Perceptions and experiences of person-centered care among nurses and nurse aides in long term residential care facilities: A systematic review of qualitative studies

OBJECTIVE

The aim of this study is to report the findings of meta-synthesis of the experiences and perceptions of person-centered care among nurses and nurse aides in long term care facilities to help managers and policy makers in providing and improving health services.

METHODS

This is a meta-synthesis of qualitative studies guided by seven steps process of meta-ethnography developed by Noblit and Hare. Systematic literature searching was conducted in CINAHL, MEDLINE, Web of Science, PubMed, PsycINFO, Scopus, Cochrane library and ProQuest dissertations databases. We assessed quality of the studies using Critical Appraisal Skills Program tool.

RESULTS

Eleven studies and one dissertation were identified as relevant for the review. The analysis of this systematic review was resulted in three categories: Recognizing resident's emotional needs and preferences under the task-based workload; holistic understanding to build relationship and participation; teamwork, being recognized and ongoing training to overcome the challenges.

CONCLUSION

The concept of PCC in direct care level is perceived well with majority of the study participants but the reality between perceived and practicing PCC is different which indicates mostly lack of organizational rearrangements and support.

Nursing staff member experiences with household model implementation in a nursing home setting

This qualitative study used conventional content analysis of interview data to examine nursing staff members' experiences with Household Model implementation in a nursing home setting. Staff members were recruited from the skilled nursing center post implementation and completed individual interviews (N=16). Participants described the impact of implementation in relation to three categories: antecedents, explicit reactions and change consequences. Participants described barriers and facilitators to implementation as well as outcomes such as role strain, feelings of isolation and harder working conditions. This study provides opportunities for further examination of nursing staff members' experiences with person centered care models in nursing homes, how those experiences may relate to effectiveness of implementation and the need for support of nursing home staff.

Evaluation of Subscription-based Culture Change Models in Care Settings: Findings From a Systematic Review

PURPOSE OF THE STUDY

Person-centered culture change models to which aged care service providers subscribe are gaining increasing traction. It has been suggested that culture change initiatives broadly are subject to a range of issues. It is difficult, however, to draw out from the existing literature specific information about the scope and quality of evidence regarding subscription-based approaches. The purpose of this study was to identify and review the peer-reviewed literature regarding these subscription-based models.

DESIGN AND METHODS

The review used the Joanna Briggs Institute process and tools. Studies reporting on subscription-based person-centered culture change models in health and aged care, published in peer-reviewed literature in English up to and including 2015 were identified and assessed. In all, 28 articles reporting on 33 studies were included in the review.

RESULTS

There was no single model for which a significant body of evidence was identified, and approaches to outcomes were fragmented. Research approaches varied. Rigor and reporting were of concern; however, strengths of the evidence base included generally adequate sample sizes and the use of multiple methods including large data sets and standardized scales.

IMPLICATIONS

Despite their structured approaches, research and evaluation for subscription-based models are limited, ad hoc, and fragmented. A more comprehensive program of research that is embedded in the implementation process is needed. Recommendations include use of longitudinal study designs, attention to implementation and contextual factors, and measurement of both process and outcomes across the full range of culture change domains.

The Green House Model of Nursing Home Care in Design and Implementation

OBJECTIVE

To describe the Green House (GH) model of nursing home (NH) care, and examine how GH homes vary from the model, one another, and their founding (or legacy) NH.

DATA SOURCES/STUDY SETTING

Data include primary quantitative and qualitative data and secondary quantitative data, derived from 12 GH/legacy NH organizations February 2012-September 2014.

STUDY DESIGN

This mixed methods, cross-sectional study used structured interviews to obtain information about presence of, and variation in, GH-relevant structures and processes of care. Qualitative questions explored reasons for variation in model implementation.

DATA COLLECTION/EXTRACTION METHODS

Interview data were analyzed using related-sample tests, and qualitative data were iteratively analyzed using a directed content approach.

PRINCIPAL FINDINGS

GH homes showed substantial variation in practices to support resident choice and decision making; neither GH nor legacy homes provided complete choice, and all GH homes excluded residents from some key decisions. GH homes were most consistent with the model and one another in elements to create a real home, such as private rooms and baths and open kitchens, and in staff-related elements, such as self-managed work teams and consistent, universal workers.

CONCLUSIONS

Although variation in model implementation complicates evaluation, if expansion is to continue, it is essential to examine GH elements and their outcomes.

High-performance workplace practices in nursing homes: an economic perspective

To develop implications for research, practice and policy, selected economics and human resources management research literature was reviewed to compare and contrast nursing home culture change work practices with high-performance human resource management systems in other industries. The organization of nursing home work under culture change has much in common with high-performance work systems, which are characterized by increased autonomy for front-line workers, self-managed teams, flattened supervisory hierarchy, and the aspiration that workers use specific knowledge gained on the job to enhance quality and customization. However, successful high-performance work systems also entail intensive recruitment, screening, and on-going training of workers, and compensation that supports selective hiring and worker commitment; these features are not usual in the nursing home sector. Thus despite many parallels with high-performance work systems, culture change work systems are missing essential elements: those that require higher compensation. If purchasers, including public payers, were willing to pay for customized, resident-centered care, productivity gains could be shared with workers, and the nursing home sector could move from a low-road to a high-road employment system.

Developing the green house nursing care team: variations on development and implementation

PURPOSE OF THE STUDY

A core component of the Green House nursing home model is an altered supervisory relationship between the nurse and direct care workers. Some have expressed concern that the Green House model might weaken professional nursing oversight, threatening the quality of clinical care. This qualitative research study explores the role of the nurse as implemented in the Green House model, focusing on how variations in the nursing team influence clinical care practices.

DESIGN AND METHODS

Dimensional analysis, a "second generation" grounded theory methodology, was used to conduct this study. Data were collected through observations and interviews with 37 nurses, 68 CNAs, and 11 Guides working at 11 Green House sites.

RESULTS

Implementation of the nursing role within the Green House model varied both within and across sites. Four nursing model types were identified: Traditional, Visitor, Parallel, and Integrated. Care processes, CNA/Shahbaz skill development, and worker stress varied with each nursing model.

IMPLICATIONS

Government policies have been enacted to support culture change. However, there is currently little guidance for regulators, providers, or consumers regarding variability in how culture change practices are implemented and consequences of these variations. This article outlines the importance of understanding these practices at a level of detail that distinguishes and supports those that are most promising.