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Chapter 39
Nursing in Long-Term Care
Facilities
Factors Contributing to Emerging Dynamic
Long-Term Care Settings
• Increasing complex resident population
• Improved standards
• Ability to develop long-term relationships with residents
– Allowing nurses to use healing arts
Development of Institutional Care
• End of the 17th century: European institutions cared for
the disabled, aged, orphaned, and poor.
• End of 19th century: Almshouses became the primary
source of institutional care in the U.S.
• 1900s: Public and charitable institutions began to
replace almshouses.
• 1946: The Hill-Burton Hospital Survey and Construction
Act provided funds for the construction of nursing homes.
• 1987: Omnibus Budget Reconciliation Act of 1987 (OBRA
’87) was enacted.
Omnibus Budget Reconciliation Act of
1987 (OBRA ’87) Provisions
• Use of Minimum Data Set (MDA)
• Timely development of a written care plan
• Reduction in the use of restraints and psychotropic drugs
• Increase in staffing
• Protection of residents’ rights
• Training for nursing assistants
Lessons for Gerontological Nurses
Learned from History
• A vision and a clear model are important foundations.
• When nursing fails to exercise leadership, non-nurses will
determine nursing practice.
• When nursing does not attempt to correct problems in
the health care system, others will, and public perception
will be that nurses are part of the problem.
• Entrepreneurial thinking can benefit nursing and patients.
Facility Residents
• Most have dependencies in their ADLs.
• Most are incontinent.
• Many are cognitively impaired.
• The average age is 8.
• For most people, nursing home placement was not the
first or most desirable choice.
Factors to Consider in Selecting a Nursing
Facility
• Cost
• Philosophy of care
• Administration
• Special services
• Staff
• Residents
• Physical facility
Factors to Consider in Selecting a Nursing
Facility (cont.)
• Meals
• Activities
• Care
• Family involvement
• Spiritual needs
Regulations Related to Nursing Facilities
• Resident rights
• Admission, transfer, and discharge rights
• Resident behavior and facility practices
• Quality of life
• Nursing services
• Dietary services
• Physician services
Regulations Related to Nursing Facilities
(cont.)
• Specialized rehabilitation services
• Dental and pharmacy services
• Infection control
• Physical environment
• Administration
New Model of Long-Term Care
• Hygiene
• Holism
• Healing
Assumptions Woven into Model of Holism
and Healing
• Psychological, social, and spiritual well-being are of equal
and sometimes greater importance than physical wellbeing.
• Medical supervision and treatment are only one
component of the overall needs of residents.
• Many of the needs resulting from chronic conditions can
be effectively and safely met with the use of alternative
and complementary therapies.
Assumptions Woven into Model of Holism
and Healing (cont.)
• Caregivers’ presence and interactions affect health,
healing, and the quality of nursing facility life.
• The physical environment can be used as a therapeutic
tool.
• The nursing facility is an integral and active member of
the community at large.
Role of Gerontological Nurses in LongTerm Facilities
• Administrative and management roles
– Director of nursing
– Supervisor
– Unit nurse coordinator
– Charge nurse
Role of Gerontological Nurses in LongTerm Facilities (cont.)
• Specialized roles
– Staff development director
– Quality assurance coordinator
– Infection control coordinator
– Geropsychiatric nurse specialist
– Rehabilitative nurse
• Direct care providers to residents
Responsibilities of Gerontological Nurses
in Long-Term Facilities
• Assist in selection of and adjustment to facility.
• Develop individualized care plan.
• Monitor health status.
• Recommend and facilitate rehabilitation as needed.
• Evaluate care.
• Identify and act upon changes in resident condition.
Responsibilities of Gerontological Nurses
in Long-Term Facilities (cont.)
• Coordinate with interdisciplinary team.
• Advocate for patient rights.
• Promote high quality of life for residents.
• Ensure and promote competency of staff.
Source
• Eliopoulos, C. (2005). Gerontological Nursing, (6th
ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN
0-7817-4428-8).