title: Culture change models and resident health outcomes in long-term care.
abstract: OBJECTIVE
  To examine the scientific evidence for the effect of comprehensive culture change model implementation on resident health outcomes in long-term care.
  
  
  METHODS
  In this integrated review, an electronic literature search was conducted for studies that examined the effect of comprehensive culture change models on long-term care residents' physical and psychosocial health.
  
  
  METHODS
  Eleven articles were thoroughly reviewed for outcomes related to resident health, and findings were integrated across models. Each study was assigned a level of evidence rating using the Scottish Intercollegiate Guidelines Network guidelines and an overall recommendation grade was determined.
  
  
  RESULTS
  Evaluation of the literature indicates that results are conflicting, although potential resident benefits as a result of model implementation may exist, particularly in regard to psychosocial health outcomes.
  
  
  CONCLUSIONS
  Evidence regarding long-term care residents' health outcomes after comprehensive culture change model implementation is inconsistent, and the grade of the evidence makes practice recommendations difficult at this time. However, integrated findings across studies demonstrate potential psychosocial benefits to long-term care residents.
  
  
  CONCLUSIONS
  Nurses working in long-term care play a crucial role in the success of culture change initiatives as well as the health outcomes of residents. Empirical evidence for the effect of comprehensive culture change models on resident health outcomes supports reasonable expectations of their implementation and indicates areas for future research and translation into practice.
authors.affiliation: The Pennsylvania State University School of Nursing, University Park, PA, USA. : nln101@psu.edu
authors.forename: Nikki L
authors.initials: NL
authors.lastname: Hill
authors.forename: Ann M
authors.initials: AM
authors.lastname: Kolanowski
authors.forename: Paula
authors.initials: P
authors.lastname: Milone-Nuzzo
authors.forename: Andrea
authors.initials: A
authors.lastname: Yevchak
mesh_terms: D006801:Humans; D008962:Models, Theoretical; D024802:Nurse's Role; D009735:Nursing Homes / Q000458:organization & administration*; D015279:Organizational Culture; D011787:Quality of Health Care