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OBRA: the government regulation that works.

Editor's Note: This was a presentation given at the 1992 Winter Institute, "Institutional Long-Term Care: The Challenge of the Decade" offered by the University of Florida Geriatric Education Center, February 12-14, 1992. We share it here with you for its positive insight into OBRA 87 (the new regulations for nursing homes) and the regulatory effects from the viewpoint of a Director of Nursing:

"As I reflected on the changes in the survey process over the years, I feel that (OBRA 87) has clearly moved us forward in the field of extended care.

"In years past, often someone decided how things were to be done and we did them that way, giving little or no thought to the resident's preference or choice. We now are forced to get in touch with an internal frame of reference. One can't regulate empathy, but OBRA is an attempt to require us to think through how to identify with the residents' personal perspectives and personal preferences regarding daily choices, as well as those that will dictate how residents want to be cared for should they become incompetent or terminal. The resident is the focal point. That's the difference!

"OBRA has mandated changes which have been difficult for some caregivers. It gives a different mind set. We no longer place emphasis on policy and procedure manuals. That doesn't diminish their importance, but emphasis is on positive outcome vs. custodial care. No longer can we just give the necessary daily care but we have to be constantly stretching to improve our services and programs for the residents. This calls for creative innovative thinking.

"Programming that addresses the needs of the various resident population, including Alzheimer's, blind, deaf, contracted, disabled and other chronic illnesses, present a tremendous challenge, which won't be met without a lot of hard work and commitment, and which absolutely requires total team effort.

"We recently opened an Alzheimer's unit with programming for the different levels of cognitive functioning. This has been intriguing and most educational, yet we have only begun to scratch the surface of the huge world of possibilities.

"Now that we have Alzheimer's-diagnosed residents separated from the remainder of the nursing home population, we have observed that their behavioral problems are being minimized because of programming to their needs and because they are not expected to perform tasks that they are not capable of doing. The frustration and acting out that used to occur is reduced. This is one example of what OBRA is about -- addressing the needs of residents at various levels or stages. Our programming is far from what we want it to be, but even with the little we have done so far we have observed that the residents are more content and happy. The challenges that lie before us all are tremendous!

"To have a successful OBRA survey (which is, essentially, to be providing good care) there must be team effort. Like any |team,' all the players must be well trained, informed and motivated. This special team must be focused on the resident, the care needed and given. Players on a team must practice regularly before they compete and so it is with our |teams.' We practice every day. We have our skull sessions. Training and inservice are ongoing so that the players will practice proper techniques every day. Then we |huddle' to review and evaluate our game plan and approaches. This we accomplish through our quality assurance reviews. Then when the big OBRA survey day comes and |they' have arrived at the door, we are ready.

"It must be understood, however, that preparation for a survey is a daily ongoing process and cannot be a last minute effort. Every day we're going to have to help staff understand that Mr. Jones can eat breakfast at 10 a.m. if he wishes or Mrs. Black doesn't have to get into the shower if she's clean and not offensive to those around her. It's hard to break old habits but we must start thinking |Resident-Centered.'

"Our task, as professional caregivers, is to enable people to be the very best they can be, all they deserve to be and all that God intended them to be. Part of the intent of OBRA is to motivate us to take our blinders off. No one saw Cinderella for who she really was until the Prince came along. We must force ourselves to look beyond the scrub girl and see the princess -- to look deeper and see the possibilities."

Barbara Bradley, RN, is Director of Nursing at the Advent Christian Village, Dowling, FL.
COPYRIGHT 1992 Medquest Communications, LLC
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Copyright 1992, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Title Annotation:OBRA '87; nursing home regulations; presentation given at the 1992 Winter Institute
Author:Bradley, Barbara
Publication:Nursing Homes
Date:Mar 1, 1992
Previous Article:Validation: a new method to ease caregiving's pain.
Next Article:Trends shaping the nursing home environment.

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