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The situation when relatives, friends or acquaintances become disabled and need continual care is familiar to many people. The existence of nursing homes simplifies the problem of providing day-and-night care to the afflicted person by his or her family members. In other words, a nursing home is the place for people who do not need to stay in a hospital but who require constant care. Family members usually must work; therefore, they have recurrence to nursing homes. A greater part of these facilities has skilled nurses on hand round the clock. In the United States, approximately 1.6 million elderly and disabled people receive care in one of the 17,000 nursing homes (Castle & Ferguson, 2010). As a result, the problem of qualified service in such facilities remains a concern for years. As a rule, the residents of nursing homes are physically and mentally compromised. This makes them considerably dependent upon others and, consequently, vulnerable to neglect and abuse. Thus, the society has to implement firm measures for preventing such occurrences. The survey conducted in 16,000 facilities of the United States over the five-year term showed that, in each nursing home, approximately 6.4 deficiencies took place every year (Venkat, 2013). For studying ways of eliminating deficiencies, first, the reader should get to know about the definition of the word deficiency and its ten types in nursing homes. Deficiency is a negative attribute at nursing facilities; it can result negatively on the safety and health of its residents. The ten common forms of deficiencies are as follows.
1. Accident environment (facilities must be secure in terms of accident hazards, housekeeping and maintenance services).
2. Quality of care (facilities provide adequate supervision and assistance to their residents for further achieving their highest levels of mental and physical well-being).
3. Comprehensive care plans (nursing homes develop an individualized care plan that meets all the residents needs).
4. Nutrition or food sanitation (facilities must serve food in a way that meets the residents needs; they should store and cook in a safe and clean way).
5. Infection control (facilities must control, investigate and prevent infections through an infection control program).
6. Pharmacy service (each residents drug regimen must be free from unnecessary drugs).
7. Clinical records (facilities should hold the records with sufficient information about each resident and his or her assessments; the plan of services and care should be provided).
8. Dignity (nursing homes must promote care for residents with dignity and respect; their staff should provide proper assistance in appropriate dressing, independent dining, allowing private space and property).
9. Professional standards (facilities must ensure that the services they provide meet professional standards of quality).
10. Labeling, storage, and controlled medications (facilities should control the storage of medications, identify them properly and limit access to them).
To lessen these deficiencies, nursing homes must be strictly regulated, inspected, certified and licensed by certain public and private agencies at federal levels. The U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services (CMS) have jurisdictions for controlling these medical facilities. These agencies have to conduct full licensure inspections or surveys for evaluating the adequacy of nursing homes, their staff, equipment, policies, finances and procedures. Health care workers of nursing facilities come under inspection as well, and have to be certified and licensed by the corresponding state bodies, such as Nursing Home Administrators Licensing Board, the Department of Health, Certified Nurse Aide (CNA) Program. These bodies bring health care workers to disciplinary action for failure to conform to the standards of practice. Consequently, the services provided by the workers of nursing homes should meet the professional standards of quality. Disregard of this postulate is a deficiency of Professional Standards. Eliminating this form of deficiency in any long-term care facility is of high necessity, since the well-beings and lives of residents often depend on the healthcare agents competence. Professional nurses must improve their services in order to create nursing homes of high quality, which would be family-centered, resident-focused, and employee-friendly. An Everyday Excellence framework for professional care in nursing homes, which is set forth below, might help in eliminating the deficiency of professional standards. The services provided to residents of any long-term facility are based on eight guiding principles such as valuing, peopling, learning, securing, empowering, leading and advanced excellences. Professional nurses demonstrate best personal excellence values in their work with residents of long-term care settings. Code of Ethics for Caregivers of Nursing homes describes professional nursing values such as commitment, compassion, advocacy, accountability, responsibility, and collective action. Peopling excellence supposes qualified relationships between staff and residents, between personnel and employers. Thus, personnel policies guarantee that the most qualified people stay with geriatric nursing. Nursing staffing standards ensure that there is a sufficient number of licensed nurses, registered nurses, and certified nursing assistants to care for residents (Lyons, Specht, Karlman &Maas, 2008). Professional nursing assistants secure excellence in the nursing home environments by creating care settings considered as healthy, respectful, and safe. Every day, healthcare workers face many hazards in nursing homes, such as needle-stick injuries, noise exposure, contact with blood borne pathogens like hepatitis, and exposure to tuberculosis or MRSA. When healthcare givers work in an unsafe environment, patients and their families are also at risk of illness or injury. As follows, nurses must create safe nursing facility environments through providing a necessary education, staff and technologies.
Learning excellence supposes the ability and obligation for the improvement in employment-based learning, personal enrichment, professional development, and leadership training.
Empowering excellence means participating in collective efforts for achieving excellence in care after residents. Nursing assistants establish forums for dialogues about professional concerns, open communication and build agreement on nursing practice issues. Peer review and evaluation favors determining the standards of care by professional nurses.
Envisioning excellence is another guiding principle for providing the best service in nursing homes. In order to create an image of nursing dignity, professional nurses must articulate a shared experience of nursing practice, formulate their thoughts in writing, and estimate progress towards this image through the standards of nursing practice.
Professional nurse assistants should improve their leadership skills as well. Thus, leading excellence implicates involvement of professional nurses in resident care planning, community service projects, organizations professional activities.
Advancing excellence is the principle that provides the improvement of residents life through the expert application of technological innovations, commitment to research, and orientation towards social policies that abide high quality health care for all. Thus, professional nurses must make informed choices before accepting technological innovations, perform wise organizational decisions and use research evidence in clinical nursing practice.
Therefore, the best strategy for improving the quality of care in nursing homes is the implementation of the professional practice models. This paper proposes eliminating of professional deficiencies through the framework Everyday Excellence; it offers eight guiding principles of service in nursing homes. These principles expose the professional standards required by nursing home assistants for further improving their services in accordance with the license terms.