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New quality regulations versus established nursing home practice: a qualitative study.
Anne Marie Sandvoll1, Kjell Kristoffersen2, Solveig Hauge3,4
1Faculty of Health Studies, Sogn og Fjordane University College, Førde, Norway.
BMC Nursing
|June 9, 2012
Summary
Implementing new nursing home regulations is difficult because established daily routines and practices in nursing care are deeply ingrained. Changing these deeply embedded practices requires systematic shifts in everyday actions and thinking to improve quality of care.
Area of Science:
- Nursing Home Quality Improvement
- Healthcare Policy Implementation
- Organizational Behavior in Healthcare
Background:
- Western governments are implementing reforms for nursing home quality, focusing on regulations and quality indicators.
- Norwegian regulations emphasize residents' rights to plan their daily lives in nursing homes.
- Research indicates significant challenges in implementing regulations that aim to change nursing practice.
Purpose of the Study:
- To explore and describe nursing practice in Norwegian nursing homes.
- To understand the challenges in implementing new quality regulations.
- To gain deeper insights into why regulatory implementation is difficult.
Main Methods:
- Qualitative study employing an ethnographic design.
- Fieldwork conducted in two nursing homes.
- Participant observation of 45 nurses and nursing aides, with 10 interviews.
Main Results:
- Nursing staff demonstrated limited awareness of new quality regulations.
- Work quality was primarily influenced by factors inherent in established nursing practice.
- Daily routines and a sense of knowing what to do formed a powerful, self-reinforcing system, making care a taken-for-granted activity.
Conclusions:
- Deeply embedded nursing practices present a significant barrier to implementing new regulations.
- Effective improvement necessitates systematic changes in everyday actions and thought processes.
- Addressing ingrained practices is crucial for successful quality improvement in nursing homes.
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