Developing the Green House Nursing Care Team: Variations on Development and Implementation

Abstract

Government policies have been enacted to support culture change. However, there is currently little guidance for regulators, providers, or consumers regarding variability in how culture change practices are implemented and consequences of these variations. This article outlines the importance of understanding these practices at a level of detail that distinguishes and supports those that are most promising.

Staff Empowerment Practices and CNA Retention: Findings From a Nationally Representative Nursing Home Culture Change Survey

“…This underscores the need for a closer look at what changes in staff relationships and responsibilities these practices require and the training across staffing levels that may be needed to put them in place and maintain them (Zimmerman et al, 2016). Going forward, it will be equally important to examine the effects of nurse supervisory style on team membership and involvement of CNAs on communication and safe and appropriate decision making (Bowers & Nolet, 2014). …”

The effects of the Green House nursing home model on ADL function trajectory: A retrospective longitudinal study

“…Because the GH model encourages residents to participate in routine and normalized daily activities, structured group activities might not be frequently provided. CNAs in GH homes are responsible for organizing activities for residents but they also need to provide direct and indirect care, which is a significantly different staff role in the GH nursing home model compared to the traditional nursing homes (Bowers & Nolet, 2014). Sharkey reported that CNAs in GH homes provide quantitatively more direct care activities and have a higher level of engagement between staff and the residents than in traditional nursing homes (Sharkey, Hudak, Horn, James, & Howes, 2011).…”

“…The GH nursing home is a relatively more standardized model than other culture change nursing home models, providing extensive training and support by the national organization for new GH adopters including general principles, architecture, and the role of the CNA in each phase of development (Bowers & Nolet, 2014). However, the details of how the other parts should be implemented including the nurses’ role have been less developed; thus, implementation of the GH model, particularly the nursing role within the GH model, varied both within and across sites (Bowers & Nolet, 2014).…”

“…The GH nursing home is a relatively more standardized model than other culture change nursing home models, providing extensive training and support by the national organization for new GH adopters including general principles, architecture, and the role of the CNA in each phase of development (Bowers & Nolet, 2014). However, the details of how the other parts should be implemented including the nurses’ role have been less developed; thus, implementation of the GH model, particularly the nursing role within the GH model, varied both within and across sites (Bowers & Nolet, 2014). Researchers have identified four nursing care models, Traditional, Parallel, Integrated, and Visitor models, based on these differences across GH homes in role boundaries between nurse and CNA, responsibility for contact with family members or professionals, and the decision authority over residents’ daily lives (Bowers & Nolet, 2014).…”

“…However, the details of how the other parts should be implemented including the nurses’ role have been less developed; thus, implementation of the GH model, particularly the nursing role within the GH model, varied both within and across sites (Bowers & Nolet, 2014). Researchers have identified four nursing care models, Traditional, Parallel, Integrated, and Visitor models, based on these differences across GH homes in role boundaries between nurse and CNA, responsibility for contact with family members or professionals, and the decision authority over residents’ daily lives (Bowers & Nolet, 2014). Given that the nurse's role and nursing care delivery processes are under-developed areas in the GH model, further research is needed to understand the detailed care practices and their consequences including care outcomes and to guide leaders to develop more effective implementation of the GH model.…”