Ellen Melis, Ph.D. is a 2020 graduate of the PHD Program in Leadership and Change at Antioch University.
Dr. Melis at her Dissertation Defense.
Clockwise: Dr. Elizabeth Holloway, Committee Chair, Dr. Madelyn Law, Committee Member, Dr. Donna Ladkin, Committee Member
- Elizabeth Holloway,, Ph.D., Committee Chair
- Donna Ladkin, Ph.D., Committee Member
- Madelyn Law, Ph.D., Committee Member
long-term care, person-centered care, personal support workers, relational care, relational leadership, leadership development, organizational culture, culture change, complex adaptive systems, grounded theory, situational analysis, leadership
This single, exemplar case study explored the context and social processes that shape person-and family-centered culture in a long-term care (LTC) home, using grounded theory and situational analysis for the data collection and analysis. Findings revealed one core dimension: needing to be heard, valued, and understood, and five key roles: personal support workers (PSWs), executive director (ED), senior leadership, nurse managers, and residents and families, which informed five dimensions, each focused on enhancing care for residents: (a) attending to residents’ daily care needs (PSWs), (b) advocating strategically (ED), (c) translating vision into programs and policies (senior leadership), (d) ensuring quality of care on the unit (nurse managers), and (e) seeking social connection and meaningful stimulation (residents and families). These interactions left PSWs with little autonomy, feeling rushed, focused on tasks, and prevented from building relationships with residents. The PSW perspective was often missed in decision-making, as decisions were made for this group rather than with them. A complex theoretical model of the interactions and the systemic blind spot they have unintentionally created is presented in the discussion. The results suggest that empowering PSWs is pivotal to improving quality of care in the LTC sector. Further research is needed to determine which methods of empowerment are most meaningful and effective. Future studies could also explore LTC homes of different sizes and with different types of governance, the competencies required by the different roles to foster a person- and family-centered LTC culture, and the criteria for relational practice and leadership in LTC. This dissertation is available in open access at AURA: Antioch University Repository and Archive, http://aura.antioch.edu/ and OhioLINK ETD Center, https://etd.ohiolink.edu/, and is accompanied by one supplemental file.
Melis, E. H. (2020). Understanding the Context and Social Processes that Shape Person- and Family-Centered Culture in Long-Term Care: The Pivotal Role of Personal Support Workers. https://aura.antioch.edu/etds/557