Nursing home employee perceptions of culture change

This study examined nursing home staff members' comfort levels with specific culture change scenarios and observed whether there were differences by occupation. We conducted a cross-sectional survey of 218 staff members in all occupational categories at four Veterans Health Administration Community Living Centers (i.e., nursing homes). Staff indicated their comfort level using a 9-point scale (1 = not at all comfortable to 9 = extremely comfortable). The culture change scenarios were divided into three subscales: Resident Safety (5 items), Resident Experience (5 items), and Staff Experience (2 items). Overall, respondents were slightly uncomfortable with the scenarios (overall mean = 4.57). Staff reported least comfort with the Resident Safety subscale (mean = 3.63) and most comfort with the Resident Experience subscale (mean = 5.65), with significant differences within these two subscales by occupational category. Existent power differentials among staff may influence comfort levels with culture change. Assessing staff comfort with culture change may help guide implementation efforts in a strategic manner.