Culture Change In LTC? - page 6

I personally think it is wonderful plan, but understand the fear and concerns direct care staff face while implementing these changes? Is anyone implementing this in there facility?If so what are... Read More

  1. by   Simplepleasures
    Quote from CapeCodMermaid
    Hmmm..interesting you want to stay on the topic and then bring up unions.....
    Culture change in LTC is a huge undertaking. I would say 95% of the residents in my building have a better, safer, more activity filled life than they did when they lived at home. Perhaps it is because we, management and line staff alike, actually care about the residents. As a manager I also have to care about the budget. As culture change grows, I hope many of the useless unneeded tasks we were once so concerned about go the way of reusing needles. No long term resident really needs their blood pressure checked 4 times a day. No one in their late 90's is going to benefit from taking 23 medications at 9am. Did these people bathe 2x/day at home? No...more like once a week and they didn't smell and didn't have dried skin. The issue of quality care and culture change AND a good quality of life is too huge an issue for one thread.

    PATRIOTS...the next Super Bowl Champions....AGAIN!
    Having a union in place would facilitate culture change, the nurse would feel secure in her position, have a say in her wages and benefits and would create a generally happier nurse. Also unions such as the CNA have been active in bringing about nurse/ patient ratios which would also help a TRUE culture change in LTC.

    I agree with your position that there are too many redundant procedures and meds that bog down the nurse, but are not some of those required by the state. I bet you know better than me how hard it is to deal with state.

    There are many things that need to be in place before culture change can take root around the country, for our seniors and fellow nurses I hope it can happen soon.
  2. by   ltcconsultant
    IMHO, culture change doesn't happen when a facility fully embraces the Eden Alternative and totally redesigns the place. Culture change happens when administration stops acting like a-holes (from the front line staff's perspective) and the front line staff starts embracing person centered care.
  3. by   Scrabbler
    Our provincial legislation regarding continuing care facilities states that there must be a certain number of hours between meals (eg, not more than 5 I think...) so that kind of culture change would mean huge shifts in everything. We have adopted the Planetree philosophy and are the first facility in our region to do so. Check it out if you're not familiar
  4. by   Simplepleasures

    the foundations of culture change: underlying principles

    culture change is bigger than any one theory or model. cultural transformation is more than just a collection of things to do in a home. instead, the best way to view culture change is as a foundational philosophy that underlies our desire to improve the quality of life for our residents and the staff who provide care for them.
    the philosophy of cultural transformation can best be summed up in two statements:
    • "making our homes places where people want to live, versus places where they go to die."
    • "making our homes places where people want to go to work, versus places where they have to go to work."
    to reemphasize this point, culture change is not merely a set of things we do or policies that we change. instead it is a global way of thinking about the work we do and how we provide care to the people who live in our homes. you have many choices about what specific plan you will follow to change the culture of your community. no matter what model(s) of care you choose, it is the foundational principles that underlie your commitment which are most important.
    the institute's 5 core principles of culture change

    principles that we believe are vital to your cultural transformation efforts are summarized below. these principles are all important and apply equally well to the residents who live in our communities and the workers who devote their lives to providing care. these principles are interconnected and shape the overall feel and atmosphere of the home.

    emphasis on respect -- each member of your community regardless of role in the home (resident, frontline worker, nurse, groundskeeper, etc.) has the right to voice views, ideas, and opinions without fear of ridicule or recrimination. each person's views should be incorporated into discussions before decisions are made.

    emphasis on empowerment -- all members of the community, regardless of role in the home, need to feel as though they make a difference. all are recognized as valued, contributing members of the community. each member is entitled to information and resources that foster critical thought. residents and workers have decision-making authority over things that impact them, while at the same time respecting more global organizational and regulatory constraints.

    emphasis on choice -- residents and workers in long term care communities should be given a range of options that reflect personal preference. having residents and/or workers buy into management directed policies is not choice. residents have the right to make choices regarding their day-to-day lives without penalty. workers are given the flexibility to make choices regarding the work they are responsible for in the home without penalty. choices should be made with consideration of global organizational and regulatory policies and procedures.

    emphasis on relationships -- relationship building should be an ongoing activity within each home. this includes strengthening the bonds among residents, among workers (at all levels), and between residents and workers.

    emphasis on community -- a primary goal of culture change is the ability of homes to evolve from a hospital-like environment to a true community. the phrase, "would i do this in my own home?" should never be far from your thoughts. along with medical care, residents' social, emotional, spiritual, cognitive, and cultural needs should receive equal attention. staff should be viewed as complete individuals versus the more traditional view of identifying workers with the tasks they perform.

    when embarking on your culture change journey, keep these principles in mind. use these principles as a touchstone for deciding if you are on track. if your ideas to change the culture of your home include respect (for residents and staff), empowerment (for residents and staff), choice, an emphasis on relationships, and a commitment to making your long term care community more homelike, then you have succeeded. most of all, remember that...
    culture change begins with you!

