Running head: QUALITY OF LIFE IN NURSING

HOMES
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Quality of Life in Nursing Homes

Andrea S. Pratt
University of Saint Mary

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The quality of life (QOL) of the elderly in nursing homes is being viewed as an important
factor. In 1995, the World Health Organization defined QOL as the individual's perception of
their position in life in the context of the culture and value system in which they live, and in
relationship to their goals, expectations, and standards according to Logsdon, Gibbons,
McCurry, and Teri (2002). Through the years nursing homes have evolved from a very
institutional living space to a more home like atmosphere for the elderly who need the
specialized care of a nursing home. A movement for cultural change in nursing homes has
gathered force since 1995, embracing transformed physical environments (e.g., smaller-scale,
more private rooms and baths and household type neighborhoods for dining and occasionally
cooking), transformed staff roles with more empowerment of line staff, and a philosophy of
individualized care.(Kane, Lum, Cutler, Degenholtz, & Yu, 2007).
According to Rabig, Thomas, Kane, Cutler, and McAlilly (2006), the concept of the
Green House project which is a small scale living setting for elderly; was articulated by William
Thomas, see floor plan p. 10. This included transforming the physical environment, empowering
staff roles, and a philosophy of individualized care. The environment was small scale, like a
house with 10 private bedrooms around a communal dining, kitchen, living area with access to
outside areas like garden, sitting areas. The staff were trained how to function in this setting. It
operated on no fixed schedule, meals, personal care, sleep, rest, and activities where done
whenever the resident choose. The vision was for the elders/residents who would like to
participate in household activities such as planning, preparing meals, gardening, cleaning, doing
laundry would do so.
Philosophy provides a broad, global explanation of the world. For example, because
nurses believe that reality varies with perception and that truth is relative, they would not try to

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impose their views of truth and reality on patients. Rather they would accept patients; views of
the world and help them seek health from within those worldviews, an approach that is a critical
component of evidenced based practice. (Groves, Burns, & Gray, 2013). Because of this
viewpoint, exploring the QOL of the elderly in nursing homes is important to their well-being.
QOL of the person with dementia has shown to be improved with smaller-scale living
arrangements. Now, to expand that to the general elderly population in nursing homes would be
expected to show improvement for them, too. I am currently working at a nursing home that
does have households for Dementia/Alzheimer residents in one building, another building has a
mixture of the elderly population in a similar setting, and a modified form in an older building.
The two new buildings have small units of 15 beds, private rooms, group living type
arrangements, see floor plan p. 11. One building has eight small units and the other has four.
The eight units are grouped into 3 secure units, two and three units grouped together for semi
secured units. It has been a struggle to work in the units, manage them, and take care of the
residents. As the facility transitions to change the setting, we will all have challenges ahead. The
nursing home is in the process of changing from an institutional living space to a more home like
atmosphere for all of the residents living there. As the facility transitions to change the setting,
we will all have challenges ahead. My unit moved into a smaller unit setting in an older building
split between two floors. It has three smaller units of 14 beds, semi-private rooms. My staff and
I have worked through several challenges to make it work with what we are given for staff to
care for the residents. We moved from a larger unit with 55 beds, mostly semi private rooms on
one level. That is why I have chosen this topic.
The Grove Model for Implementing Evidence-Based Guidelines in Practice would be
useful for guiding research to keep researchers on track. My topic of research of QOL in nursing

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homes does not have a guideline developed at this time. The literature search has yielded more
specific disease processes or groups of people instead of a general population of older people
with multiple disease processes that have been studied. Because of not finding an evidencebased practice (EBP) guideline specific to my topic, it will take additional research to form a
guideline. The Grove Model will guide researchers through the process to develop an EBP
guideline during the process of synthesizing the studies available that address the QOL in
nursing homes.
The evidence that was revealed in the studies reviewed show a smaller nursing home
setting increases the QOL of the older people living there. The majority of the studies were
through observations and interviews which could have a bias of the data collectors and/or
researchers. Also of note, there were additional variables in the studies reviewed to connect the
QOL in nursing homes to staff satisfaction, better working conditions, better working
environment, additional staff, and community presence. My topic has limited studies which is a
barrier to finding a pattern that is strong enough to develop an EBP guideline. At my nursing
home there are two buildings with the smaller settings: one for Dementia/Alzheimer's residents
and another building for a mixture of the general older population. There have not been any
formal data collections or studies completed with those two populations regarding QOL in
nursing homes.
The QOL in nursing homes is important to the resident, family, and all involved in the
care of the individual. The small-house nursing homes are more home like settings with an
intentional community of 10 to 14 persons, staff, and a setting with a community kitchen, living
areas, patios, private rooms with showers, and access to all areas by the persons living there
(Rabig & Rabig, 2008). According to an article by Kane, Lum, Cutler, Degenholtz and Yu

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(2007), the small-house nursing home is a promising model to improve the QOL for nursing

home residents, with implications for staff development and medical director roles.
The standards of practice 13 of collaboration and 11 of communication is important for
the viewpoints and communication of everyone involved (American Nurses Association [ANA],
2010) The QOL of residents' is affected by an interaction of the setting, staff, family, and
community. Number 1 through 6 apply to the basic day to day care of residents and evaluation
of outcomes (ANA, 2010). The assessment, diagnosis, outcomes identification, planning,
implementation, coordination of care, health teaching and promotion, and evaluation are all
elements included to promote the increase in QOL of residents living in a nursing home.
Numbers 15 resource utilization and 16 environmental health (ANA, 2010) would be needed for
the overall functioning of the small-house nursing home. In some way all of the standard of
practice apply to QOL of residents in the nursing home or small-house nursing home.
Nursing is the protection, promotion, and optimization of health and abilities, prevention
of illness and injury, alleviation of suffering through the diagnosis and treatment of human
response, and advocacy in the care of individuals, families, communities, and populations.
(ANA, 2010, p. 10) Most residents are dependent on the nursing home staff for the provision of
important resources for QOL. Moreover, they may be unable to express or even determine what
really is important to them. More insight into the QOL of nursing home residents, how it can be
improved, and it implications for the quality of care, will increase the effectiveness of
approaches to the care, and thus the QOL of residents. (Gerritsen, Steverink, Ooms & Ribbe,
2004)
The residents that are in nursing homes are there for assistance with activities of daily
living, health care, and basic needs that were not able to be met on their own in the community.

