Published Mar 1, 1999
Most of the literature does not address the CNA point of view about quality of care. What is it in their terms? Surely health care administrators and staff must want to know. Anybody have any thoughts on what is quality of care? Nurses and nurses aids are both subject to the public interpretations of what their role is supposed to be, but seldom do they hear any voices talk about the reality of long term care and resident well being from the front line.
You've asked the million dollar question! We've all the heard the term a gazillion times. It has been used to protest staffing trends and institute new facility policies. LTC facilities and hospitals alike have been blasted for poor "quality care" and I have yet to see a concrete definition of the term posted or guidelines set for healthcare workers to follow along the lines of this phrase.
As a nurse, I have my own views of what quality entails based on my morals, skills, knowledge, experience, and work ethics. It encompasses such a wide spectrum of issues, that it is difficult to place my ideals into a few short words. However, to simplify as best as I can in short-order, I envision quality care as the state in
which every means is employed to provide care which maintains the optimal physical, recreational, spiritual, and emotional health of a patient. It includes a wide range of activities which include, but are not limited to assessing the health needs of a resident, implementing care to return to optimal health, assessing the plan to make sure it is appropriate and notifying family and Drs. if it is not. It also includes delivery of basic grooming needs, adm. meds, treatments, and collaborating with other healthcare members to devise plans of care to meet the patients goals, and to ensure the patient's rights to safety, comfort, care, and dignity issues are delivered in a timely manner. The bottom line is that all of my patients are cared for as if they were one of my loved ones, and treated no less than I would expect if I were in the patients' and families' shoes.
This makes my job quite difficult. Most days there isn't enough time for 1 individual to address all the patients' needs and overall health status, deliver the appropriate care and monitor its effectiveness, keep family and Drs. informed, and document this all. It has to be a team approach consisting of social workers, physical therapies, speech, occupational, and resp. therapy, dietitians, etc. Most importantly there has to be an excellent rapport and communication between all these healthcare members.
Everyone has a different variation of the meaning of quality care. Until it is better defined, I will continue to be guided by my heart, morals, and ethics. In addition, I will continue to discuss with my patients and families what exactly it is they expect in the terms of quality and care. If these needs and patient requests are met, along with holistic health care maintenance, then I am confident they've obtained quality care.
As for the CNA's point of view on the meaning of quality of care, this is rather an important question as they are the ones on the front line--spending more time interacting with the patients than any other healthcare giver in the LTC setting. The ones I've asked have said it means keeping the residents clean, dry, well groomed and comfortable at all times, toileted on a regular basis to prevent incontinence, making sure residents are not overtired from their activities, observing to make sure they are safe, fed and hydrated, keeping positions changed to prevent breakdown, watching for any changes in mentation or health status, and watching to see if treatments are effective for each individual. It also means spending time to talk to the residents to ease their lonliness and maintaining dignty in embarrassing situations. One CNA said it depended on whom we were talking about, and I think she hit the nail on the head here. Each patient is an individual with different needs from all others. It would be impossible and unjust to tie the term down to one generic definition. The best one can do is assess each person as an individual and provide the care and attention he/she needs to function at an optimal level. The majority of CNA's I work with are wonderful! On top of all this, they are excellent about reporting everything to the nurse in charge for follow-up, etc. This is crucial if you want patients to receive what I consider to be quality care.
The concept of Quality of Care, from a medical model, parallels with the Critical Pathway concept that was introduced in the healthcare field. It's intent was to reduce the high cost of healthcare through the reduction of resources and reorganizing or redefining the sequence of a patient's hospital stay. Ultimately, the goal was to reduce the length of stay for hospital patients. This is mostly in response to the changing "rules' of reimbursement.
This transition has seen the emphasis placed on an outpatient basis which has had a powerful effect on the long term care industry. Although nursing homes has seen a small decrease of residents, due to the onslaught of assisted living facilities, the profile of the typical nursing home resident has seen change. They tend to be older and sicker, possibly there for a short stay while they recuperate from a hospital stay.
So...the variable that changes the definition of Quality of Care is the length of stay (LOS). LTC environments count the LOS in terms of months and years, while a typical hospital LOS can be counted in hours, days and sometimes, weeks. In a LTC environment, the concept of Quality of Care transitions into the concept regarding the Quality of Life since the residents live in the facility full time vs. a short stay. In a very real sense, the medical model transitions into a social model. That's a the big difference. One aspect inherently involved in a living environment vs. a short term care environment (acute care) is the heightened need for socialization and communication (a connection with others). Psychosocial needs increase in LTC environments.
The above posts by BethanyJ state the Quality of Life objectives in a very clear manner. The residents in her facility are very fortunate. The Quality of Life concept goes well beyond the Quality of Care issue in LTC environments, although the medical care of a resident is very important.
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