    (emphasis in red is mine.)
    Last edit by Simplepleasures on Jan 24, '08
  5. by   dream'n
    How lovely it sounds. But if LTC is the same as it was when I was working in it, we need to focus on fixing the basic, most important problems first. Redunant paperwork, high turnover and ratios, and inane policies and laws. Nurses are so busy trying to provide the basics of safe medical care, they don't have time to worry about providing spa treatments, individualized mealtimes, etc. Does management/TPTB think nurses and CNAs have the time to do this? If they really want to implement Culture Change, they need to put their money where their mouth is and provide much, much, more staff. Perhaps if nurses and CNAs weren't run ragged all the time, they would stay and the ratios would decrease, then they would have the time to provide the little special touches that they would love to do. I say to TPTB; Put up or shut up.
    The state of LTC is generally awful in this country, and all I see being done is more laws/policies which bring more paperwork and problems, and 'window-dressing.'
  6. by   ltcconsultant
    Dream'n, I agree with you wholeheartedly. What I see as a major problem is that nursing homes don't even make an attempt to understand the law. They don't realize that the MDS can legally replace at least a half-dozen other assessments (MDS 3.0 appears to replace even more than that). The excessive paperwork is due to ignorance in regards to what is actually required by the state/feds, and a groundless fear of lawsuits. Paper doesn't serve as lawyer repellent, decent staff-family relationships do.
  7. by   RN 4 Life
    Quote from Dixiecup
    We are implementing some of the changes now.

    The way we did the "get up when you want to" thing is we interviewed each resident (the ones who were cognitively impaired, we interviewed family members to see what their routine was like earlier in their life) and asked what time they would like to get up in the morning. Then we made a list of all the times and that is when they were assited with getting up.(in other words, they just couldn't choose a different time each day but they could pick a later time than they were getting up now.)

    We are trying open dining for breakfast only right now. From 7am-9am. There are menus on the table and we take their order every day and they can pick from virtually anything on the breakfast menu. The residents seem to really like this.

    We just ripped out our old nursing station that was, as someone put it, right in the middle of their living room. We still have a nurses station but it was moved to an office room out of the way.

    Haven't tackled the shower issue yet.

    We are taking it little steps at a time and it hasn't been to bad.
    How are things coming along? How are the patients and their families responding and how is the staff adjusting. I think your facility taking the best approach to implementing culture change.
  8. by   RN 4 Life
    Quote from ltcconsultant
    ..... They don't realize that the MDS can legally replace at least a half-dozen other assessments (MDS 3.0 appears to replace even more than that). The excessive paperwork is due to ignorance in regards to what is actually required by the state/feds, and a groundless fear of lawsuits. ....
    The MDS 3.0 is going to a poweful tool. Its ability to help us assess and collect data regarding how our patient is doing is going to change to face of care in the nursing home. I do believe that people are afraid of having deficent practices in theree nursing homes so they push excessive documentation to prove we are doing all we can. In my opinion, the MDS 3.0 puts us one step closer to a facility where meeting the needs of the patient [despite what they may be]are at the top of the list. Which is truly what culture change is all about.

    Additionally, I think it is important for us as nurses in LTC to advocate for the things we need to make culture change successful. Policy reform is also apart of our responsibility. Do you communicate with your legislature your concerns? There are many strong opinions within this thread that deserve to be heard by the local health care advocates. They are our we need to consistently communicate with them.
  9. by   Merced
    I don't like the term, "skilled nursing facilities" because, at least here in California, that is not really an accurate description in the majority.

    I am aware that other states have some alternative nursing homes, where the environment is homey more than clinically correct.

    I know there are plenty of arguments on the other side, but I happen to be a person who when I get older, want to belong to a caring & emotionally pleasing community. I personally care about this much more than about attempts to prolong my life or protect me from harm.

    Of course there would still be real "skilled nursing facilities" ideally ones that lived up to the name, for the acutely ill who needed clinically skilled nursing care. If I had just had surgery, perhaps I would opt for a short stay in one myself, so I am not against highly skilled medical care for the elderly. I am for living out the end of my life in a community setting rather than a place where they worry I will sue if I get up by myself & fall, or if I want to eat ice cream when I'm a diabetic, etc.

    So, I am interested in people who have real, rather than my own "theoretical" knowledge of such places. I can go online & read about them but I want to talk to someone with some experience. Does anyone here fit that bill?