AGING IN OREGON
Understanding Long Term Care Services for the Older Adult
Module 4 –Culture Change & The Emerging Role of the Nurse in LTC
Long Term Care Culture Change
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What is Culture Change?
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What does Culture Change Transformation Support?
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The common name given to the national movement for the transformation of
older adult services, based on person-directed values and practices where the
voices of elders and those working with them are considered and respected.
Core person-directed values are choice, dignity, respect, self-determination and
purposeful living.
The creation of both long and short-term living environments as well as
community-based settings where both older adults and their caregivers are able
to express choice and practice self-determination in meaningful ways at every
level of daily life.
What does Culture Change Transformation Require?
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Changes in organization practices, physical environments, relationships at all
levels and workforce models – leading to better outcomes for consumers and
direct care workers without inflicting detrimental costs on providers.
To learn more about Culture Change go to the Pioneer Network website.
Person-Directed Care
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A philosophy of Person Directed Care (PD) strives to implement and
support the choices that the person being assisted makes and to keep
all decision-making as close to them as possible.
It recognizes that some individuals lack the physical or cognitive
abilities to tell us with words what their wishes are, but that within
their past choices and present behaviors lies the key to what will most
honor their current wishes.
In these cases, those who work with them on a daily basis (the family
or other direct caregivers) need to have the ability to adapt routines
to fit their expressed and implied wishes. PDC recognizes the inherent
value of each individual and is focused on supporting their strengths
and abilities, capacity for social contribution, unique values,
preferences and living habits, and promoting autonomy and choice
(White, D. et. al. 2008).
Applying Person-Directed Care to the
Care Planning Process
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Click on this link to open a document from the
Department of Human Services in Wisconsin that
provides a good overview of how to apply persondirected care to the care planning process for an older
adult with dementia (it will open in a separate window).
Pay particular attention to:
The Five Basic Needs of People with Dementia
 The Well-Being Profile
 Descriptive Language and Old & New Language
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Culture Change in Oregon: Making
Oregon Vital for Elders (M.O.V.E.)
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M.O.V.E. is the local culture change organization
representing key stakeholders in LTC. The group
offers approximately 4 seminars/workshops on a
variety of culture change topics each year.
Building on principles of the Pioneer Network,
Oregonians from a variety of organizations and
experiences founded M.O.V.E., a coalition in which
ideas and actions come together to create culture
change for the benefit of elders and those who
support them.
http://orculturechange.org/
Culture Change in Oregon: Making Oregon Vital for
Elders (M.O.V.E.)
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Vision: We share the vision that Oregonians will live and work in communities that
embrace aging; where individual contributions are valued, unique talents celebrated
and personal life experiences honored.
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Building on principles of the Pioneer Network, a national grassroots organization
committed to changing the culture of aging in America, Oregonians from a variety of
organizations developed a statewide coalition in which ideas and actions come together
to support culture change.
Mission: To create and sustain personalized, enriching communities where older adults
and those who support them can thrive.
We are dedicated to culture change by enhancing the way care and services are
delivered to older adults throughout Oregon. Our goal is for all people to live in
communities where each person’s capabilities and individuality are affirmed and
developed regardless of setting.
http://orculturechange.org/
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Culture Change in Oregon
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In many ways, the LTC culture change began,
particularly in Oregon, with the development of
community-based care settings such as assisted
living and adult foster care. The need to address
issues such as privacy, respect, choice, and
promoting independence are written into the
Oregon laws governing these services.
Culture Change in Oregon
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Many pioneers, including nurses such as Joanne Rader
from Oregon (who has contributed to major nursing
practice changes such as individualized dementia care,
restraint reduction and bathing without a battle) and
Anna Ortigara (who created the training program
“LEAP” – Learn, Empower, Achieve, Produce), have
spent their careers focusing on changing nursing home
practices.
These efforts, as well as those of countless
administrators, regulators, and providers have
culminated in a national movement.
Issue Paper: Nurses Involvement in Nursing Home Culture Change:
Overcoming Barriers, Advancing Opportunities
From the Hartford Institute for Geriatric Nursing, New York University College of Nursing
Coalition for Geriatric Nursing Organizations (CGNO), The Pioneer Network, Spring, 2009
Recommendations:
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6.
Develop and distribute a Statement of Goals for Practicing Nurses in Culture
Change Nursing Homes.
Develop competencies for nurses practicing in culture change nursing homes.
Conduct a comprehensive review of culture change content in pre-licensure
(associate degree and bachelor of nursing) nursing programs.
Disseminate existing tools/resources on culture change and nursing’s role in culture
change to academic nursing programs, including strategies for incorporating this
content into the curriculum.
