The Omnibus Budget Reconciliation Act (OBRA), also known as the Nursing Home Reform Act of 1987, has dramatically improved the quality of care in the nursing home over the last twenty years by setting forth federal standards of how care should be provided to residents. 

This Act is interpreted with the U.S. Code of Federal Regulations (42 CFR Part 483). Such improvements include less use of antipsychotic drugs, a reduction in chemical and physical restraint use, and a reduction in inappropriate use of indwelling urinary catheters.

Mandates

The quality of care mandates contained within OBRA, and the regulations, 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. 

In order to participate in Medicare and Medicaid programs, nursing homes must be in compliance with the federal requirements for nursing homes.

The mandates of OBRA are regarded in the nursing home 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 to exercise the degree of reasonable care and skill that should be expected.

Penalties

The Indiana State Department of Health is responsible for ensuring that nursing homes follow these mandates through the state survey process. The Department of Health and Human Services (DHHS) and the states may apply penalties against nursing homes for failure to meet the minimum standard of care as defined in the OBRA regulations. 

Such penalties may include fines, appointment of administrative consultants to run the nursing home while deficiencies are remedied, and even closure of a nursing home.

• Residents must be assessed to identify their medical problems and their abilities to perform basic self-care activities. The DHHS established a uniform data set, referred to as the minimum data set (MDS), to document this assessment.
• The nursing home is responsible for the safety of each resident. This includes being responsible for orders written by the resident’s primary physician or other medical provider. If the physician writes an order that does not comply with the federal regulations, the nursing home is responsible for making sure the physician changes such order. The mere presence of a physician’s inappropriately written order does not absolve the nursing home of responsibility in providing safe care.
• Provide services that will enhance each resident’s quality of life to its fullest (42 CFR §483.15).
• Maintain the dignity and respect of each resident (42 CFR §483.15).
• Develop a comprehensive care plan for each resident (42 CFR §483.20).
• Conduct a comprehensive and accurate assessment of each resident’s overall health upon admission and at each required interval (42 CFR §483.20).
• Prevent a decline in activity of daily living (ADL) activities, including the ability to eat, toilet, bathe and walk. Staff must provide for ADL care when necessary (42 CFR §483.25).
• Prevent the development of pressure sores, and if a resident has pressure sores, provide the necessary treatment and services to promote healing, prevent infection, and prevent new sores from developing (42 CFR §483.25).
• Provide appropriate care to those who have urinary incontinence and restore bladder function if possible. This also includes only using urinary catheters when appropriate as outlined in the regulations to prevent adverse consequences related to such use (42 CFR §483.25).
• Prevent accidents, including falls, accidental poisonings and other incidents that could cause injuries (42 CFR §483.25).
• Maintain adequate nutrition to prevent unnecessary weight loss (42 CFR §483.25).
• Provide each resident with sufficient fluid intake to prevent dehydration (42 CFR §483.25).
• Ensure that residents are free from significant medication errors (42 CFR §483.25).
• Have sufficient nursing staff (42 CFR §483.30).
• Ensure that each resident’s rights to choose activities, schedules, and health care are maintained (42 CFR §483.40).
• Provide pharmaceutical (medication) services to appropriately meet the physical and psychological needs of each resident (42 CFR §483.60).
• Maintain accurate, complete, and easily accessible clinical records for each resident (42 CFR §483.75).

Mrs. J is repeatedly asking for a nurse; other patients are complaining, and you simply cannot be available to Mrs. J for long periods.  Considering the setting and the OBRA guidelines, what would you do to manage the situation?

1. Analyze the challenges anatomical and physiological changes in the aging individual have on providing safe and effective care
2. Conclude the health outcomes of the health promotion, disease prevention, and early detection and treatment of diseases
3. Organize an interdisciplinary plan of care for the aging client
4. Advocate for the protection of the aging population in the conduct of research

  1. Appraise the literature and find a minimum of ten peer-reviewed journal articles written in the last 5 years or less Regarding Indwelling urinary catheter during hospitalization that causes infection/Foley catheters significantly raise the risk of infection specifically catheter-associated urinary tract infections (CAUTIs). Use the Appendix G Individual Evidence Summary Tool to synthesize and organize your findings. ( SEE APPENDIX G FORM ATTACHED BELOW) . Submit the completed Appendix G table with the attached reference for all articles in APA format. 

