Traditional nursing homes are based on a model that can limit a resident’s ability to make basic choices, minimize opportunities to direct their own lives, and ultimately destroy the human spirit. As an alternative to the traditional model, the household model is an arrangement in which small groups of residents direct their daily lives in a shared home setting (a household), supported by a decentralized self-led service team of frontline professionals empowered to be responsive to the residents’ needs. While many frontline nursing staff members are advocates of the need for change, it is also common for them to react negatively toward the process of household model implementation. The purpose of this qualitative study was to examine nurse aides’ and licensed nurses’ reactions to household model implementation. Sixteen semi-structured interviews were transcribed verbatim, divided into 524 units of meaning, and coded using concepts of Oreg, Vakola, and Armenakis’ (2011) theoretical model, derived from 60 years of qualitative studies on change recipients’ reactions to organizational change. In this model, employee reactions are a function of antecedents, categorized as pre-change (individual characteristics and internal context) and change antecedents (change process, perceived benefit/harm, and change content). Antecedents influence affective, cognitive, and behavioral reactions to change and, subsequently, lead to change consequences, including work-related and personal consequences. Two trained independent coders reviewed transcripts and achieved 70% agreement. Explicit reactions accounted for 48% of comments, followed by antecedents (27%) and change consequences (25%). Most common antecedents were related to change process (71%), perceived benefit/harm (24%), and change recipient characteristics (4%). Study participants reported difficulties with cross training, initial experiences of hardship and fear, confusion over the new model, and perceptions that it would be harmful to staff members and residents. Although experiences improved over time, some staff members, who self-identified as positive individuals, still reported perceived harm and engaged in resistant behaviors. Explicit reactions to change were behavioral (41%), cognitive (33%), and affective (26%). Most staff members supported household model implementation through their actions. They communicated with each other to learn and to cope with change. While three staff members actively resisted changes, they still supported at least some aspects of the household model. Cognitive and affective reactions were mixed, ranging from excitement and happiness to fear, nervousness, and frustration. Core household model components were received as positive, especially for residents. Concerns regarding work accounted for 94% of all reported organizational change consequences and included insufficient household staffing, harder working conditions, insufficient time to get everything done (or to do it well), and widespread feelings of isolation. The theoretical model for analyzing organizational change proved to be useful in understanding nursing staff members’ reactions to household model implementation and for identifying proactive steps to manage this change. Ongoing education is recommended to ensure staff members follow through with changes over time and to reduce confusion and perceptions of harm. The household model may need to be staffed at a higher level, at least initially, to maintain the same quality of care as in the traditional care delivery model. Ongoing team training within each household can serve to improve operations and balance responsibilities of blended roles. Due to the decentralized environments, potential feelings of isolation among residents and staff members are anticipated, which can be alleviated through regular multi-household gatherings.
|Advisor:||Ivanitskaya, Lana V.|
|Commitee:||DeLellis, Nailya, Kelly, Steven G.|
|School:||Central Michigan University|
|School Location:||United States -- Michigan|
|Source:||DAI-B 77/12(E), Dissertation Abstracts International|
|Subjects:||Gerontology, Health care management|
|Keywords:||Culture change, Household model, Long term care, Nursing home, Person centered care, Resident centered care|
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