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With this dependence comes a sense of loss experienced by everyone. So, the caregivers are

important as well as the setting or environment that care is given. The more invested staff are to
the residents, the more effective the care given to the residents will be, thus improving the QOL.
The impact of the QOL on residents in nursing homes involve multiple variables which include
the caregivers, environment, family support, and support systems within a nursing home. The
small house nursing homes being built for nursing home residents are to bring back the home
like setting moving away from the institutionalization of nursing homes in the past. The small
house nursing homes is a promising model to improve QOL for nursing home residents, with
implications for staff development and medical director roles. (Kane, Lum, Cutler, Degenholtz,
& Yu, 2007)
Provision Six contains what I feel is important to providing quality health care leading to
improved quality of life in nursing home residents. It states The nurse participates in
establishing, maintaining, and improving health care environments and conditions of
employment conducive to the provision of quality health care and consistent with the values of
the profession through individual and collective actions. (ANA, 2010) In a study by Kane,
Lum, Cutler, Degenholtz, and Yu (2007) found that the quality of care in small house care
settings at least equaled, and for change in functional status exceeded, the comparison nursing
homes. Kane et al. (2007) concluded that it is a promising model to improve quality of life for
nursing home residents.
Numbers never lie; a phrase we have all heard at one time or another. The goal of
research is to generate sound scientific knowledge, which is possible only through the honest
conduct, reporting, and publication of studies. (Grove, Burns, & Gray, 2013) The types of
misconduct included fabrication and falsification which directly involve numbers and reporting.

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According to Grove et al. (2013), those two were the most common acts of research misconduct
managed by the Office of Research Integrity (ORI). If the people doing the research cannot be
honest about their findings; then, how can we further our knowledge base through research? The
role of ORI is responsible for defining important terms used in the identification and
management of research misconduct (Grove et al., 2013). Through the ORI, policies,
procedures, and regulations are developing. With the ORI in place to supervise the
implementation of the rules and regulations related to research misconduct and to manage any
investigations of misconduct, the research being conducted should be better regulated. This, in
turn, would increase the integrity of the research being conducted and reported, since the
formation of the ORI (Grove et al., 2013).
Quantitative studies work with numbers. Numbers and collection of numbers needs to be
accurate and precise. If the numbers are manipulated, then the study results would be influenced.
So, not knowing if the rules were followed would present a problem. Qualitative studies work
with words and meanings of a phenomenon of interest. The researcher is simultaneously
collecting data and interpreting it. The researcher has to have the ability to form a relationship
during the data collection process and be able to interpret the data without their own bias and
past experience interfering. The data collection needs to be what the subject is reporting without
the researcher changing it. Both of these types of studies have the ability to be unethical.
In my facility, the staff nurses were not aware of what the meaning was behind the
change in the care setting. Through the review of literature related to this topic, I am able to start
to understand where the administration in my facility was going with the changes over the last 5
years. The change from a long hallway setting with 55 beds (semi private) to smaller areas with
fifteen beds (semi private) has shown some of the reasons for the change in the care settings to

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smaller households to improve the quality of life and care for the residents. We are a large

facility where it would be hard to have input from nursing at all levels prior to the construction of
the new buildings. All staff were given the opportunity to view the plans and give input when
the plans were almost ready to be implemented. So, it was informing staff without a real
investment into the decision making for the changes. After the buildings were built and residents
moved into them, staff at all levels were given the opportunity to give input good and bad related
to the functioning of them. Several changes have taken place and will continue to take place as
the care evolves.
The QOL in nursing homes affects several people and groups of people. The older
person, resident, who is living there and their family or guardians would be looking at what is
offered for care, how it will affect the person, how it looks, if it would meet their needs, and the
overall effect on their QOL. The administration, nursing staff, physicians, housekeeping, dietary,
therapists, activities, maintenance, security, and volunteers are all a part of shaping the nursing
home setting for our older person. With all of these people and groups involved in the day to day
care and running of the nursing homes, there is a vested interest for all involved to improve the
QOL in nursing homes. We must think of what it will be like when we are possibly looking at
going into a nursing home or care facility. What do we want, need, expect?
If the nursing homes are kept as the traditional institutional type homes, the QOL may
suffer as the needs of the resident changes. In a study by Kane, Bershadsky, Kane, Degenholtz,
Liu, Giles, and Kling (2004), indicates that it is possible to differentiate among facilities on the
basis of resident self-reported QOL. Kane et al. (2004) reports QOL will possibly be included in
the Minimum Data Set (MDS) 3.0 and surveyor procedures. The emphasis on QOL will force
nursing homes to change the way care is delivered in many aspects. Funding, staffing changes,

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and building structures will need to be addressed. Small-house nursing homes are starting to be
built to make a more home like atmosphere for residents. This trend will continue as studies are
showing greater QOL for residents who are living in this type of facility. (Kane, Lum, Cutler,
Degenholtz, & Yu, 2007)

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Rabig, Thomas, Kane, Cutler, and McAlilly (2006)

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Iowa Veterans Home/Veterans Administration

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