An evaluation of a consumer directed care training program for nursing home staff

The Impact of Nursing Home Culture Change: An Integrative Review

OBJECTIVES

The Nursing Home Culture Change (NHCC) movement promotes a person- and relationship-centered approach and a small-scale, homelike model for NHs. The present study aimed to integrate the most recent empirical findings regarding the impact of NHCC on resident, staff, family, and organizational outcomes.

DESIGN

Integrative review.

SETTING AND PARTICIPANTS

Not applicable.

METHODS

OVID MEDLINE, PsycINFO, Embase, and CINAHL databases were searched for quantitative or mixed studies published in English between 2018 and 2022 and examining the effect of NHCC on resident, staff, family, and/or organizational outcomes. A narrative and tabular synthesis of the results is provided.

RESULTS

A total of 1687 references were identified. Following duplicate removal, title and abstract screening, and full-text screening, 75 studies were retained for synthesis and suggest a positive impact of NHCC on resident (eg, quality of life and neuropsychiatric function), staff (eg, job satisfaction and stress), family (eg, satisfaction and depressive symptoms), and organizational (eg, NH attractiveness and occupancy rate) outcomes.

CONCLUSIONS AND IMPLICATIONS

NHCC shows promising results in all studied outcome categories. Future research should further investigate obstacles to NHCC implementation, conduct cost-benefit analyses supported by appropriate statistical tests, and define ways to improve NH staff education as well as NH policies and regulations to better support NHCC initiatives.

Consumer Directed Care and Resident Quality of Life: How Leadership and Organizational Factors Impact on Success

Previous studies have demonstrated inconsistency in the effectiveness of staff training programs in consumer directed care (CDC) as a means of enhancing the quality of life (QoL) of residents. The aim of this study was to investigate why this might be the case. We analyzed disaggregated cluster-by-cluster resident QoL outcomes after nursing home staff completed a CDC training program. In total, 33 nursing homes (11 clusters) participated in the study. As with previous studies, the outcomes across nursing homes were inconsistent - QoL improved at some sites but at many it remained stable or declined. Analysis of facilitator notes from the most and least successful clusters indicated that a lack of organizational support, for both the training and subsequent practice of CDC, was potentially the key barrier to effective implementation of training and so improvement in resident QoL. These findings demonstrate that all levels of aged care organizations - on the floor staff, managers and senior staff - need to fully support a CDC model of care to optimize outcomes for residents. Staff require training in CDC as well as long-term culture change within the nursing home so that training can be translated into practice.