Kansas Culture Change Instrument KCCI. resident centered care, a homelike environment, staff/resident relationships, staff

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2 KansasCultureChangeInstrumentKCCI residentcenteredcare,ahomelikeenvironment,staff/residentrelationships,staff empowerment,nursinghomeleadershipsqualityimprovement sharevalues nkcci. rp 74

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4 . ProblemandPurpose 76

5 culturechange LiteratureReview PioneeringChange( ) 77

6 EdenAlternative EdenAlternative EdenAlternative EdenAlternative p EdenAlternative 78

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9 SampleandSetting range nn Measures 81

10 KansasCultureChangeInstrumentKCCI KCCI residentcenteredcare,ahomelikeenvironment,staff/resident relationships,staffempowerment,nursinghomeleadershipsqualityimprovement. KCCIsharevalues, QualityImprovement KCCI ResidentDirectedCareandActivities HomeEnvironment 82

11 RelationshipswithStaff,Family,Resident&Community withstaff,family,resident&community StaffEmpowerment NursingHomeLeadership 83

12 QualityImprovement, QualityImprovement SharedValues, Sharedvalues Procedures 84

13 DataAnalysis p 85

14 r SDSD SDSD p LeadershipHomeEnvironment p MSDMSDTotalCulture Change TotalCultureChange StaffEmpowermentQualityImprovement ResidentCare QualityImprovement 86

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17 Kansas NursingFacilityProjectReport Culturechangeinnursinghomes:Howfarhavewe come?findingsfromthecommonwealthfund2007nationalsurveyofnursinghomes PioneeringChange. NursingAdministrationQuarterly Journalof GerentologicalNursing, Journalof AmericanMedicalDirectorsAssociation Medicineand Health/RhodeIsland,89 89

18 Table1 SampleDemographics Leaders (n = 457) Staff (n = 2,260) Characteristics Category % Category % Years in NH <1 year 1-5 years >5 years <1 year 1-5 years >5 years Role in NH Administrator/ Assistant Director of Nursing/ Assistant Department Heads Other RN/LPN CNA/CMA Dietary/Activities/ Social Services PT/OT/ST/ Restorative Aides Other Education Some High School (HS) HS Diploma Technical/AD Bachelors or higher Some High School (HS) HS Diploma Technical/AD Bachelors or higher Primary Shift Worked Days Evenings Nights Other Days Evenings Nights Other Gender Male Female Male Female Race/ Ethnicity Caucasian African American Hispanic Other Caucasian African American Hispanic Other

19 Table2 Cronbach salphasforthesevensubscalesofthekansasculturechangeinstrumentforleadersand Staff * * Subscales Leaders Staff Resident Care Home Environment Relationships Staff Empowerment NH Leadership Quality Improvement Shared Values

20 Table3 DefinitionsofNursingHomeCultureChangeGroupswithCutpoints. Group Definition Cut point Limited The nursing homes had either not been involved or involved for less than one year in culture change activities and culture change had not changed or had had limited impact on the way residents were cared for in some areas. < 2.5 Partial Extensive The nursing home had been involved in culture change activities for at least one year and culture change had partially changed the way residents were cared for in some or all areas The nursing home had been involved in culture change activities for more than one year and culture change had extensively or completely changed the way residents were cared for in some or all areas

21 Table4 CultureChangeSubscaleScoresforLeadersandStaff Leaders Staff Total Scale & Subscales M SD M SD p Total Culture Change Score <.001 Resident Care <.001 Home Environment <.01 Relationships <.001 Staff Empowerment <.01 NH Leadership <.001 Shared Values <.001 Quality Improvement <

22 Table5 PearsonCorrelations(r)betweenLeadersandStaffforCultureChangeSubscales TotalScale&Subscales Total Limited a Partial b Extensive c r r r r a Limited Culture Change nursing homes b Partial Culture Change nursing homes c Extensive Culture change nursing homes *p<.05 **p<.01 ***p<

23 Figure1 TheoreticalFrameworkusingthe2006CommonwealthFundDefinitionofCultureChange Quality Improvement Resident CenteredCare NursingHome Leadership Homelike Environment Staff Empowerment Staff/Resident Relationships 95

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