Restorative Care, Culture Change & Long-Term Care
By Richard Shank
Researchers at the University of Maryland conducted a study to test the effectiveness of a 12-month restorative care program.
Previous research elevated worries that traditional forms of nursing home care unintentionally facilitate unnecessary declines in functioning. Efforts to transform the care environment to a more restorative form of care have grown out of this concern. Most of these efforts have been targeted at changing the culture of the nursing home to become focused on developing life skills and catering to the needs of nursing home residents from their perspective. In the 1980s, these unintended consequences started to be addressed through legislation mandating that care focus on the restoration of the functional abilities of nursing home residents.
Restorative care is based on the theory of self-efficacy, which is the belief in one’s own capability to perform a certain task. This belief is based on the expectation that an attempt to perform this task will lead to a certain outcome. The stronger the self-efficacy, the harder the person works toward achieving a certain task. Restorative care was developed in the belief that traditional nursing home care undermined the self-efficacy of residents and taught them to expect less of themselves.
The restorative care intervention tested in this research is a program that is meant to increase the self-efficacy of nursing assistants and, in turn, the nursing home residents in their care.
This research was able to demonstrate that the intervention increased the CNAs belief in and knowledge of how to deliver restorative care, improved their job satisfaction, and influenced their caring behaviors. The intervention did not, however, influence the self-efficacy of the CNAs. Interestingly, the CNAs already had a high level of self-efficacy with regard to their abilities to perform restorative care prior to the study. It appears the training merely helped to reinforce this belief, while at the same time increasing the CNAs satisfaction with their work.
In all, this study demonstrates the important role that culture change interventions can play in increasing staff morale, knowledge, and care skills. More research needs to be done, however, on how restorative care translates into practice and whether or not it truly delivers on its promise of increasing the self-efficacy of nursing home residents and preventing unnecessary disability.
Source: Resnick, B., Gruber-Baldini,A., Galik, E., Pretzer-Aboff, I. The Gerontologist 49(2): 175-184.
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