Create new tools/resources based on the competencies for nurses in nursing
homes
Identify research priorities for examining the role of nurses in nursing home culture
change.
http://hartfordign.org/policy/position_papers_briefs/
Nurse Competencies for Nursing Home* Culture
Change
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Models, teaches and utilizes effective communication skills such as
active listening, giving meaningful feedback, communicating ideas
clearly, addressing emotional behaviors, resolving conflict and
understanding the role of diversity in communication.
Creates systems and adapts daily routines and “person-directed”
care practices to accommodate resident preferences
Views self as part of team, not always as the leader.
Evaluates the degree to which person-directed care practices exist
in the care team and identify and addresses barriers to person
directed care.
Views the care setting as the residents’ home and works to create
attributes of home.
Creates a system to maintain consistency of caregivers for
residents.
Nurse Competencies for Nursing Home*
Culture Change (cont.)
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Exhibits leadership characteristics/ abilities to promote persondirected care.
Role models person-directed care.
Problem solves complex medical/psychosocial situations related
to resident choice and risk.
Facilitates team members including residents and families, in
shared problem-solving, decision-making, and planning.
*Note: although developed specifically for nursing homes, these competencies are
relevant to nurses in other LTC settings such as ALF, RCF, AFC, Home care.
Developed through a collaboration of Pioneer Network and Hartford Institute for
Geriatric Nursing, 2010, www.pioneernetwork.net
Culture Change in Oregon
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Nurses in long term care (LTC) need to be
knowledgeable about the key tenants of this
movement.
The role of nursing in these settings, particularly in
community-based care settings, is evolving.
Long term care nurses will have a unique
opportunity to work in an interdisciplinary
partnership to shape LTC services to meet the future
needs of residents and their families, and staff.
The Important and Emerging Role of the
Nurse in Long Term Care
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Nurses have had a presence in long term care for
some time, particularly in the nursing facility.
As the population ages and nursing’s focus shifts
toward care of the older adult, nurses have an
opportunity to significantly influence care in the long
term care setting.
The nurse’s role in long term community care is also
emerging, especially in the assisted living and
residential care environments.
Nursing Expertise in Assisted Living and
Residential Care
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Oregon was the first state to provide housing/care in
assisted living facilities (ALF), often as a substitute for
nursing home placement.
There is no “ceiling” on the level of care that can be
provided in ALF in Oregon. Older adults living in ALFs
have chronic conditions such as dementia, diabetes, and
cardiovascular concerns that require complex clinical
management and demand expert nursing oversight,
observation, and intervention (Singer, McDaniel, &
Hornby, 2002; McDaniel, 2003).
Nursing Expertise in Assisted Living and
Residential Care (cont.)
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Recent changes in Oregon ALF and RCF regulations
require an increased level of nursing services and a
nurse who is able to respond to complex resident care
needs, including frequent change of condition
assessments; medication, wound, and pain management,
nursing delegation; end-of-life care; and directing
unlicensed staff.
The knowledge and effectiveness of the nurse can make
the difference for an older adult to age successfully in
place.
Nursing Competencies
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Four competency domains for nursing practice in the
assisted living/residential care setting have been
identified.
 Care
of Older Adults (care/clinical management)
 Systems (policies, procedures, quality improvement,
regulatory compliance)
 People (interpersonal communication/supervision with
staff, residents, families, and outside agencies)
 Time Management (organization, planning,
prioritization)
McDaniel, 2009
In their own words…
Click on the links below to hear nurses who are
working in long term care share their thoughts about
the rewards and challenges of this role.
Please note: Allowing the YouTube clips to fully load in your browser window may result
in better video quality.
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Polly Youngren, RN, MN talks about providing the best possible care for patients.
Hannah Perry, BSN, RN talks about the high potential to make a difference in long
term care.
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Beth Jackson, RN talks about seeing the positive impact of caring for patients
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Brad Finley, RN talks about what gets him to work in the morning.
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Joan Morris, RN talks about the best parts of her job.
In their own words…
Click on the links below to hear nurses who are working in
long term care share their advice for nursing students:
Please note: Allowing the YouTube clips to fully load in your browser window may result in
better video quality.
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Polly Youngren, RN, MN advises students to ask a long term care nurse about the
work that they do.
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Beth Jackson, RN talks about being fulfilled by seeing her impact on patients.
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Brad Finley, RN talks about misperceptions of long term care nursing.
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Joan Morris, RN talks about autonomy and decision making as a long term care
nurse.
Leslie Joy Boyer, RN talks about the many qualities important for a long term care
nurse to possess.
Resources
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Check out these great resources to enhance your
learning and support your nursing practice with
older adults.
 Hartford
Center for Geriatric Nursing
 ConsultGeriRN.org
 Oregon State Board of Nursing, Division 47, RN
Delegation of Nursing Tasks to Unlicensed Persons
 Nursing Delegation Self-Directed Course