Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, Davenport, IA 52803, USA.
Gerontologist. 2010 Jun;50(3):327-39. doi: 10.1093/geront/gnp157. Epub 2009 Dec 11.
Although nursing homes (NHs) are criticized for offering poor quality continence care, little is known about the organizational processes that underlie this care. This study investigated the influence of organizational culture on continence care practices in two NHs.
This ethnographic study explored continence care from the perspectives of NH stakeholders, including residents and interdisciplinary team members. Data were collected through participant observation, interviews, and archival records.
Human relations dimensions of organizational culture influenced continence care by affecting institutional missions, admissions and hiring practices, employee tenure, treatment strategies, interdisciplinary teamwork, and group decision making. Closed system approaches, parochial identity, and an employee focus stabilized staff turnover, fostered evidence-based practice, and supported hierarchical toileting programs in one facility. Within a more dynamic environment, open system approaches, professional identity, and job focus allowed flexible care practices during periods of staff turnover. Neither organizational culture fully supported interdisciplinary team efforts to maximize the bladder and bowel health of residents.
Organizational culture varies in NHs, shaping the continence care practices of interdisciplinary teams and leading to the selective use of treatments across facilities. Human relations dimensions of organizational culture, including open or closed systems, professional or parochial identity, and employee or job focus are critical to the success of quality improvement initiatives. Evidence-based interventions should be tailored to organizational culture to promote adoption and sustainability of resident care programs.
尽管养老院（NH）因提供劣质的控尿护理而受到批评，但对于支撑这种护理的组织流程却知之甚少。本研究调查了组织文化对两家 NH 中的控尿护理实践的影响。
本民族志研究从 NH 利益相关者的角度探讨了控尿护理，包括居民和跨学科团队成员。通过参与观察、访谈和档案记录收集数据。
组织文化的人际关系维度通过影响机构使命、入院和招聘实践、员工任期、治疗策略、跨学科团队合作和群体决策，影响控尿护理。在一个设施中，封闭式系统方法、狭隘的身份认同和员工关注稳定了员工流动率，促进了循证实践，并支持了分层的便盆计划。在更具动态性的环境中，开放式系统方法、专业身份认同和工作重点允许在员工流动期间灵活进行护理实践。两种组织文化都没有充分支持跨学科团队努力最大化居民的膀胱和肠道健康。
NH 中的组织文化存在差异，塑造了跨学科团队的控尿护理实践，并导致了在不同设施中对治疗方法的选择性使用。组织文化的人际关系维度，包括开放或封闭式系统、专业或狭隘的身份认同以及员工或工作重点，对于质量改进计划的成功至关重要。应根据组织文化调整循证干预措施，以促进居民护理计划的采用和可持续性。
