Health care organizations generally announce that they are caring and compassionate in their mission and values statements and in public relations notices. However, often little is done to instill caring and compassion among staff or to develop a humanistic culture.
Much can be done and is being done at many nursing homes and hospitals across the country. In this article, a number of programs that have been found to work are described. With dedication and focus, a positive culture can be permanently established—a culture where a nursing home stands out among others, is a pleasure to work at, and is a happy home for residents.

Guiding Coalitions

John Kotter, a leading writer on organizational change, says that successful change efforts require a powerful guiding coalition.

In nursing homes, the administrator and the director of nursing must be strong and consistent advocates. Even better is when they are role models that exemplify caring at all times. When department heads, charge nurses, and facility leadership are all consistently supportive of this culture, then the staff naturally follow.

On the other hand, role models are generally found at all levels of a dynamic facility, from nurse assistants and housekeepers to the upper-level managers and department heads.

As much as possible, facilities should hire for attitude. Virtually all facilities have a few special staff members who are loved by residents. Obviously, these staff should be retained and valued.

On the other hand, charge nurses and managers need to advise and counsel staff who have room for improvement. Staff members who are warm, caring, and helpful should be rewarded and recognized in their annual evaluations.

One approach is for staff to rate each other on the human dimensions of work and resident care.

Exemplary staff should be honored. In fact, at some organizations an annual Caring Professionals Day has been instituted.

Educational Programs

Most nursing homes have a full slate of required educational programs for nurses and nurse assistants. However, caring behaviors can often be integrated into existing educational experiences. For example, active listening—listening with compassion, testing for understanding, and giving feedback—can be part of learning communication skills.

Staff also can be briefed on how to handle specific situations, such as what to say to an upset resident or family member.

Compassion and empathy are fostered when a caregiver is able to experience another’s situation and difficulties, such as putting herself in the resident’s shoes. To begin to consider that “one day this could be me” or “what would it be like to be old and disabled” helps to develop the emotional maturity that is needed to provide the best care.

One effective method for training allied health professionals is the use of “aging games.” In one of these experiences, participants may be partially immobilized with splints or ace wraps, and cotton balls are placed in their ears; wax paper is placed over the eyes, and thick gloves are worn. These give the participants some sense of the loss of sensory input and the physical functioning that most elderly experience.

Another activity involves staff listing on cards the activities they enjoy, things they are thankful for, people who are important to them, and the four roles they currently play. The cards are gradually removed, thus helping staff to develop greater empathy through imaginatively experiencing the losses that residents have experienced.

Sharing, Problem Solving

A great catalyst for staff is to share their experiences, problems, and successes in caring for residents. Erie Chapman instituted Care Circles in hospitals for small groups and teams to communicate and to uplift each other. Such gatherings are both practical and inspirational.

Another well-known program in many health care organizations is called Schwartz Rounds. This is a forum for health care professionals to discuss difficult emotional and social issues that arise in caring for patients and to discuss and obtain input on how they can better provide compassionate care. Through conversations and gatherings, compassion is often “caught, not taught.” Those with less grow by interacting with those who have more compassion.

New Patterns Of Care

There are many nursing homes throughout the country that have implemented new patterns of care, several of which are mentioned here. Sage Consulting of Novato, Calif., has developed a noteworthy program, known as First Touch (see sidebar) to foster better clinician/resident relationships.

Nurses, when beginning their shifts, enter the room without any equipment or supplies and, before starting their clinical or task-oriented activities, stay “present” for the resident while developing a personal relationship.

Near the end of the shift, the caregiver lets the resident and family know she is leaving and talks about the time she spent with the resident. She also informs the resident who the next nurse will be and “transfers trust” by saying positive things about the new caregiver.

Nurses at some participating sites were initially concerned that this process would add to an already busy schedule. However, Lolma Olson, president of Sage Consulting, says that First Touch actually saves time and has reduced call-light use.

A similar approach that supports the humanity of each resident is to actively value the individual’s life experiences and interests.

Some facilities place a card at each resident’s door with a photo and a brief description of the resident’s interests, hobbies, birthplace, and other key personal features.

This helps both staff and visitors to know the resident. It also helps to initiate conversations.
Caring and compassion generally do not require additional time—most often, the same things are done, but in a more respectful and loving manner.

Some examples: letting a resident know why her privacy curtain is being closed, using touch appropriately, not using the cell phone when giving a shower to a resident, asking for a resident’s permission before moving her.

Developing a caring culture is just as important as delivering quality care and operating efficiently. It should not be considered a passing project, but should be a cornerstone of what the nursing home is all about.
Having a warm, supportive resident care culture is its own reward, is the right thing to do, and needs no further justification. However, a caring culture will be recognized by family members and the community, will contribute to financial success, and will provide meaning in life to those who work there.
David Graber

David R. Graber, PhD, associate professor at the Medical University of South Carolina, can be reached at or (843) 792-9218.