A Nursing Home and Its Organizational Climate, An Ethnography by Bonnie Cashin Farmer, 1996, Westport, CT: Auburn House, 159 pages, hard cover, $49.95
A Nursing Home and Its Organizational Climate is a description of the culture of a nursing home. The author presents an ethnography of her 10 months observing the daily events, routines, conversations, and processes in an 86-bed skilled nursing facility located in New England. The author uses weather as a metaphor for describing organizational climate.
After a somewhat laborious introduction to the weather-as-ametaphor concept, the author offers a detailed picture of daily routine in this nursing home. The description of "morning, evening, and night" offers a succinct and accurate picture of the 24-hour cycle of nursing home life. The major climate elements presented in Chapters 3, 4, and 5 include: structure (physical features, organizational hierarchy, rules, and decision making); core values (appearances, service, and residents rights); and processes (maintaining building and body, communicating, and moving). In Chapter 6 the author identifies two determinants of organizational climate in this nursing home: vision (e.g., excellence, perspective of what can be) and regulation (State Department of Public Health).
The author is at her best when discerning, describing, and naming observed patterns. The description of the three dominant processes (maintaining, communicating, and moving) is a particularly thought provoking. Relatively little time is spent on the nursing assistant/resident relationship, though hands-on caregiving is acknowledged as a major process. What is presented is tantalizing in its exploration of the views and nature of this relationship from observations and comments of nursing assistants, administration, other departments, and residents.
While there is an attempt to provide the reader with some path through the descriptions, the author occasionally veers off the subject at hand. This tendency decreases the clarity and impact of the developing themes. For example, a section on maintaining others digresses into a discussion of changing nursing home ownership and the general difficulties of living in a nursing home. In some cases, the author fails to suspend her valuation of cultural practices by interspersing opinions and hasty conclusions, e.g. "...every time residents lie exposed... tarnishes the goodness of the organization." In a description of feeding residents at mealtime, the author concludes that staff gave "little consideration for the pleasure of the experience," while offering perfunctory observational support. Perhaps consideration was present in ways the author failed to observe.
Somewhat distracting were superfluous wordiness and sometimes folksy descriptions (e.g., "water pitchers...sit patiently to be filled," .... "the sun peeks and hints of a new day," .... "human suffering and tragedy lurk in... darkened rooms," ....communication "spreads like wildfire in a desert").
Appendices include perspectives on aging, review of the literature on nursing homes, review of the literature on organizational climate, and ethnographic design.
A Nursing Home and Its Organization Climate is an important work that adds to our understanding of the culture of nursing homes. This understanding can provide an opportunity for improving the quality of life for residents and staff.