Culture Change Models and Resident Health Outcomes in Long-Term Care


Nikki L. Hill, The Pennsylvania State University School of Nursing, 201 Health & Human Development East, University Park, PA 16802. E-mail:


Purpose: To examine the scientific evidence for the effect of comprehensive culture change model implementation on resident health outcomes in long-term care.

Design: In this integrated review, an electronic literature search was conducted for studies that examined the effect of comprehensive culture change models on long-term care residents’ physical and psychosocial health.

Methods: Eleven articles were thoroughly reviewed for outcomes related to resident health, and findings were integrated across models. Each study was assigned a level of evidence rating using the Scottish Intercollegiate Guidelines Network guidelines and an overall recommendation grade was determined.

Findings: Evaluation of the literature indicates that results are conflicting, although potential resident benefits as a result of model implementation may exist, particularly in regard to psychosocial health outcomes.

Conclusions: Evidence regarding long-term care residents’ health outcomes after comprehensive culture change model implementation is inconsistent, and the grade of the evidence makes practice recommendations difficult at this time. However, integrated findings across studies demonstrate potential psychosocial benefits to long-term care residents.

Clinical Relevance: Nurses working in long-term care play a crucial role in the success of culture change initiatives as well as the health outcomes of residents. Empirical evidence for the effect of comprehensive culture change models on resident health outcomes supports reasonable expectations of their implementation and indicates areas for future research and translation into practice.