Anyone have experience with Culture Change?

[gladheart]

Hi,

Forgive me if there is another thread out there, but I only found a few from several years ago and want some input from nurses who are working or have worked in LTC that have gone through culture change, or are doing so now.

We are looking to implement changes in my facility that improve our resident's lives, make it more of a home environment, give them more choices, etc.

Right now, we are focusing (the team I am on) on dietary - we recently started a dessert cart with several choices instead of "everyone gets a brownie" kind of thing.

What kind of changes have you made that worked, what didn't work, any ideas?

Please, lets not turn this into a "until they increase staffing or correct staffing issues it will never work" thread. Realistically, I know they will NOT increase staffing or spending to implement any changes, so I am looking for things others have made work, and even things that did not work and why. How did your residents respond to it? Staff will grumble and complain, because we don't like change, but its not about us.

Thanks in advance!

[mazy]

Let's see. We implemented a policy that let's residents get up when they want to get up and go to bed when they want to go to bed. When I first heard of that I thought it was going to be complete chaos and thought well, these well-intentioned administrators have never worked the floor, what kind of a flustercluck are they creating now.

But once we got a system down and really made up a schedule of who likes what, it ended up working really well. Kind of staggers the wake up/lie down load so the CNAs aren't scrambling to get everyone up at the same time. Helps the nurses too, once we become familiar with the residents' routines, we can stagger our med pass accordingly. And the residents are in a much better mood. Who wants to be dragged out of bed at 5:30 in the morning? Or dragged off to bed at 7 o'clock at night?

Along with that we have eliminated set times for med pass (except for those that are time specific, like insulins, some narcs, and ABX). We do the AM block (7-10A), midday block (11-2P), PM block (3-7P), and HS block (8-10P). Also have some AM ac meds, and PM ac meds. Again, I thought it was going to be a disaster, but it is actually a lot more organic.

We catch the residents when they are up and want to take the meds, and can organize our pass around when they are in the mood to take them. Which is actually what ended up happening before, even with set times, it's just now we have an actual official policy that it's OK to do that.

The only issue I have is that one hour gap between blocks, a lot of my residents who go to bed early don't want to be woken up at eight to get a med that they would prefer to get at 7:30, right before they hop into bed.

We are also a lot more flexible with showers, and just overall more responsive and aware of the residents' needs and wishes.

Also, we have a special dining cafe for the more active residents, where they can eat together and socialize more, and have a different and more interesting selection of food.

My facility has always been very resident-oriented in terms of routines. The resident wants to stay in bed all afternoon, well they can do it. They want to go out at 9 at night with their family? Well unless there is some critical reason for why they can't, then they can do it. Don't want to take a shower? OK. You can do your best to convince them, but they can choose. And you know, if you give them a sense of choice, they actually choose to take the shower.

Tons of activities too.

I love it really. Sure we've got our problems, just like everywhere else, but in general, it's a much happier environment.