title: "The way we do things around here": an international comparison of treatment culture in nursing homes.
abstract: OBJECTIVE
  In this study, we sought to measure treatment culture (beliefs, values, and normative practices associated with medication prescribing and administration) in two samples of nursing homes (in Northern Ireland and New Zealand) and to document the range of scoring achieved by staff in both countries. Responses between nurse managers and registered nurses were also compared.
  
  
  METHODS
  A cross-sectional study using an adapted treatment culture questionnaire was distributed by mail (in June and September 2008) to 159 nursing homes in Northern Ireland and completed by the nurse manager and registered nurses. In New Zealand, staff in 14 facilities participated and questionnaires were distributed by a research assistant who visited the homes (March to November 2008).
  
  
  METHODS
  Completed questionnaires were scored using a prespecified scoring system, with a higher score indicating a more resident-centered treatment culture and a lower score indicating a more traditional approach to care. The maximum score possible was 75. Scores were compared between countries and between different categories of staff. Views were also sought and knowledge tested (from structured questions) on the use of psychotropic prescribing in the nursing home environment.
  
  
  RESULTS
  The response rates for nurse managers and nurses in Northern Ireland were 35.5% and 10.1%, respectively; in New Zealand, the response rate was 90.9% for managers and 71% for nurses. The mean score for the Northern Ireland and New Zealand homes was 39.5 and 39.1, respectively (P > .05). There were also no differences between scores achieved by nurse managers and registered nurses between and across both countries. There were some cross-country differences on the approach to challenging behavior in residents and nurses (in both countries) were more likely than nurse managers to report (incorrectly) that haloperidol is indicated for short-term insomnia.
  
  
  CONCLUSIONS
  This quantitative assessment has raised interesting issues in relation to the measurement of treatment culture in the nursing home setting in two countries. Further insights into the importance of treatment culture will be pursued in qualitative studies.
authors.affiliation: School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland. c.hughes@qub.ac.uk
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hughes
authors.forename: Ailis
authors.initials: A
authors.lastname: Donnelly
authors.forename: Simon A
authors.initials: SA
authors.lastname: Moyes
authors.forename: Kathy
authors.initials: K
authors.lastname: Peri
authors.forename: Shane
authors.initials: S
authors.lastname: Scahill
authors.forename: Charlotte
authors.initials: C
authors.lastname: Chen
authors.forename: Brendan
authors.initials: B
authors.lastname: McCormack
authors.forename: Ngaire
authors.initials: N
authors.lastname: Kerse
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D005069:Evaluation Studies as Topic; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006707:Homes for the Aged / Q000592:standards* / Q000639:trends; D006801:Humans; D008134:Long-Term Care / Q000592:standards / Q000639:trends; D008297:Male; D009520:New Zealand; D009660:Northern Ireland; D009723:Nurse-Patient Relations; D009732:Nursing Care / Q000592:standards / Q000639:trends; D009735:Nursing Homes / Q000592:standards* / Q000639:trends; D057184:Practice Patterns, Nurses' / Q000592:standards / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends; D011795:Surveys and Questionnaires