A comparative exploration of culture change in nursing homes: The residents' perspective

The need to provide an environment that ensures both quality care and quality of life for residents of nursing homes has long been recognized. The culture change movement in nursing homes emphasizes both principles. This mixed-methodology research explores the culture change process in nursing homes by evaluating to what extent core principles of culture change: quality of life, resident choice and control, and resident satisfaction, are demonstrated in the behaviors, attitudes, and day-to-day experiences of the residents. Four groups of subjects in two not-for-profit nursing homes, in which culture change is being implemented, participated in this study. Data were collected in the form of surveys and interviews from nursing home administrators, residents, direct care staff, and family members or friends of residents.The level of the culture change process was found to vary between the two nursing homes and a comparative inferential analysis of the quantitative data as to the resident quality of life, perceptions of choice and control, and level of satisfaction at the two nursing homes showed statistically significant differences in the quality of life domains of privacy and security only. No significant differences were found in resident satisfaction with the nursing home or resident perceived latitude of control.The analysis of the qualitative data from the four groups of participants identified the major themes in the categories of resident quality of life, perceptions of choice and control, and level of satisfaction. Common themes in the factors reported as essential to quality of life by the residents at both nursing homes were quality of care, relationships, activities, physical/functional ability, faith, and safety/security. Relationships and faith were again identified as common themes in the factors reported as essential to maintaining control in their lives by the residents at both nursing homes as were attitude and the ability to advocate for oneself. Only one theme common to both residents at both nursing homes was identified as the worst thing about living in a nursing home and as the best thing about living in a nursing home, the noise/behavior of other residents and relationships respectively.Implications for practitioners include the recognition of the importance of both peer-relationships and relationships with staff to resident quality of life, choice and control, and satisfaction and the process of adjustment to institutional living and the influence of resident attitude towards their living situation. Privacy and security were found to be important factors in the experience of the residents as was quality of care. Recommendations for future research include longitudinal and qualitative studies to explore resident perceptions of ongoing culture change and additional research to provide an increased understanding of the mechanisms by which relationships are formed and maintained between residents and staff in the long-term care environment. Further research exploring resident adjustment to institutional living, both in the short and long-term, would also be of value.