Adaptation of a Nursing Home Culture Change Research Instrument for Frontline Staff Quality Improvement Use

• Published in: Psychological services Vol. 14; no. 3; pp. 337 - 346
• Main Authors: Hartmann, Christine W., Palmer, Jennifer A., Mills, Whitney L., Pimentel, Camilla B., Allen, Rebecca S., Wewiorski, Nancy J., Dillon, Kristen R., Snow, A. Lynn
• Format: Journal Article
• Language: English
• Published: United States Educational Publishing Foundation 01-08-2017; American Psychological Association
• Subjects: Activities of Daily Living; Cognition; Cognitive Interview; Cognitive interviews; Culture; Culture Change; Health Personnel; Home health care; Human; Humans; Interpersonal relations; Interpersonal Relationships; Interviews; Measurement; Military hospitals; Nursing Homes; Nursing Homes - organization & administration; Organizational Culture; Organizational Innovation; Quality Improvement; Quality management; Quality of Care; Quality of Services; Test Construction; Transformation; Treatment Effectiveness Evaluation; United States; United States Department of Veterans Affairs; Veterans; Veterans Health; instrument development; nursing home; person-centered care; cognitive interview; quality improvement
• ISSN: 1541-1559; 1939-148X
• DOI: 10.1037/ser0000137

Enhanced interpersonal relationships and meaningful resident engagement in daily life are central to nursing home cultural transformation, yet these critical components of person-centered care may be difficult for frontline staff to measure using traditional research instruments. To address the need for easy-to-use instruments to help nursing home staff members evaluate and improve person-centered care, the psychometric method of cognitive-based interviewing was used to adapt a structured observation instrument originally developed for researchers and nursing home surveyors. Twenty-eight staff members from 2 Veterans Health Administration (VHA) nursing homes participated in 1 of 3 rounds of cognitive-based interviews, using the instrument in real-life situations. Modifications to the original instrument were guided by a cognitive processing model of instrument refinement. Following 2 rounds of cognitive interviews, pretesting of the revised instrument, and another round of cognitive interviews, the resulting set of 3 short instruments mirrored the concepts of the original longer instrument but were significantly easier for frontline staff to understand and use. Final results indicated frontline staff found the revised instruments feasible to use and clinically relevant in measuring and improving the lived experience of a changing culture. This article provides a framework for developing or adapting other measurement tools for frontline culture change efforts in nursing homes, in addition to reporting on a practical set of instruments to measure aspects of person-centered care.