title: Regulation and mindful resident care in nursing homes.
abstract: Regulatory oversight is intended to improve the health outcomes of nursing home residents, yet evidence suggests that regulations can inhibit mindful staff behaviors that are associated with effective care. We explored the influence of regulations on mindful staff behavior as it relates to resident health outcomes, and offer a theoretical explanation of why regulations sometimes enhance mindfulness and other times inhibit it. We analyzed data from an in-depth, multiple-case study including field notes, interviews, and documents collected in eight nursing homes. We completed a conceptual/thematic description using the concept of mindfulness to reframe the observations. Shared facility mission strongly impacted staff perceptions of the purpose and utility of regulations. In facilities with a resident-centered culture, regulations increased mindful behavior, whereas in facilities with a cost-focused culture, regulations reduced mindful care practices. When managers emphasized the punitive aspects of regulation we observed a decrease in mindful practices in all facilities.
authors.affiliation: Duke University Medical Center and the Durham VA GRECC, Durham, NC, USA. colon001@mc.duke.edu
authors.forename: Cathleen S
authors.initials: CS
authors.lastname: Colón-Emeric
authors.forename: Donde
authors.initials: D
authors.lastname: Plowman
authors.forename: Donald
authors.initials: D
authors.lastname: Bailey
authors.forename: Kirsten
authors.initials: K
authors.lastname: Corazzini
authors.forename: Queen
authors.initials: Q
authors.lastname: Utley-Smith
authors.forename: Natalie
authors.initials: N
authors.lastname: Ammarell
authors.forename: Mark
authors.initials: M
authors.lastname: Toles
authors.forename: Ruth
authors.initials: R
authors.lastname: Anderson
mesh_terms: D000368:Aged; D006707:Homes for the Aged / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D006801:Humans; D009735:Nursing Homes / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D018802:Patient-Centered Care / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration