1 Culture Change in Long-Term Care Facilities Over the last few decades, long-term care has experienced a significant culture change from the conventional biomedical environment to a person-centered climate. The culture change is triggered by several innovative care models that reconfigure the roles, structure, and nursing home processes to transform these facilities from healthcare organizations to person-centered homes offering high-quality long-term care. Further, the change is supported by the perception that chronic disability management should focus on personal independence, participation, fairness, and dignity. The ideology of individualized person-centered care influences the attempts to restructure the culture of longterm facilities.
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2 This philosophy emphasizes implementing interventions that address residents' and families' physical and psychological needs. Person-centered care acknowledges the significance of enhancing residents' purpose, meaning, and autonomy by placing their preferences and values at the center of care (Bru-Luna et al., 2021). Successful implementation of a patient-centered environment in LTC is pegged on a cultural change in the facility. Critical components of culture change in long-term care facilities include a homelike atmosphere, collaborative decisionmaking, and resident direction. Other elements of culture change are close relationships, qualityimprovement processes, and staff empowerment (Hemphill et al., 2023). Recognizing residents as individuals with values, cultural identities, differences, and preferences extending beyond their medical status is integral to culture change in LCT. Long-term care Culture change fosters positive and trusting relationships that enable the staff members to attend to the needs of residents and uphold the values and preferences of family and staff (Ho et al., 2021). Administrators assign specific teams to the residents to promote broader understanding and encourage supportive and trusting interactions between residents and staff. This approach enables the teams to focus on individual resident needs and wishes. Research Culture change movement in long-term residential care Nursing care culture change from medical to person-centered environments in long-term facilities has roots in the United States. However, the culture change is complex and challenging. Donnelly and Macentee (2016) clarified that it is difficult to maintain person-centered care due to conflicting priorities in LTC. A national survey revealed that only one-third of nursing homes in the United States had adopted the person-centered culture change. The biomedical model
3 practiced for years prevails in most LTC settings where person-centered care is attempted (Donnelly & Macentee, 2016). Moreover, stakeholders view this model differently, including residents and their families, nursing staff, and administrators. Nursing homes have recognized the significance of person-centered care to resident care outcomes and staff-resident interactions despite the challenges. The culture change movement has gained remarkable momentum to improve longterm care services (Donnelly & Macentee, 2016). The culture change reflects a fundamental shift in perceptions about long-term care facilities. Stakeholders no longer view these facilities as medical care institutions but as person-centered homes providing quality care services to residents. Cultural change practices are influenced by concerns among stakeholders regarding the quality of care and the value of services provided in conventional nursing facilities (Ho et al., 2021). The culture change has shown the potential to transform long-term care service delivery and improve residents' quality of life while curbing nursing challenges such as high staff turnover.
4 Goals of person-centred care In the person-centered care model, social and healthcare professionals collaborate with service users at different levels to address users' needs while achieving organizational goals and sustainability. This model recognizes that individuals have values, preferences, needs, and interests that nurses must address to increase satisfaction with care (Duan et al., 2021). The goal of this model is to support individuals to develop the skills, self-assurance, and understanding needed to successfully manage and make informed choices regarding their health and healthcare. This model is responsive to and respectful of individual needs, preferences, and values. Another goal of person-centered care is to help residents achieve greater independence. It assumes that empowering individuals increases participation in care processes, creating a platform for better care outcomes (Duan et al., 2021). Empowered residents can cope with current and future challenges effectively. Furthermore, person-centered care promotes a meaningful life among residents. This model employs a holistic focus on the exceptionality of an individual irrespective of their sickness (Bru-Luna et al., 2021). It aims to promote health activation where individuals are motivated, educated, and equipped with knowledge and skills to be effective managers of their health. It changes an individual's perception of the care process, thus improving interactions with staff and family members at all levels. Standards of practice The Canadian Gerontological Nursing Standards of Practice (CGNA) addresses all nursing processes and their application to Gerontological nursing. These standards direct and maintain culturally sensitive and clinically proficient nursing care. The two standards of care highlighted by the CGNA (2020) that support person-centered care are relational care and self-
