1. Implementing the Eden Alternative Philosophy
By: Jennifer Delasko
Ferris State University
NURS 631 Leadership Role for Nurse Administrators
Implementing the Eden Alternative Philosophy. A presentation for Ferris State University's Nursing 631 Leadership Role for Nurse Administrators course by Jennifer Delasko

2. Objective Introduction Change Model Evidence-Based Practice
Benefits/Resources/Barriers
Recommendations
Anticipated Outcomes
Conclusion
The objective of this presentation is to introduce the Eden Alternative Philosophy concept and explain how the Plan, Do, Study, Act (PDSA) model can be used to implement this change in care. I will be discussing the evidence-based practices associated with this model of care as well as list the benefits, resources, and barriers regarding the implementation process. Next, I will go over recommendations to create change processes and anticipated outcomes of implementing the Eden philosophy. Lastly, this presentation will end with a conclusion and overview of the information discussed.

3. The Eden Alternative Philosophy at Saint Francis Home
Introduction
The Eden Alternative Philosophy at Saint Francis Home
Creates individualized resident-centered care
Focus on elderly decline:
Loneliness
Helplessness
Boredom
Principles:
Improve companionship
Interactive activities
High quality healthcare
Autonomy in decision making
The change project I will be conducting is implementing the Eden Alternative philosophy into the organization I currently work at. Saint Francis Home is a rehabilitation and long term care facility that I am a charge nurse at. Right now administration is planning and creating ideas on how to apply this philosophy into the care for the residents to improve their quality of life and health. Being an active participant in this change process will help me learn more about the evidence-based research on this model of care and help disseminate the information to administration and staff at Saint Francis. The Eden Alternative philosophy is a care model that caters to geriatric facilities to help achieve individualized resident centered care. The philosophy is centered around the theory that increased elderly decline is associated with loneliness, helplessness, and boredom (Eden Alternative, 2015). To eliminate these quality of life hindrances organizations that use Eden work under principles that involve improving companionship, providing meaningful interactive activities, giveing high quality healthcare, and allowing elders into the decision-making process in regards to their care needs (Eden Alternative, 2015). The goal of implementing this care model we will be to enhance the healthcare system at Saint Francis Home by improving care, increasing resident satisfaction, and reducing wasteful spending by continually making improvements (Roussel, Thomas, & Harris, 2016, p. 115).
Eden Alternative, 2015
Roussel, Thomas, & Harris, 2016, p. 115

4. Change Model: Plan-Do-Study-Act (PDSA)
To implement the Eden Alternative philosophy at Saint Francis Home the plan-do-study-act (PDSA) change model will be utilized. This model correlates with the scientific method and will allow healthcare professionals to test small goals to achieve higher quality patient care (Graban, 2012).This simplistic model will assist nursing leaders to make obtainable goals and integrate research into improving the quality of care individuals receive (Sherwood & Barnsteiner, 2012, p. 333). PDSA is a cycle that incorporates creating a plan to make quality improvements, carrying out the change, monitoring the outcomes of the plan, fixing problems that occurred, and running through the cycle again with the appropriate changes (Roussel, Thomas, & Harris, 2016, p. 374). Following PDSA encourages healthcare professional to make quality improvements by small changes that are evidence-based (Sherwood & Barnsteiner, 2012). This model will be useful with Eden because it involves monitoring the implemented changes and identifying problems or concerns that occur in the process. When problems arise the cause can then be identified, changes can be made to the initial plan, and the PDSA cycle starts over again until the goal is achieved (Sherwood & Barnsteiner, 2012, p. 123).
Graban, 2012
Roussel, Thomas, & Harris, 2016, p. 374
Sherwood & Barnsteiner, 2012

5. Evidence-Based Research/Benefits
The Eden Alternate philosophy:
Improves psychological wellbeing in the elderly
Decreases negative behavior with dementia residents
Less need for psychotropic medications
Increase resident empowerment and autonomy
Improves job satisfaction and performance
Research reveals the many positive effects the Eden Alternative philosophy has on the geriatric population and the staff caring for them. A study by Li and Porock (2014) revealed that long term care facilities that utilize models that incorporate patient-centered care, like Eden, can benefit the resident’s psychological wellbeing. The study also showed significant improvement, particularly with individuals with dementia, in decreasing negative behaviors and using less psychotropic medications (Li & Porock, 2014). An article by Burgess (2015) demonstrated that implementing Eden into healthcare facilities improves resident satisfaction in their care received due to an increase in autonomy and empowerment. Staff job satisfaction also increased due to the encouragement to foster therapeutic relationships with residents and co-workers. Job performance benefited as well due to improved time management and a reduction in wasting needed resources (Burgess, 2015).
Burgess, 2015
Li & Porock, 2014

6. Resources Needed Time Finances Educational Opportunities Equipment:
Supplies
Remodeling
Multiple resources are needed to effectively implement the Eden care model into a nursing facility like Saint Francis Home. One example is having a long time frame to implement this project. This change of care cannot happen instantly and research shows that it takes organizations years to see positive results in the quality of care and resident wellbeing associated with Eden (Coleman et al., 2002). For change processes it is up to nurses to be financially responsible in budgeting nursing resources and programs based on the needs of the organization (Roussel, Thomas, & Harris, 2016, p. 168). Budgeting is a continuous process that requires strict monitoring of revenue and expenses. To implement the Eden Alternative philosophy a cost-benefit analysis is needed to address goals, interventions, and benefits of the change plan (Roussel et al., 2016, p. 183). It costs around $20,000 to initiate Eden into a long-term care facility (Rowles & Teaster, 2016). This cost includes staff training, resources, new equipment, and care for animals. It also entails developing new programs for interactive activities, pet therapy, and social gatherings. It is worth the investment since Eden is linked to facilities saving money by decreasing turnover rates, improving health outcomes, and enhancing resident satisfaction which in turn creates an increase in census (Rubertino, Lubin, Kruschke, & Hyde, n.d). Next, providing staff education in regards to transitioning into an Eden care facility is critical for implementing changes. The Eden Alternative organization offers numerous training opportunities and educational sessions to assist healthcare providers in improving care using the Eden philosophy. These webinar-based educational opportunities include sessions about alternatives to handling disruptive behaviors and how to be proactive with developing meaningful relationships that can improve resident care (Eden Alternative, 2015). The Eden educational training sessions also involve ideas to engage staff in the change process and how to maintain focusing on current evidence-based practices once goals are achieved. Lastly, supplies are needed to provide high quality care and to renovate the facility. A large part of the Eden philosophy is to steer away from medical or institutional looking nursing homes and instead provide a more welcoming warm atmosphere. Remodeling skilled nursing facilities to look more like a home is essential in improving the wellbeing of the residents and helps reduce depression as well as anxiety (Eden Alternative, 2015).
Coleman et al., 2002
Eden Alternative, 2015
Roussel, Thomas, & Harris, 2016
Rowles & Teaster, 2016
Rubertino, Lubin, Kruschke, & Hyde, n.d

7. Barriers to Change Staff resistance Nurse turn-over
Utilize PDSA
Nurse turn-over
Financial restrictions
Monitor wasteful spending
Lack of communication
Implement routine staff meetings
Obstacles that can occur with this care model is resistance to change from staff. Any change project will involve time management, flexibility, and staff involvement so it is important for administration to engage staff with these changes. PDSA will be a beneficial model for staff that are resistant to change because it involves monitoring small achievable goals so it will not be over whelming. A major expense to implement this change project is hiring more nurses to fill our current vacancies. Right now, Saint Frances is currently short 10 nurses and 2 nurse managers. To fill in the shifts we are utilizing agency nurses which adds extra costs to an already limited budget. The Eden Philosophy care model is shown to decrease staff turnover and improve job satisfaction (Rubertino, Lubin, Kruschke, & Hyde, n.d, p. 6). Long-term care facilities that incorporate Eden reveal cost savings of $1000 a month to $3.5 million a year from lowering turnover rates and minimizing the use of agency staff (Rubertino et al., n.d, p. 6). Also in regards to financial restrictions it is important to involve nurses that are proficient in budgeting processes so wasteful spending is eliminated and the necessary resources are being provided to ensure high quality resident care (Graban, 2012). A barrier I have noticed at work in developing human resources is the lack of communication between administration and staff. Administrators at work are rarely seen and do not hold routine meetings that include floor staff which makes them appear unapproachable. This creates a disconnect between all the disciplinarys and can hinder the success of any change plans. To create a nurturing work culture that promotes healthy changes administration need to be provided expectations of their roles, connect with all departments to assist with financial and resource support, and promote open communication with staff that fosters active listening (Roussel et al., 2016). I plan on being the liaison between managers and staff to initiate routine meetings to help build supportive relationships between all employees and to get everyone involved in the change plan.
Graban, 2012
Roussel et al., 2016
Rubertino et al., n.d

