Practice style in the nursing home: Dimensions for assessment and quality improvement

Objective: Based on research staff observations during several studies in nursing homes and the findings of other studies, we propose a nomenclature of components of care for the elderly in nursing homes. The paper seeks thereby to operationalize those aspects of the nursing home practice style that can be improved. Methods: This operationalization examines two main components (staff and institutional components) of practice style of care in nursing homes. Four domains characterize staff conduct (knowledge, practice style proficiency, flexibility and individualization of care and communication) and three domains define institutional conduct (staff support, resources and flexibility/rigidity of policies). Results: The paper addresses critical aspects of staff conduct, and by extension, key features that require training, monitoring, and systemic change. Examples for each domain of practice style are provided. Conclusions: After systematically reviewing the observations and findings it was concluded that enhancing practice styles in the nursing home requires knowledge, communication, flexibility, understanding, and genuine concern on the part of nursing home staff and administrators at all levels. We acknowledge and understand, of course, that changing practice styles in nursing homes is a difficult and time-consuming process.