title: Negotiated risk and resident autonomy: Frontline care staff perspectives on culture change in long term care in Nova Scotia, Canada.
abstract: BACKGROUND
  Regulating risk, freedom of action, and autonomy in decision making are problems shared by both caregivers and residents in long term care settings, and may become the subject of tension and constant negotiation.
  
  
  OBJECTIVE
  This study focuses on long term care staff and management perceptions of day to day life in a care community which has gone through a culture change transition, where small residentially scaled households replace large instutional models of care. In each household, the setting is considered to be home for the 8-12 residents, creating a major shift of roles for the caregivers; they are, in essence, coming into a home rather than institutional environment as a place of work. This potentially changes the dynamics of both patterns of work for caregivers and patterns of daily living for residents.
  
  
  METHODS
  Participant observations and care staff interviews.
  
  
  RESULTS
  Several key themes emrged which include: teamwork; the culture of care; regulating risk; the physical environment and care staff empowerment.
  
  
  CONCLUSIONS
  An unexpected outcome was the consensus among care staff that it is they who feel at home while working in the care households, leading to empowerment in their work roles and a deeper understanding of the importance of their role in the lives of the residents.
authors: Emily
authors: E
authors: Roberts
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000458:organization & administration / Q000523:psychology*; D003657:Decision Making; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D007374:Interior Design and Furnishings; D008134:Long-Term Care / Q000458:organization & administration*; D017008:Negotiating; D009674:Nova Scotia; D015279:Organizational Culture; D026684:Personal Autonomy; D011209:Power, Psychological; D024382:Professional Role; D011369:Professional-Patient Relations; D012307:Risk Factors
keywords: Person-centered care; skilled nursing facility; small house model