A Planned Change Process of Physical Activity Promoting Structures in Nursing Homes Using a Participatory Integrated Counselling Approach

Abstract

In light of the changing conditions of the residents, the acute staff shortages and the findings of previous research, there is a clear need for a planned and sustainable change in PA promotion and PA-promoting structures within the nursing home setting. The dissertation’s research is grounded in the field of organisational sociology, particularly Kurt Lewin’s Model of Change, which is used to conceptualise processes of change in three steps. The dissertation comprises five arti-cles that highlight all three steps of the change process and is guided by the primary pilot study, BaSAlt. Kurt Lewin’s Model of Change was applied for the first time to investigate and accompany a planned change process aimed at increasing PA-promoting structures in the nursing home set-ting. The specific challenge in this setting was the pseudo-total characteristic, prioritising basic care and mobilisation, rather than PA promotion. According to the first step of Lewin’s model, several quantitative and qualitative data analyses identified the need for action in different areas of the nursing home. Within the second step, PA-promoting actions were developed, integrated, and embedded with relevant stakeholders. These PA-promoting actions led to learning processes on both an individual and organisational level, resulting in changes in PA-related norms, values, schedules, and structures in the third step. By applying a holistic approach, multiple factors and areas of PA promotion were investigated and changed. The most prominent ones were staff train-ing, activities for weekly and individual schedules, regular communication and cooperation, the distribution of responsibilities, and the inclusion of activities of daily living into daily routines. The most notable implication for practice is the practical guide, which empowers nursing home man-agement staff to initiate change processes independently. Nevertheless, there is still room for improvement. Especially in pseudo-total institutions, structural inertia makes it difficult to embed new structures sustainably, and it is unclear to what extent this can be maintained without scien-tific monitoring and support.