Culture Change in Nursing Homes

Culture change in nursing homes refers to the new and revolutionary patient care practices developing in modern long term care. The overarching goal is to transform these facilities from institutions into real homes and communities.

This change is guided by a shift in focus aimed at enhancing the respect and care given to elderly patients. Culture change stresses the importance of patient choice, dignity, autonomy, and purposeful living. One of the goals of this movement is to expand patient care beyond just physical boundaries; the patient’s mental and emotional well-being also becomes a priority. By attending to every aspect of a patient’s needs while maintaining high respect for the patient, more trust is established between patient and caregiver and the patient will be more satisfied with the care that he or she is receiving.

Healthcare facilities and nursing homes that are involved in this culture change will notice that small changes can lead to big results. For example, changing certain aspects about the language used in the workplace will create a community atmosphere where patients and workers are known as “friends.” Referring to patients as “friends” or “neighbors” and nursing homes as “communities” or “life centers” is a subtle way to deinstitutionalize the atmosphere.

Personalized Care is the Most Important

Creating “neighborhoods” within the nursing home, consistently staffed by the same caregivers, helps enhance the relational aspect of the culture change. Personalized one-on-one care is an important part of nursing home culture change. By having the same caregivers care for the same group of patients, the patients become more familiar and friendly with the workers, and healthy relationships are encouraged.

Also, many times nursing homes that are creating these neighborhoods will allow the staff of each area to maintain high levels of self-management, which increases job satisfaction.

Patient choice plays an important role in nursing home culture change. Certain choice options, such as allowing patients to choose what to eat for dinner, what activities to participate in, or when they would like to go to bed can go a long way toward improving the patients’ perceived quality of life. Also, more nursing homes are making efforts to provide each resident with a private room, as this allows the patient to feel more independent.

New Technology Assists in Nursing Home Culture Change

New remote patient monitoring technology, such as Dalcon Alert!, helps nursing homes “deinstitutionalize” and create a homelike environment by eliminating loud alarms and the need to use the overhead pager. The system also greatly improves staff communication and the quality of care.

The culture change in long term care movement is gaining momentum, mostly because of the benefits that it brings to both residents and employees. Nursing homes that adopt the principles of culture change often see improvements throughout the entire organization, such as reduced operational costs, increased staff retention rates, higher occupancy rates, and increases in overall competitive position.

Decentralized Nursing Stations: A Change for the Better

As hospitals move further into the 21st century, decentralized nursing stations are becoming the standard for enhancing the quality and efficiency of nursing care.

In the past, when medical information was stored on paper, centralized nursing stations were necessary to keep all medical data stored in an easy to access place. However, with the advent of new digital information storage and communication technology, centralized nursing stations have become an increasing burden on the quality of patient care.

The Value of Decentralization

The primary benefit of a well-managed system of decentralized nursing stations is the positive impact the system has on patient care. Having multiple nursing stations located throughout a floor instead of one centrally located station puts nurses in closer proximity to the patients. A result of close nurse-patient proximity is improved nurse response time and room observations.

Also, the close nurse to patient proximity helps hospitals with decentralized nurse stations better prevent never events due to patient falls.

Decentralized nursing stations also save nurses thousands of steps each day traveling back and forth from patient rooms to the central station. Less travel fatigue leads to enhanced quality of care. Also, hospitals with successfully implemented decentralized systems experience lower staff turnover due to improved work satisfaction.

When planning the decentralization process, it is important that nurses retain an area where they can gather and collaborate. Nurses, like many workers, enjoy camaraderie and need to have particular areas allocated for their gathering. Effective nursing requires teamwork, and the social aspect of the job must be respected. Thus, a central nursing workroom is an important part of any decentralized system.

Hospitals looking to incorporate decentralized nursing stations should be prepared to expand their supply inventories since there will be more stations. However, the added cost of expansion will be offset by decreased nursing staff turnover and more efficient workspace.

Importance of Nurse Communication

Communication is a key issue when developing a successful decentralization plan. Because the stations are spread out, effective nurse communications become a more important factor in determining quality of patient care. Communications technology to solve this problem is currently available. Dalcon has multiple communication solutions, including Dalcon Alert!, that can effectively bridge this nurse communication gap by placing wireless phones in the hands of caregiving staff.

Dalcon Alert! is a Remote Patient Monitoring system that places fully functional wireless phones in the hands of caregiving staff. When a patient monitoring device triggers an alert connected to Dalcon Alert!, the system sends a text message to caregivers’ wireless phones so they can respond to the patient immediately. Alerts are simultaneously sent to the PC displays of all nursing stations. The alert is tracked in real time so that caregivers at each station can observe which alerts have been canceled and which have not.

Preventing Pressure Ulcers (Bed Sores) Never Events with Technology

In October 2008, the Center for Medicare & Medicaid Services (CMS) began requiring hospitals that receive federal funding from Medicare and Medicaid to begin disclosing “never events.”  CMS has stated that they will no longer reimburse hospitals for any costs associated with never events, and hospitals are prohibited from passing costs onto the patient.

What are Never Events?

Never events are a series of medical errors that are defined by CMS as, “clearly identifiable, preventable, and serious in their consequences for patients, and that indicate a real problem in the safety and credibility of a health care facility.” Included in the CMS financial year 2009 list of never events that will be denied federal reimbursement are the following medical errors:

How Dalcon Alert! Helps Prevent Pressure Ulcers (Bed Sores)

Obviously, never events can be quite costly for hospitals.  Yet some occur much more frequently than others.  Preventing bed sores can be difficult, but new technology is available to help hospitals prevent bed sores. Dalcon Alert! is a system that contains 3 distinct sections that help nurses treat and prevent pressure ulcers.

1. Remote Patient Monitoring
2. Alert Management Software
3. Pressure Ulcer Management System

Dalcon Alert! Remote Patient Monitoring

Remote Patient Monitoring is achieved by integrating with existing patient monitoring devices in the hospital.  Dalcon Alert! automatically forwards all device alerts—via a text message—to wireless phones carried by the nursing staff.

Although Dalcon Alert! contains the technology for nurses to remotely monitor patients via wireless phones, the pressure ulcer management system does not require their use or purchase.  If desired, hospitals can implement Dalcon Alert!‘s Alert Management software & Pressure Ulcer Management System as a stand alone system, and use it as a tool to create and manage bed turn alerts using current hospital policy.

Dalcon Alert! Alert Management Software

Dalcon Alert!’s Alert Management application helps caregivers actively manage the many patient monitoring alerts that are created in the hospital. The Alert Management software is similar to a web application, but it can only be accessed from the browsers of computers on the hospital network.

The function of the Alert Management software is to display, in real time, all active alerts that are being managed by the Dalcon Alert! system. Combined with Dalcon Alert!’s pressure ulcer management system, Dalcon Alert!‘s Alert Management software makes sure no pressure ulcer treatment is overlooked by staff.

Dalcon Alert! Pressure Ulcer Management System

Dalcon Alert!’s pressure ulcer management system is a unique solution. When this feature is turned on, the system automatically creates a “bed turn” alert that reoccurs after a set period of time (dictated by the hospital).  This “bed turn” alert is treated the same as any other alert that Dalcon Alert! manages; relevant caregivers receive the alert on their wireless phone, and the alert is reported on the system’s alert management software.  Thus, caregivers are continually reminded to attend to and turn at risk patients. Because Dalcon Alert! helps nurses pro-actively prevent pressure ulcer negligence, the occurrence of dangerous pressure ulcers in at risk patients is significantly reduced.