Developing the green house nursing care team: variations on development and implementation.
OBJECTIVE
A core component of the Green House nursing home model is an altered supervisory relationship between the nurse and direct care workers. Some have expressed concern that the Green House model might weaken professional nursing oversight, threatening the quality of clinical care. This qualitative research study explores the role of the nurse as implemented in the Green House model, focusing on how variations in the nursing team influence clinical care practices.


METHODS
Dimensional analysis, a "second generation" grounded theory methodology, was used to conduct this study. Data were collected through observations and interviews with 37 nurses, 68 CNAs, and 11 Guides working at 11 Green House sites.


RESULTS
Implementation of the nursing role within the Green House model varied both within and across sites. Four nursing model types were identified: Traditional, Visitor, Parallel, and Integrated. Care processes, CNA/Shahbaz skill development, and worker stress varied with each nursing model.


CONCLUSIONS
Government policies have been enacted to support culture change. However, there is currently little guidance for regulators, providers, or consumers regarding variability in how culture change practices are implemented and consequences of these variations. This article outlines the importance of understanding these practices at a level of detail that distinguishes and supports those that are most promising.
*Address correspondence to Barbara J. Bowers, RN, School of Nursing, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792-2455. E-mail: bjbowers@wisc.edu.
Barbara J
BJ
Bowers
Kimberly
K
Nolet
D000368:Aged; D000369:Aged, 80 and over; D003210:Concept Formation; D006284:Health Plan Implementation / Q000379:methods*; D006707:Homes for the Aged; D006801:Humans; D007407:Interviews as Topic; D016294:Models, Nursing; D024802:Nurse's Role; D009726:Nurses; D009728:Nursing Assistants; D009735:Nursing Homes; D009740:Nursing Staff; D009745:Nursing, Supervisory / Q000458:organization & administration*; D036301:Qualitative Research; D000078329:Workforce
Culture change; Empowerment; Nursing homes; Nursing studies; Qualitative research methods