This study will investigate the effects of the implementation of two models: The Self-Care Model of Nursing Practice (SCMN) and the Regenerative Community Model (RCM) on the institutionalization of elderly adults in a nursing home setting. Institutionalization is conceptualized as having three components: The Place, The Process, and The Effect. Institutionalization of an individual occurs when routine, structure, and control are used to create a care-giving environment (place) that systematically dehumanizes a person by denying him self-care and self-determination in living day-to-day (process). The resulting effect is a chronic condition in which the individual's ability for self-determination is so markedly impaired that independent functioning may not be possible (effect). This impaired condition is often cited in quality of life concerns about nursing home care patients.
The specific aim of this research is to determine if a change in the process of care (implementation of two models) can influence the interaction of place and process in producing institutionalization, thereby significantly decreasing the effect of institutionalization on the elderly nursing home patient. The Nursing Home Care Unit of the Menlo Park Division of the Palo Alto Veterans Administration Medical Center is a 150 bed facility which has three (3) structurally identical units. Units will be randomly assigned to one of three treatment conditions: The SCMN, The RCM and Control. The Multiphasic Environmental Assessment Procedure, Affect Balance Scale and Stockton Geriatric Rating Scale will be used to measure the effects of the models and control conditions on each unit over a period of 30 months. This approach was selected to track change over time, to determine the rate and stability of the implementation of the SCMN and RCM, to allow for comparisons within and between treatment conditions.