5 care. In Gerontological settings, nursing professionals develop and maintain relational care. This standard of care is defined as a humanistic enterprise typified by respectful interactions and reciprocal communications. This standard supports person-centered care since nurses use empathy and understanding to support care delivery interventions and ensure long-term care residents and their care partners are provided high-quality services (CGNA, 2020). Relational care aims to optimize the health and well-being of older adults. This standard recognizes all aspects of care as integral components of the inter-professional collaborative team. The standard of self-care supports the person-centered care model in long-term care facilities. This standard promotes collaboration between nurses, older adults, and care partners. It acknowledges the older person’s need for autonomy and the right to live free of health risks (CGNA, 2020). Gerontological nurses assess residents' health literacy, health risk, safety, and interpersonal relationships and use culturally competent and safe interventions to promote health outcomes. The standard encourages nurses to respect and promote older adults’ right to safety and self-determination and uphold inclusivity in all care processes. Reflection Thoughts and feelings of person-centred care The personalized care model increases one's satisfaction with care by addressing physical, psychological, and social needs. This model employs a holistic approach to care to ensure that individuals are treated respectfully and that their values and interests are upheld. I have experienced scenarios whereby older persons exhibited more satisfaction with personalized care delivered in long-term care facilities than medical care in other nursing facilities. For instance, one of my older relatives was diagnosed with irritable bowel syndrome. She was more
6 satisfied with care services provided in the long-term facility than in hospitals. She clarified that nursing staff in LTC kept the residents safe and clean, irrespective of their conditions. Unfortunately, not all staff employ a personalized and holistic approach to patient care. It is depressing that some long-term care staff do not respond to their patient's needs. These professionals have yet to embrace the principles of person-centered care. Clearly, these professionals view residents as burdensome and need to be more willing to support them during care processes. Furthermore, the staff members only respond to suggestions by patients if the administration intervenes. In other instances, the staff members need to respond to the residents' hygiene needs, thereby decreasing trust and satisfaction with care. Regrettably, these health professionals do not utilize their knowledge and skills to support and offer quality care services to older persons. Implications for practice Nursing staff can utilize the responses highlighted by Donnelly and Macentee (2016) to change their practice. Evidence shows that the residents were dissatisfied with the care provided by irresponsive staff. For instance, some respondents noted that the facility needed to respond to their suggestions. Further, they noted that nurses were unwilling to help them with hygiene activities, including bathing and diaper changes (Donnelly & Macentee, 2016). These responses indicate that residents were discontented with the insensitivity of the staff. Therefore, leaders could use this information to develop policies to facilitate care delivery and staff response to the resident’s needs. Moreover, the participants noted that even though specific nursing teams were assigned to individual residents, decisions were made by the administrators (Donnelly & Macentee, 2016). Nurses could only resolve the issues presented by the residents once the administrators gave the
7 go-ahead. This information could help the leaders create policies to grant nursing teams the authority to make relevant decisions during care. Conclusion Long-term care culture change from medical care approaches to person-centered care models is a beneficial trend that improves satisfaction with care and Gerontological care outcomes. Person-centered care holistically addresses the psychological and physiological needs of individuals. Also, it establishes a platform for enhanced communication and improved interpersonal interactions.
8 References Bru-Luna, L. M., Martí-Vilar, M., Merino-Soto, C., & Livia, J. (2021). Reliability generalization study of the person-centered care assessment tool. Frontiers in Psychology, 12, 712582. https://doi.org/10.3389%2Ffpsyg.2021.712582 Canadian Gerontological Nursing Association (CGNA). (2020). Gerontological nursing standards of practice and competencies (4th ed.). https://img1.wsimg.com/blobby/go/036d4df6-e252-4a6f-9603-35d9db22fbf0/ CGNA_Standards-Competencies_2020.pdf Donnelly, L., & Macentee, M. (2016). Care perceptions of residents in LTC facilities purporting to offer person-centered care. Canadian Journal on Aging, 35(2): 149–160 http://doi:10.1017/S0714980816000167 Duan, Y., Mueller, C. A., Yu, F., Talley, K. M., & Shippee, T. P. (2022). The relationships of nursing home culture change practices with resident quality of life and family satisfaction: toward a more nuanced understanding. Research on Aging, 44(2), 174-185. https://doi.org/10.1177/01640275211012652 Hemphill, J., MacGregor, L., Austen, A., Calay, R., Kikuta, S. C., Dockery, J., ... & Hitzig, S. L. (2023, July). The process of implementing culture change across a city-operated longterm care home and the importance of stakeholder engagement. In Healthcare Management Forum (p. 961). Los Angeles, CA: SAGE Publications. Ho, P., Cheong, R. C. Y., Ong, S. P., Fusek, C., Wee, S. L., & Yap, P. L. K. (2021). Personcentered care transformation in a nursing home for residents with dementia. Dementia and Geriatric Cognitive Disorders Extra, 11(1), 1-9. https://doi.org/10.1159/000513069
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