Abstract The culture change movement has pushed for reform for more than two decades to align policy, the long-term care industry, and resident preferences with regard to care. Evidence from research indicates that culture change has the potential to improve quality in nursing homes. There is no one-size-fits-all way to implement culture change; however, there are key elements and associated concepts and models. A common thread is that they run counter to the medical model, typically found in nursing homes, where care is provided in a hospital-like setting according to the schedules and routines of physicians and staff with little resident input. This qualitative study looks for evidence of culture change in a traditional model of care compared to a newer culture change model, by describing the differences in practices associated with the medical model, person-centered care, and person-directed care between the two settings. Our results indicate that there is evidence of person-directed care in one model of culture change—the Green House home—but not in the traditional nursing home. Future studies should examine other culture change models to compare the differences in the utilization of person-directed care. This information will help to clarify the definitions and concepts of culture change, along with developing best practices for future culture change models.

中文翻译：

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熟练护理的文化变迁：传统家庭与新模式的探索性比较

摘要 二十多年来，文化变革运动一直在推动改革，以调整政策、长期护理行业和居民对护理的偏好。研究证据表明，文化变革有可能提高疗养院的质量。没有一种万能的方式来实施文化变革；然而，有一些关键要素和相关的概念和模型。一个共同点是，它们与医疗模式背道而驰，通常出现在疗养院中，根据医生和工作人员的时间表和例行程序，在类似医院的环境中提供护理，几乎没有住院医师的投入。与较新的文化变化模型相比，这项定性研究寻找传统护理模型中文化变化的证据，通过描述两种环境之间与医疗模式、以人为本的护理和以人为本的护理相关的实践差异。我们的结果表明，有证据表明在一种文化变革模式——绿屋之家——中存在以人为本的护理，但在传统的疗养院中却没有。未来的研究应该检查其他文化变革模型，以比较个人导向护理利用的差异。这些信息将有助于阐明文化变革的定义和概念，以及为未来的文化变革模型制定最佳实践。未来的研究应该检查其他文化变革模型，以比较个人导向护理利用的差异。这些信息将有助于阐明文化变革的定义和概念，以及为未来的文化变革模型制定最佳实践。未来的研究应该检查其他文化变革模型，以比较个人导向护理利用的差异。这些信息将有助于阐明文化变革的定义和概念，以及为未来的文化变革模型制定最佳实践。