Page 55 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
WHAT MAKES NEW IDEAS DIFFICULT?
Summarized well in recommendations by Christine Mueller in Nurses Involvement in Culture Change, “...the transformation of nursing homes is too important to be slowed down for a research agenda. The current living situation of the great majority of residents in nursing homes is unacceptable and must be attended to. Researchers are encouraged to also see the urgency in strengthening the empirical base for Nursing Home Culture Change and act accordingly.” (Mueller, 2008)
While the growing research base refines knowledge of best practice, and is clarifying the statistical significance of outcomes from varying approaches to transforming organizations, to date, no research has confirmed harm, or negative outcomes from the new approaches. When the right answer seems morally obvious, delaying any action that could make life better for residents waiting for empirical proof seems morally wrong. While some approaches may eventually be defined as best practice, honoring individuality seems to assure that a variety of outcomes from any specific approach could be expected as individual organizations establish new practices for their individual staff and individual residents.
Self-Determination and Professional Standards of Quality
Meeting the challenges of resident self-determination and professional standards of quality were reviewed in the previous section on the complexities of the care planning process. Eliminating the barrier of lack of clarity of best practice in these areas is one of the greatest challenges to honoring resident directed care.
Recognizing that additional research is needed to establish validated processes supporting resident self-determination, it is hoped the work of related service sectors can be accepted as an interim standard to provide much needed guidance for immediate provider implementation pending the final researched guidelines. In the absence of such guidance, providers are left with the daunting (or impossible) task of individually developing their own approaches to resident/family education on the risks/benefits of choice, and the interpretation of the appropriateness of each facility approach of is a purely personal matter to surveyors, consumers and attorneys.
As with the issues of self-determination, resources related to best practice in clinical nutrition for elders abound, but translating them into practice in long-term care is a challenge to all and an
Recommendation: Researchers aggressively address research agenda in academia, while providers continue to be encouraged by CMS and all other stakeholders to
aggressively increase opportunities for resident self-determination in their organization.
Recommendation: National workgroup with representatives from all stakeholders and peer organizations develop guidelines to self-determination—including the right to refuse treatment for residents with full and diminished cognitive ability—to provide regulatory overview and interpretive protocol and investigative guidance, and prepare related
educational materials to facilitate implementation.
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