Nursing Standards of Care in the Nursing Home

The quality of care mandates contained within the Omnibus Budget Reconciliation Act (OBRA) require that a nursing home must provide services and activities to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident in accordance with a written plan of care. The federal mandates of OBRA are regarded in the long-term care setting to represent minimum accepted standards of care. The failure of a nursing home to comply with the OBRA quality of care mandates in caring for a resident represents a failure by such nursing home to exercise the degree of reasonable care and skill in providing healthcare as would a reasonably careful and skillful healthcare provider acting under the same or similar circumstances.

The following are standards of nursing care that should be provided by certified nursing assistants, staff nurses, the director of nursing, and nursing home administrator in the nursing home setting:

  • Use effective communication and interpersonal skills with residents
  • Ensure effective infection control practices
  • Utilize safety/emergency procedures, including the Heimlich maneuver and cardiopulmonary resuscitation (CPR) when indicated
  • Promote residents' independence
  • Respect residents' rights
  • Take and record accurate vital signs
  • Measure and record height and weight as ordered and indicated
  • Administer medications and treatments as ordered and prevent errors in such administration
  • Provide appropriate measures to prevent falls
  • Provide an accurate assessment and individualized care plan for each resident
  • Utilize appropriate interventions and equipment to prevent pressure sores and heal existing pressure sores.
  • Provide for a safe and caring environment
  • Provide meaningful activities based on resident interests
  • Ensure appropriate referrals are made for specialist care as indicated (ex. mental health services)
  • Recognize abnormal changes in body functioning and the importance of reporting such changes to the physician
  • Provide for personal care, which includes bathing, grooming, mouth care, dressing, toileting, and assisting with eating and hydration
  • Ensure appropriate and safe transfers, positioning, and turning
  • Implement appropriate behavioral management techniques to manage problem behaviors
  • Recognize and treat pain
  • Enhance resident dignity by allowing as much personal choice as possible while maintaining resident safety
  • Recognize medication side effects and report to the physician
  • Recognize and report to the physician signs of infection
  • Communicate with the physician and family regarding changes in orders and decline in resident condition
  • Recommend physical, occupational, and speech therapy as indicated to promote and restore function
  • Provide for basic restorative nursing services as follows:
    • Train the resident in self-care according to abilities
    • Use of assistive devices in transferring, walking, eating, and dressing
    • Maintenance of range of motion
    • Proper turning and positioning in bed and chair
    • Bowel and bladder training
    • Care and use of prosthetic and orthotic devices (ex. splints)
  • Maintain resident rights as follows:
    • Provide privacy and maintenance of confidentiality
    • Promote resident rights to make personal choices to accommodate their needs
    • Give assistance in resolving grievances and disputes
    • Provide needed assistance in getting to and participating in resident, family, group, and other activities
    • Maintain care and security of residents' personal possessions
    • Promote resident rights to be free from abuse, mistreatment, and neglect. Report any instances of such treatment to appropriate nursing home staff and state agencies as indicated
    • Avoid the need for restraints in accordance with current professional standards

Resources

Indiana Health Facilities; Licensing and Operational Standards

American Nurses Association