The complexity of implementing culture change practices in nursing homes.
ABSTRACT The culture change (CC) movement aims to transform the traditional nursing home (NH) that is institutional in design with hierarchical management structure into a homelike environment that empowers residents and frontline staff. This study examines differences in adoption of CC practices according to a NH's self-reported extent of CC implementation and its duration of CC adoption. Furthermore, it examines differences in adoption by whether a CC practice is considered less versus more complex, using complexity theory as the theoretical framework for this classification.
Using data from a 2007 Commonwealth-funded study, we analyzed a national sample of 291 US nursing homes that identified as being "for the most part" or "completely" CC facilities for "1 to 3 years" or "3+ years." Also, using a complexity theory framework, we ranked 16 practices commonly associated with CC as low, moderately, or highly complex based on level of agreement needed to actuate the process (number of parties involved) and the certainty of intended outcomes. We then examined the prevalence of CC-associated practices in relation to their complexity and the extent and duration of a NH's CC adoption.
We found practices ranked as less complex were implemented more frequently in NHs with both shorter and longer durations of CC adoption. However, more complex CC practices were more prevalent among NHs reporting "complete" adoption for 3+ years versus 1 to 3 years. This was not observed in NHs reporting having CC "for the most part."
Less complex practices may be more economical and easier to implement. These early successes may result in sufficient momentum so that more complex change can follow. A nursing home that more completely embraces the culture change movement may be more likely to attempt these complex changes.
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ABSTRACT: Throughput performance of a multichannel wireless access protocol with non-instantaneous feedback taking into account the effect of bursty packet losses, caused by a correlation in the multipath fading process is analyzed. M equal capacity orthogonal traffic channels are shared by N mobile users (M≤ N) on the mobile-to-base link. Based on the status (busy/idle) of the M receivers transmission attempts are made on the uplink. The BS (base station) broadcast the status in every slot on the downlink (base station-to-mobile link). A first order Markov model is used to describe the correlation in the packet success/failure process on a Raleigh fading channel. Using the above method., analytical expressions for the average throughput per channel are derived for a multichannel wireless access protocol with non-instantaneous feedback. The effects of Doppler bandwidth on the performance of the protocol with and without capture conditions are compared. For fixed values of N the single channel system perform better than the multichannel system, but for a fixed N/M ratio the multichannel system perform better than the single channel system.Networks, 2002. ICON 2002. 10th IEEE International Conference on; 02/2002
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ABSTRACT: A growing number of nursing homes across the country are embarking on culture change transformations that focus on maximizing elder residents' quality of life (QOL). Challenges to culture change implementation include the wide range of possible interventions as well as a lack of research-based evidence to guide these choices. The purpose of this study was to determine those components of nursing home QOL that are associated with elder satisfaction so as to provide direction in the culture change journey. A cross-sectional study using a survey administered face-to-face. Three large urban nursing homes within a long term care system in New York State. Sixty-two elder nursing home residents participated in face-to-face interviews. All elders had resided in their nursing communities for at least 3 months before participation. The survey included the Quality of Life Scales for Nursing Home Residents, which examines elder QOL in 11 domains: autonomy, dignity, food enjoyment, functional competence, individuality, meaningful activity, physical comfort, privacy, relationships, security, and spiritual well-being. Elder satisfaction with the nursing home and nursing home staff were also examined. After accounting for cognitive and physical functioning, among the QOL domains, dignity, spiritual well-being, and food enjoyment remained predictors of overall nursing home satisfaction. Additionally, dignity remained a significant predictor of elder satisfaction with staff. These results provide one possible path in the culture change journey based on empirical findings.Journal of the American Medical Directors Association 10/2010; 13(1):48-53. DOI:10.1016/j.jamda.2010.08.002 · 4.78 Impact Factor
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