The Green House model carries out its vision of a more intimate long-term care environment by creating the position of an empowered front-line worker—the Shahbaz. The Shahbaz acts as most patients’ first outlet to care, by performing the duties of a Certified Nursing Assistant (CNA) with added responsibilities such as meal time, social activities, communication and assistance with activities of daily living (ADL).
This study was conducted in response to concerns expressed by members of the nursing community worried about the weakening of professional nursing oversight. In their role, Shahbazim do not have a direct reporting relationship to nurses; the implications of this difference in nursing structure has not been studied.
Bowers and Nolet studied four Green House nursing models: Traditional, Parallel, Integrated and Visitor. The Traditional nursing model is hierarchical with clearly defined roles for nurses and Shahbazim; the Parallel nursing model is non-hierarchical but still defines distinct responsibilities for nurses and Shahbazim; the Integrated nursing model shows considerable collaboration between Shahbazim and nurses; and the Visitor nursing model places the Shahbazim in charge, with nurses acting as outsiders in the care environment. Eleven Green Houses were visited and variations in nursing structure were evaluated to determine the effect each model has on patient care.
The results of the study suggest that for three out of the four Green House workforce models, the empowered Shahbazim did not detract from nurse involvement or patient quality of care. However, in the Visitor model of care, clinically relevant information was less reliably passed on to nurses. Significantly, in the Integrated model, there was evidence of practice patterns that may have the potential to improve quality of care.
Findings like these are essential to highlighting evidence-based practices in nursing structure and improving outcomes in long-term care facilities.