Hermer Linda, Bryant Natasha S, Pucciarello Madeline, Mlynarczyk Carolina, Zhong Bridget
Center for Applied Research, LeadingAge, Washington, DC.
Department of Public Health, Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ.
Innov Aging. 2017 Dec 28;1(2):igx033. doi: 10.1093/geroni/igx033. eCollection 2017 Sep.
Several studies suggest that to substantially improve residents' psychosocial well-being, traditional-model nursing homes should redesign themselves as small, homelike "households" along with comprehensively adopting other aspects of "culture change," a set of reforms meant to improve residents' quality of life. But this evidence mainly comes from qualitative studies. This comparative, observational study tested quantitatively whether residents in a household-model nursing home that had comprehensively adopted culture change reforms displayed greater positive affect, increased cognitive engagement, more extensive social interactions with staff and greater use of the environment than did residents at partial culture-change-adopting facilities with traditional, institutional environments.
Household-model residents were matched on clinical and demographic factors with residents at two institutional control facilities that had partially adopted culture change and were observed for 8 hours each. To provide potentially converging evidence, aides and nurses were also observed. Finally, a culture change implementation assessment was conducted.
The implementation assessment showed that the household-model home had implemented culture change beyond national norms, whereas the control facilities were U.S.-typical partial adopters. It also revealed that household-model staff cared for residents in a more person-centered manner. Observation analyses revealed that household-model residents spent less time idle and less time stationary at wheelchair hubs. Moreover, although household-model residents did not spend the most time in the dining area overall, they spent the greatest percentage of time there talking with staff, displaying positive affect, and displaying active engagement. Finally, household-model residents and staff spent the most time in task-oriented interactions, including personal care.
These results suggest that the intended psychosocial benefits materialize in household-model facilities, particularly in the dining area and in resident-staff relationships. The findings raise the possibility that facilities may be able to achieve these outcomes without entirely redesigning their environment.
多项研究表明，为大幅改善居民的心理社会福祉，传统模式的养老院应将自身重新设计成小型、类似家庭的“住户单元”，同时全面采用“文化变革”的其他方面，这是一系列旨在提高居民生活质量的改革措施。但这方面的证据主要来自定性研究。这项比较性观察研究定量测试了全面采用文化变革改革措施的住户模式养老院中的居民，与采用部分文化变革措施、具有传统机构环境的设施中的居民相比，是否表现出更积极的情感、更高的认知参与度、与工作人员更广泛的社交互动以及对环境的更多利用。
将住户模式养老院的居民与两家部分采用文化变革的机构对照设施中的居民，在临床和人口统计学因素上进行匹配，并对他们每人观察8小时。为提供可能相互印证的证据，还对护工和护士进行了观察。最后，进行了文化变革实施情况评估。
实施情况评估表明，住户模式养老院实施文化变革超过了国家标准规范，而对照设施是典型的美国式部分采用者。评估还显示，住户模式养老院的工作人员以更以人为本的方式照顾居民。观察分析表明，住户模式养老院的居民空闲时间和在轮椅集中区域静止不动的时间较少。此外，尽管住户模式养老院的居民在餐厅的总停留时间不是最长，但他们在餐厅与工作人员交谈、表现出积极情感以及积极参与活动的时间占比最大。最后，住户模式养老院的居民和工作人员在包括个人护理在内的任务导向互动中花费的时间最多。
这些结果表明，住户模式养老院实现了预期的心理社会效益，尤其是在餐厅以及居民与工作人员的关系方面。研究结果提出了一种可能性，即设施无需完全重新设计环境也可能实现这些成果。
