*Address correspondence to Sheryl Zimmerman, School of Social Work and the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Boulevard, Campus Box 7590, Chapel Hill, NC 27599-7590. E-mail:
Gerontologist. 2014 Feb;54 Suppl 1:S25-34. doi: 10.1093/geront/gnt145.
Culture change aims to fundamentally improve care provision in a manner consistent with individual preferences. However, few studies of culture change have focused on the quality of daily care, despite the fact that system-wide efforts are important to assure the effectiveness, adoption, and sustainability of person-centered care to meet daily needs. This paper describes a new culture change practice, Mouth Care Without a Battle. The focus on mouth care is predicated on the important association between person-centered support for oral hygiene and quality of life.
Mouth Care Without a Battle is a person-centered approach to quality mouth care for persons with cognitive and physical impairment. It was developed by an interdisciplinary team of clinician researchers based on literature review, consultation with experts, environmental scan of existing programs, and testing in nursing homes. Building from the success of Bathing Without a Battle, Mouth Care Without a Battle was evaluated in terms of changed care practices and outcomes, developed into a training program, and packaged for dissemination as a digital video disk (DVD) and website.
The development and evaluation of Mouth Care Without a Battle demonstrate attention to the areas necessary to establish the evidence-base for culture change, to ultimately empower and support staff to provide care to achieve quality outcomes.
As illustrated in this paper, it is beneficial to build the evidence base for culture change by attending to care processes and outcomes benefiting all residents, ability to implement culture change, and costs of implementation.
文化变革旨在以符合个人偏好的方式从根本上改善护理服务。然而，尽管全系统努力对于确保以满足日常需求为目的的以患者为中心的护理的有效性、采用和可持续性至关重要，但很少有文化变革研究关注日常护理的质量。本文介绍了一种新的文化变革实践，即“无需战斗的口腔护理”。关注口腔护理是基于以患者为中心的口腔卫生支持与生活质量之间的重要关联。
“无需战斗的口腔护理”是一种针对认知和身体障碍患者的以患者为中心的优质口腔护理方法。它由临床医生研究人员组成的跨学科团队开发，基于文献回顾、与专家协商、对现有计划进行环境扫描以及在养老院进行测试。在“无需战斗的沐浴”取得成功的基础上，“无需战斗的口腔护理”在护理实践和结果的改变方面进行了评估，开发成培训计划，并包装成数字视频光盘 (DVD) 和网站进行传播。
“无需战斗的口腔护理”的开发和评估表明，关注建立文化变革证据基础所需的领域对于最终赋予和支持员工提供护理以实现优质结果非常重要。
正如本文所述，通过关注有益于所有居民的护理过程和结果、实施文化变革的能力以及实施成本，可以为文化变革建立证据基础带来益处。