8. Recommendations Private Rooms
Redesign rooms for comfort: Less institutional looking
Remodel dining rooms
Integrate more interactive activities
Routine pet/children therapy
Hire/maintain nursing staff
The following are recommendations to implement within the long term care facility to improve resident wellbeing and health as well as enhance staff engagement with care. The Eden Alternative (2015) website recommends private rooms for residents that are transformed into comfortable bedrooms and less “hospital” looking. This helps ensure individual privacy, reduces infection rates, and gives residents the feeling they are in a welcoming home and not an institution (Eden Alternative, 2015). Other areas of the facility should be remodeled as well to resemble a home like atmosphere such as living rooms and activities rooms. Many skilled nursing facilities have renovated their dining rooms to resemble restaurants as opposed to the traditional cafeteria style of eating. To counteract boredom routine interactive activities that residents of all cognitive abilities should be widely available throughout the day (Eden Alternative, 2015). To prevent the negative effects of loneliness pet therapy and interactions with children should occur on a routine bases. This enhances opportunities for residents to connect with others and find meaningful companionship (Eden Alternative, 2015). Lastly reducing staff turnover rates will help improve resident outcomes and provide the quality of care they deserve.
Eden Alternative, 2015

9. Anticipated Outcomes Increased autonomy
Security: Reduced anxiety and enhanced privacy
Nature, pets, and children= Joy and meaning to life
Relationships between residents and staff= Improved outcomes
Evidence shows that organizations the implement the Eden philosophy into their care model greatly benefit residents and staff. With initiating Eden residents will experience more autonomy with being the center of their care decisions (Eden Alternative, 2015). Residence report an increase sense of security and a reduction in anxiety living in a comfortable safe environment that this model provides. Incorporating nature, pets, and children into the elderly’s lives creates meaning, joy, and connection in one’s life (Eden Alternative, 2015). Also encouraging staff to build meaningful relationships with residents can improve assessment skills and treatment outcomes.
Eden Alternative, 2015

10. Conclusion
Identify interventions to improve loneliness, helplessness, and boredom
Utilize the PDSA change model
Obtain necessary resources
Address barriers to change
Implement recommended changes under the Eden philosophy
Changes will enhance wellbeing and healthcare outcomes
This concludes my presentation on implementing the Eden Alternative philosophy within Saint Frances Home. For implementation to be successful nursing leaders are needed to develop interventions to address the main concerns affecting elderly decline which is loneliness, helplessness, and boredom. This will involve improving companionship, providing meaningful interactive activities, implementing high quality healthcare, and allowing elders into the decision-making process in regards to their care needs. This care model will be implemented by utilizing the PDSA change process. Research shows that the Eden philosophy greatly improves the elderly’s quality of life and can enhance job satisfaction among staff. To initiate Eden, resources needed are time, finances, educational opportunities, and equipment to make facility improvements. Strong administrators are needed to encourage open communication to help identify barriers to the change process that includes staffing concerns, resistances to change, and financial restrictions. Recommended changes to be implemented that correlate with the Eden philosophy include providing private rooms, remodeling, interactive activities, pet therapy, interactions with children, and maintaining adequate nursing staff. These change initiatives will enhance the resident’s wellbeing and help build therapeutic relationships with staff members which can improve the quality of healthcare individuals receive.

11. References
Burgess, J. (2015). Innovation: Improving dementia care with the Eden Alternative. Nursing Times, 111(12), Retrieved from ovidsp.tx.ovid.com.libcat.ferris.edu/sp a/ovidweb.cgi?QS2=434f4e1a73d37e8cd39f90c3d533e15a01b24ad a b0
Coleman, M. T., Looney, S., O’Brien, J., Ziegler, C., Pastorino, C. A., & Turner, C. (2002). The Eden Alternative: Findings after 1 year of implementation. The Journal of Gerontology, 57(7), Retrieved from
Eden Alternative. (2015). About the Eden Alternative. Retrieved from
Eden Alternative. (2015). Mission, vision, values, principles. Retrieved from
Graban, M. (2012). Lean hospitals: Improving quality, patient safety, and employee engagement (2nd ed.). Boca Raton, FL: CRC Press.

12. References
Li, J., & Porock, D. (2014). Resident outcomes of person-centered care in long- term care: A narrative review of interventional research. International Journal of Nursing Studies, 51(10), doi: /j.ijnurstu
Roussel, L., Thomas, P. L., & Harris, J. L. (2016). Management and leadership for nurse administrators (7th ed.). Burlington, MA: Jones & Bartlett Learning.
Rowles, G. D., & Teaster, P. B. (2016). Long-term care in the aging society: Theory and practice. New York, NY: Springer.
Rubertino, F., Lubin, S., Kruschke, C., & Hyde, D. (n.d). The Eden Alternative journey: Impacting the MDS 3.0 and QIS process. Retrieved from QISProcessv2_for_website.pdf
Sherwood, G., & Barnsteiner, J. (2012). Quality and safety in nursing: A competency approach to improving outcomes. Ames, IA: Wiley-Blackwell.