University of Missouri - Columbia.
Back to Story Archive

Posted 11.05.06


Nursing Homes Need 'Attitude Shift' to Improve Care, Study Finds

Culture of Blame Must be Replaced by Culture of Safety, MU Researcher Says

COLUMBIA, MO - The issue of nursing home quality is getting more attention as baby boomers age. It is estimated by the U.S. Census Bureau that 35 percent of the total population will be older than 65 by 2020. A recent study by a University of Missouri-Columbia nursing researcher found that a shift in attitude is needed to improve the quality of care in nursing homes.

Jill Scott-Cawiezell.According to the study, preventable errors in the healthcare system are the eighth most common cause of death. The study suggests that medication errors could be a large part of the problem. In nursing homes, administering medicine is viewed as a routine task. However, because most nursing home residents are frail and elderly, even minor medication discrepancies can have very negative outcomes, according to Jill Scott-Cawiezell, assistant professor in the MU Sinclair School of Nursing.

Related Links

In broaching the subject of medication errors and ways to correct them during the study, Scott-Cawiezell said she was surprised by her experiences working with 'front-line staff' who often faced so many demands and were so stressed they didn't even want to know about their mistakes. Her study suggests that nursing home leaders are aware of fewer than 5 percent of the errors in the system, but that staff members are aware of all of them.

"We have to help them see things differently," she said. "They need to see the problems so they can solve them. We have to help them create a culture of safety and move away from a culture of blame."

The study concludes that it is up to nurse leaders to create an environment of safety in a nursing home. Team members must feel a sense of responsibility to make sure residents are safe. Nurse leaders must invite participation in decision making and improve communication. Instead, many nursing homes are challenged by limited resources and overwhelmed leadership. The study found that staff members were frustrated by leaders who did not provide clear expectations or support.

During the study, researchers intervened in five different nursing homes. Communication, relationships and leadership were measured. Staff members were frustrated by disorganization in most cases. Also, a survey showed that only a small percentage of the staff felt that they were well informed about everything from what happened on other shifts to what nursing leaders expected of them.

The study -- Moving from a Culture of Blame to a Culture of Safety in the Nursing Home Setting -- was published in the most recent issue of Nursing Forum.



MU News Bureau: