1 Resident Directed Care and Resident Directed Care and Culture Change in Nursing Culture Change in Nursing Homes Homes Christine Mueller, PhD, RN, FAAN University of Minnesota School of Nursing Mathy Mezey, EdD, RN, FAAN, Sarah Greene Burger, RN-C, MPH, FAAN Ethel Mitty, EdD, RN Hartford Institute for Geriatric Nursing, New York University College of Nursing Module 3 of Nursing Homes as Clinical Placement Sites for Nursing Students Series
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1 Resident Directed Care and Culture Change in Nursing Homes Christine Mueller, PhD, RN, FAAN University of Minnesota School of Nursing Mathy Mezey, EdD,
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Resident Directed Care and Resident Directed Care and Culture Change in Nursing Homes Culture Change in Nursing Homes
Christine Mueller, PhD, RN, FAANUniversity of Minnesota
The Path to Resident Directed Care and The Path to Resident Directed Care and Culture ChangeCulture Change
Nursing homes vary as to how they incorporate the principles and practices of culture change. Nursing homes differ in the extent to which they:
Reconfigure nursing services and create staff
empowerment
Create a “homey” environment
Implement practices of resident choice for food choice, dining, bathing,
taking medications
Click to View CMS Survey and Certification Letter, 4/09
Culture Culture change is change is
described as described as a journey.a journey.
To learn what nursing homes are participating in the culture change journey, contact the state’s culture change coalition or Google: “culture change coalition.”
DefiningDefining a “Home Like” Environmenta “Home Like” Environment
Household model:Household model: the generic term the generic term
Neighborhood::
Small units of 8-20 residents Consistent staff assignment Separate dining and living areas Local (i.e., community) decision making
Eden Alternative: a philosophy of home and practice
“Where elders live must be habitats for human beings, not sterile institutions.” Goal: eliminate the “3 plagues of loneliness, helplessness, boredom.” Eden concepts are integrated into different living models
Green House::
Built from the bottom up Changes in facility size, layout, interior design Staffing patterns modified to reflect resident needs and preferences Goal is to eliminate large nursing homes and de-institutionalize LTC
Artifacts of Culture ChangeArtifacts of Culture Change
Artifacts of Culture Change is a Artifacts of Culture Change is a CMS tool to evaluate a nursing CMS tool to evaluate a nursing home’s progress from institutional home’s progress from institutional to resident-directed care to resident-directed care
The tool has five key domains of The tool has five key domains of culture change:culture change:- 1. Care Practices 1. Care Practices - 2. Environment2. Environment- 3. Family and Community3. Family and Community- 4. Leadership4. Leadership- 5. Workplace practices5. Workplace practices
Click to Learn more about the Development of the Artifacts of Culture Change Tool
Click to Learn more about Artifacts in culture change at the Pioneer Network
Artifacts of Culture Change 1: Artifacts of Culture Change 1: CARECARE PRACTICES ArtifactsPRACTICES Artifacts
• 24 hour dining where residents can order food 24 hour dining where residents can order food from the kitchen 24 hours/dayfrom the kitchen 24 hours/day
• Snacks, drinks available at all timesSnacks, drinks available at all times• Waking and bedtimes and bathing preferences Waking and bedtimes and bathing preferences
and times are chosen by the residentand times are chosen by the resident• Care plans are in the “voice” of the resident, Care plans are in the “voice” of the resident,
called “I” Care planscalled “I” Care plans• Residents can have their pet live with themResidents can have their pet live with them• Someone is with a dyingSomeone is with a dying resident at all timesresident at all times
Artifacts of Culture Change 2: Examples of ENVIRONMENT Artifacts
• Residents have private rooms or privacy is Residents have private rooms or privacy is enhanced in shared roomsenhanced in shared rooms
• Nurse’s stations are not visibleNurse’s stations are not visible• Medications are kept in the resident’s roomMedications are kept in the resident’s room• Overhead paging system is used only in cases of Overhead paging system is used only in cases of
emergencyemergency• Personal laundry is done in the area where the Personal laundry is done in the area where the
resident livesresident lives• Bathroom mirrors are wheelchair accessibleBathroom mirrors are wheelchair accessible
Artifacts of Culture Change 4: Artifacts of Culture Change 4: Examples of LEADERSHIP ArtifactsExamples of LEADERSHIP Artifacts
• Nursing assistants attend and participate in care Nursing assistants attend and participate in care plan conferencesplan conferences
• Learning circles (or equivalent) are used in Learning circles (or equivalent) are used in resident and staff meetingsresident and staff meetings
• Residents and families serve on nursing home Residents and families serve on nursing home quality assessment/assurance committeesquality assessment/assurance committees
• Community (household/neighborhood) meetings Community (household/neighborhood) meetings are held regularly with staff, residents, and are held regularly with staff, residents, and families.families.
Professional Nurse PracticeProfessional Nurse Practice Model Should Model Should UnderpinUnderpin Culture Change Nursing Homes Culture Change Nursing Homes
Interdisciplinary team shares accountability
for care outcomes
Site-specific innovations designed and
implemented by nurses
Empowered bedside staff (i.e., CNAs)
Decentralized organization
Aspects of Aspects of Professional Nurse Professional Nurse
The Pioneer Network Consumer’s Guide to Finding a Nursing The Pioneer Network Consumer’s Guide to Finding a Nursing Home on the Culture Change JourneyHome on the Culture Change Journey
This guide provides key questions and “listen for” answers, including:
How will you get to know my family member?What is your policy regarding food choices and alternatives?How do you build a sense of community?