In this article the author reviews the practical issues related to implementing culture change in nursing homes. The merits of model replications are discussed and the barriers to creating and sustaining culture change in nursing homes are highlighted. This is followed by a description of the various dimensions of culture that must be changed including the approach to clinical training and practice, the nature of management and job design, the approach to caring, and the characteristics of the residential environment. The article then identifies the major elements required to maximize the potential for nursing homes to create and sustain cultural change.
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