The Challenge of Translating Culture Change

It is perhaps not an exaggeration to state that all nursing home administrators, directors of nursing, and long-term care researchers have heard the term “culture change.” It is promoted by the Advancing Excellence in America’s Nursing Home Campaign—in which more than 60% of nursing homes have registered (Advancing Excellence in America’s Nursing Homes, 2014)—as well as by the American Health Care Association (AHCA), the National Association Directors of Nursing Administration in Long Term Care (NADONA/ LTC), and numerous other organizations. In an online search for books and research articles about “nursing home culture change,” as of July 2014, Amazon.com listed 117 books, and PubMed 259 articles. Consequently, a new book on the topic of culture change in long-term care sets high expectations and faces competition, especially if it intends to make a novel contribution. Jurkowski’s book, Implementing Culture Change in Long-Term Care: Benchmarks and Strategies for Management and Practice, creates its niche by listing the culture change benchmarks presented in the Artifacts of Culture Change Tool (Bowman, 2006) and setting out to provide guidance to put those benchmarks into practice. The Artifacts tool creates a weighted score based on 79 “artifacts” representing culture change. Artifacts are listed under six categories: (a) care practices (14 items, 70 points; e.g., baked goods are baked on resident living areas); (b) environment (27 items, 320 points; e.g., no traditional nurses’ stations); (c) family and community (6 items, 30 points; e.g., regularly scheduled intergenerational programming); (d) leadership (5 items, 25 points; e.g., residents or family members serve on committees); (e) workplace practices (14 items, 70 points; e.g., a paid volunteer coordinator is on staff); and (f) outcomes (13 items, 65 points; e.g., longevity of the director of nursing). An important caveat regarding the Artifacts tool, however, and as noted by Jurkowski, is that it has not been psychometrically evaluated, nor is there evidence regarding its validity, reliability, and scoring algorithm (Zimmerman et al., in press). Thus, the Artifacts may be viewed by the research community as a weak standard around which to organize this book. Also, the Artifacts is but one of a number of available tools related to culture change (California Foundation for Medical Care, 2006), and its developers expressly note that it is meant to add to the available tools, not replace them. At the same time, the Artifacts has been embraced by many providers and advocates, and so practical instruction in achieving its benchmarks is certain to be welcomed. Part II of this book presents the Artifacts and text intended to offer practical instruction to promote culture change implementation. In some cases, the text is helpful (e.g., an example and photograph of an altimeter clock in the room of a former pilot to illustrate personalization), but in others it is less so. For example, text to support the benchmarks related to using aromatherapy, making extra lighting available, having outdoor walking/wheeling paths, using a buddy system, and other sections do not provide the detailed instruction that could truly benefit a reader. That said, Part II also includes discussion of topics ranging from person-centered care to social engagement, leadership practices, measurement