Providing professional nursing care in nursing homes: a dilemma.

by Ngozi 0. Nkongho, PhD, RN

The need for nursing homes is apparent. Both the increasing number of elderly and those requiring home-care services that cannot be provided in the acute-care setting are increasing. The quality of care that the resident of those facilities receives has come into public focus in the past decade. Most would agree that the quality of care in nursing homes needs improvement. How might this be accomplished? The quality of care issues can be related to two factors: those related to the home and those related to the degree that nurses practice professional nursing.

Factors related to the home are ownership and size. It has been reported that nonprofit homes have the best quality of care, and proprietary and public homes have the worst.' Based on that finding, one might wonder: Is patient care compromised when cost containment (in the public homes) and increasing profits (in the proprietary homes) are the modus operandi of the facilities? The size of the home has been found to relate to the quality of care.' Smaller homes generally have a more homelike atmosphere than larger facilities, and create fewer disruptions in accustomed living arrangements and routines.

It is the contention of this writer that the quality of care in nursing homes is related to professionalism - specifically to the degree with which nurses practice professional nursing. The question is: Do nurses practice nursing in nursing homes? Most nurses who practice in those settings will answer "no," based on their current experience. According to the American Nurses Association, the scope of nursing practice is to diagnose and treat human responses to actual and potential health problems.sup.2

The reality is that most nurses are not able to carry out appropriate nursing functions that they have identified for their patients. When that happens day after day, the nurse may begin to question her contribution toward patient care, resulting in low morale and decreased concern over outcome of care of the patient. For example, in one situation two elderly residents who were roommates had a conflict over how long to keep the lights on at night. The nurses on the unit developed a plan to assist the residents to resolve their differences, which called for experimenting with different times to put out the lights, until a compromise was attained. However, after two days, it was "ordered" by the physician that the residents be separated. Each of the residents then acquired new roommates who were ...