2. When appraising the literature complete either Appendix E or F (SEE APPENDIX E and F FORM ATTACHED BELOW) depending on whether your article is research or non-research. Do this for one of your final articles. 

Reference in APA format for the article.

Plagiarism receipt requires 

Reflection on Learning 2

Reflective inquiry allows for expansion in self-awareness, identification of knowledge gaps, and assessment of learning goals. Each week, you will reflect upon what you have learned and complete a reflective journal assignment: Reflection on Learning. Each weekly reflection is placed in one document, which will be submitted for grading at the end of Week 7. There is no weekly reflection in Week 8 because a reflection is incorporated into the discussion question. Create a document where you will keep your weekly reflection.

Access your reflection document. Reflect upon your Week 2 learning journey in NR701 and consider the following in one or two paragraphs.

·  Provide one specific example of how you achieved the weekly objectives.

·  Why is the information important?

·  In what ways will you use this learning? 

Week 2: Readings

American Association of Colleges of Nursing. (2004, October). AACN Position Statement on the Practice Doctorate in Nursing. https://www.aacnnursing.org/Portals/42/News/Position-Statements/DNP.pdf (Links to an external site.)

American Association of Colleges of Nursing. (2006). The essentials of doctoral education for advanced nursing practice. https://www.aacnnursing.org/Education-Resources/AACN-Essentials (Links to an external site.)

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (2016). Translation of evidence into nursing and health care (2nd ed.). Springer Publishing Company.

Chapter 6: Translation of Evidence for Leadership

Clearly, diagnosis is a critical aspect of healthcare. However, the ultimate purpose of a diagnosis is the development and application of a series of treatments or protocols. Isolated recognition of a health issue does little to resolve it.

In this module’s Discussion, you applied the Clark Healthy Workplace Inventory to diagnose potential problems with the civility of your organization. In this Portfolio Assignment, you will continue to analyze the results and apply published research to the development of a proposed treatment for any issues uncovered by the assessment.

To Prepare:

• Review the Resources and examine the Clark Healthy Workplace Inventory, found on page 20 of Clark (2015).
• Review the Work Environment Assessment Template.
• Reflect on the output of your Discussion post regarding your evaluation of workplace civility and the feedback received from colleagues.
• Select and review one or more of the following articles found in the Resources:
  • Clark, Olender, Cardoni, and Kenski (2011)
  • Clark (2018)
  • Clark (2015)
  • Griffin and Clark (2014)

The Assignment (3-6 pages total):

Part 1: Work Environment Assessment (1-2 pages)

• Review the Work Environment Assessment Template you completed for this Module’s Discussion.
• Describe the results of the Work Environment Assessment you completed on your workplace.
• Identify two things that surprised you about the results and one idea you believed prior to conducting the Assessment that was confirmed.
• Explain what the results of the Assessment suggest about the health and civility of your workplace.

Part 2: Reviewing the Literature (1-2 pages)

• Briefly describe the theory or concept presented in the article(s) you selected.
• Explain how the theory or concept presented in the article(s) relates to the results of your Work Environment Assessment.
• Explain how your organization could apply the theory highlighted in your selected article(s) to improve organizational health and/or create stronger work teams. Be specific and provide examples.

Part 3: Evidence-Based Strategies to Create High-Performance Interprofessional Teams (1–2 pages)

• Recommend at least two strategies, supported in the literature, that can be implemented to address any shortcomings revealed in your Work Environment Assessment.
• Recommend at least two strategies that can be implemented to bolster successful practices revealed in your Work Environment Assessment.

Nutrition plays a vital role in a person’s overall health and well-being. Not getting enough of the recommended nutrients over the long-term can lead to malnutrition which often results in disease and illness.

In a 3-page paper, written in APA format using proper spelling/grammar, address the following:

1. Define malnutrition and identify a specific disease that can result from it.
2. Perform library research about the selected disease, and explain its physiological effects on a person’s body. 
3. Describe the relationship between specific foods/nutrients and the disease. Use the questions below to guide your response.
   1. Does research indicate that a lack of specific foods/nutrients increase a person’s chance of contracting the disease?
   2. Are there specific foods/nutrients that should be avoided by an individual afflicted with the disease?
   3. How do specific foods/nutrients work physiologically within the body to help combat the disease?
4. Evaluate nutritional recommendations to help combat the disease.
5. Cite at least 3 credible references and present the resources in APA format on the References page.