Publication Date


Document Type


First Advisor

Gray, Jennifer

Degree Name

Ph.D. (Doctor of Philosophy)

Legacy Department

School of Interdisciplinary Health Professions


Background: Documentation of patient care and characteristics is an important part of nursing home operations, because it affects financial aspects, quality improvement efforts, inter-provider communication, and potential for dangerous medical errors. However, little is known about the relationships between workplace culture, quality improvement, and documentation-related attitudes. Purpose: The purpose of this study was to explore perspectives of a total of 10 nursinghome staff and administrators on these variables within 8 Wisconsin facilities, based on a composite framework of Schein’s organizational culture typology and Shortell’s Quality Improvement Implementation Survey concepts. Methods: This qualitative interview study examined participant perspectives and emotions related to their facilities’ documentation quality, workplace culture, improvement efforts, and nursing staff turnover. Data quality measures taken included member checks, team-based transcript coding and analysis, and verbatim transcripts from a standardized interview guide. Thematic analysis was performed on data collected to construct a “storyline” and determine its fit within the originally proposed theoretical model. Results: Results indicated that the theoretical model was supported by sample data and that pairwise perceived relationships existed between nursing home culture, quality improvement, and documentation. One of Schein’s culture types was not represented in the sample. Attitudes were predominantly negative, as were perceived influences on documentation quality and related attitudes. Conclusions: The results of this research contribute to knowledge on long-term care and could point future research in several directions: (1) similar work in dissimilar nursing homes to see whether results hold, (2) closer examination of staffing variability, (3) quantitative work on impacts of education and auditing on documentation-related attitudes, and (4) strategies to improve attitudes for quality improvement that does not increase staff stress levels.


119 pages




Northern Illinois University

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