kane, R.A., Lum, T.Y., Cutler, L.J., Degenholtz, H.B., & Tzy-Chyi, Y. (2007). Resident outcomes in small-house nursing homes: A longitudinal evaluation of the initial Green House Program. Journal of the American Geriatrics Society, 55, 832–839.CrossRefGoogle ScholarPubMed
Kane, R.A. (1994). Ethics and the frontline care worker: Mapping the subject. Generations 18, 71–74.Google ScholarPubMed
Kanter, R.M. (1979). Power failure in management circuits. In Shafritz, J.M., Ott, J.S. & Jang, Y.S. (Eds.), Classics of organization theory (6th ed.). (pp. 342–351). Belmont, CA: Thomson Wadsworth.Google Scholar
Kirschenbaum, H. (2004). Carl Roger’s life and work: An assessment on the 100th anniversary of his birth. Journal of Counseling and Development, 82, 14–20.CrossRefGoogle Scholar
Kitwood, T. (1997). Dementia reconsidered: Person comes first. Buckingham, UK: Open University Press.Google Scholar
Laschinger, H.K. (1996). A theoretical approach to studying work empowerment in nursing: A review of studies testing Kanter’s theory of structural power in organizations. Nursing Administration Quarterly, 20, 25–41.CrossRefGoogle Scholar
Laschinger, H.K., Finegan, J., & Shamian, J. (2001). The impact of workplace empowerment, organizational trust on staff nurses’ work satisfaction and organizational commitment. Health Care Management Review, 26, 7–23.CrossRefGoogle ScholarPubMed
Lutz, B., & Bowers, B. (2000). Patient-centered care: understanding its interpretation and implementation in health care. Scholarly Inquiry for Nursing Practice, 14, 165–183.Google Scholar
Nadler, D.A. & Tushman, M.L. (1980). A model for diagnosing organizational behavior. Readings in the management of innovation (2nd ed.). (pp. 148–163). New York: Ballinger Publishing/Harper & Row.Google Scholar
O’Rourke, N., Hatcher, L., & Stepanski, J. (2005). A step-by-step approach to using SAS for univariate and multivariate statistics (2nd ed.). New York: Wiley-Interscience.Google Scholar
Paulhus, D.L. (1991). Measurement and control of response bias. In Robinson, J.P., Shaver, P.R. & Wrightsman, L.S. (Eds.), Measures of personality and social psychological attitudes (pp. 17–59). San Diego, CA: Academic Press.CrossRefGoogle Scholar
Rader, J., & Semradek, J. (2003). Organizational culture and bathing practice: Ending the battle in one facility. Journal of Social Work in Long-Term Care, 2, 269–284.CrossRefGoogle Scholar
Ransom, S. (2000). Eden Alternative: The Texas project. San Marcos, TX: Institute for Quality Improvement in Long Term Health Care.Google Scholar
Ruckdeschel, K., & Van Haitsma, K. (2001). The impact of live-in animals and plants on nursing home residents: A pilot longitudinal investigation. Alzheimer’s Care Quarterly, 2, 17–27.Google Scholar
Stermer, M. (1998). Notes from an Eden Alternative pioneer. Nursing Homes Long Term Care Management, 47, 35–37.Google Scholar
Stone, R.I., & Yamada, Y. (1998). Ethics and the frontline long-term care worker: A challenge for the 21st century. Generations, 22, 45–51.Google Scholar
Stone, R.I., Reinhard, S.C., Bowers, B., Zimmerman, C.D., Phillips, C.D., Hawes, C., Fielding, J.A., et al. (2002). Evaluation of the Wellspring model for improving nursing home quality. The Commonwealth Fund, publication #550.Google Scholar
Talerico, K.A., O’Brien, J.A., & Swafford, K.L. (2003). Aging matters. Person-centred care: an important approach for 21st century health care. Journal of Psychosocial Nursing and Mental Health Services, 41, 12–16.Google Scholar
Thomas, W.H. (1996). Life worth living: how someone you love can still enjoy life in a nursing home. Acton, MA: VanderWyk & Burnham.Google Scholar
Thomas, W.H. (2003). Evolution of Eden. Journal of Social Work in Long-Term Care, 2, 141–157.CrossRefGoogle Scholar
Walker, L., Porter, M., & Gruman, C. (1999). Developing individualized care in nursing homes: Integrating the views of nurses and certified nurse aides. Journal of Gerontological Nursing, 6, 30–35.Google Scholar