Page 32 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHO OWNS THE CARE PLAN
resident’s “normal” choice, but if written too specifically, it can actually limit the right of the resident to change their mind in the moment. Only when we care plan their right to choose, rather than simply a predetermined choice, can the care plan support self-determination.
Communicate the resident’s individualized care plan in a convenient, accessible way to the care- giving team. Traditional task-oriented care plans are relatively simple for staff to honor, as only exceptions must be learned. Individualized resident-directed care plans, on the other hand, are complex and variable, specific to each resident and must be communicated in a real time and in an accessible format. Only with new technology can this be simple, but with some effort, it can be communicated effectively, even with paper care plans.
Educate the team on resident self-determination and monitor their effectiveness in QAA.
The concept of accountability for facilitating resident self-determination in the care planning process may well assure the success of the team. Yet it is often lacking in the professional education of team members and during their internships completed in traditional facilities. Only through education and accountability can we expect true change. Only with the development of best practice guidelines can we grow together, assuring resident rights and regulatory compliance.
In a Pioneer Network Issue Paper, Nurses Involvement in Nursing Home Culture Change: Overcoming Barriers, Advancing Opportunities, Burger et al. detail recommendations for nurses working in nursing homes that comprehensively address the issue for nursing professionals in long-term care. (Burger, 2008) Work in progress is addressing these needs for administrators, medical students and medical directors. Only when all professional disciplines explore their role in overcoming barriers and advancing opportunities in nursing home culture change will the team be whole.
Fortunately, pioneering facilities across the country have modified their care planning process to support resident self-determination. Krugh and Bowman show us the way in their workbook, Changing the Culture of Care Planning: A Person-Directed Approach. (Krugh and Bowman, 2006)
Madalone observes: “The care planning process and the interdisciplinary team have different levels of understanding of the impact of allowing choice, and of their role in advocacy for the elder, and as an educator to all who impact on that elder’s quality of life, to the MD, the NP, the PA, the therapist, the MD’s office staff, the hospital with transfer, and more. In addition, the problem statements and goal statements that focus on the outcome, leaving the elder out in a lot of our documentation, and at times forgetting what the elder has agreed to accept all contribute to the problem of honoring resident rights. Collaboration is key, for resident control is restored.” (Madalone, 2009)
Only when true resident-centered care planning is incorporated into best practice through survey interpretive guidelines will the resident truly be the central focus and really own the care plan. And only then will the role of all other care plan team members in supporting resident self- determination be clear.
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