1. Setting and Phases Study took place in a 200 bed private for-profit skilled nursing facility in South Florida Project Phrases: Coming to Know Design Phase Implementation and Refinement Evaluation Replication of the model

2. Coming to Know Interviews/Focus groups with residents, families, professional nursing staff, other professional staff, nursing assistants, residents and families on one nursing home unit 17 professional nursing staff 15 certified nursing assistants 16 non-nursing staff (therapists/housekeeping/dietary) 15 family members 17 residents

3. Coming to Know Pre-Study Measures : Caring Behaviors Inventory (Wolf) Satisfaction with Nursing Home: Resident and Family (Ryden et al) Turnover rate

4. Interview/Focus group questions: Staff “Look inside yourself and tell me what is most important when caring for a resident” “Can you share with me a particular experience that you had with a resident or family that best represents caring” “Is caring or being cared for different in a nursing home setting?”

5. Interview/Focus group questions: Family/Residents “Can you tell me what is most important to you when being cared for (or having your family member cared for)” “Can you share a situation here that represents what is important to you in care” “Do you think caring is different in a nursing home”

6. Responding to That Which Matters

7. Caring as a Way of Expressing Spiritual Commitment

8. Devotion Inspired By Love For Others

9. Commitment to Creating a Home Environment

10. Coming to Know and Respect Person as Person

11. Outcomes Increase in scores on CBI in the areas of listening, treating the person as an individual, spending time, touching to communicate caring, and being hopeful

12. Outcomes Increased family and resident satisfaction (although scores high at initiation of project) Turnover rate on the unit was the lowest in the facility during the 18 month project No additional staff or salary increases Pride in being on the “Caring” wing Growth in the ability of the staff to express and value their caring and the important work they do

13. Caring: Foundation for Culture Change Nursing has a great responsibility to create cultures of caring and the theory of nursing as caring may provide the philosophical and ethical framework for a model of culture change that will improve quality of life, quality of care, and resident and staff satisfaction in nursing homes

14. From: Sikma, S. (2006)

15. “I tell you that when you do a caring thing for a person in my country, they look at you as a great person, they respect and value you because you are doing a great job, a job that you can’t find just anyone to do for you, it’s a special person that does that for you.”

16. THANK YOU

17. References Carpenter, J. (2008). CNAs’ experiences in the nursing home: “It’s in my soul.” J Gerontol Nurs 34(9), 25-32. Sikma, S. (2006). Staff perceptions of caring: the importance of a supportive environment. J Gerontol Nurs 32(6), 22-29. Touhy, T., Brown, C., & Smith, C. (2005). Spiritual Caring: End of Life in a Nursing Home. Journal of Gerontological Nursing 31(9), 27-35. Touhy, T., Strews, W., & Brown, C. (2005). Expressions of Caring as Lived by Nursing Home Staff, Families and Residents, International Journal for Human Caring, 9(3), 31-37.