The purposes of this study were to characterize the state of quality improvement (QI) in nursing facilities and to identify barriers to improvement from nursing leaders' perspectives. The study employed a non-experimental descriptive design, using closed- and open-ended survey questions in a sample of 51 nursing facilities in a midwestern state. Only two of these facilities had active QI programs. Furthermore, turnover and limited training among these nursing leaders represented major barriers to rapid implementation of such programs. This study is consistent with earlier findings that QI programs are limited in nursing homes.

The Omnibus Budget Reconciliation Act of 1987 required nursing facilities to complete a standardized comprehensive assessment known as the Resident Assessment Instrument (RAI) and to formulate a plan of care from the RAI to guide nursing care. The purpose of this retrospective case study was to examine the issues around the translation of nursing facility resident care plans to documents that guide daily care. Data were obtained by auditing 96 resident care plans in 10 nursing facilities in two states. Despite the importance of the resident plan of care, the audit revealed the provider approaches to resident problems varied appreciably in nursing facilities. The results of this study support the need for further research to assist in the development and implementation of strategies in nursing facilities that focus on standardized practices. Consistent systems can be promoted that translate the resident care plan into daily practice.

This article has described the key points in the evidence-based practice guideline entitled Nursing Management of Hearing Impairment in Nursing Facility Residents. The guideline outlining the nursing management of nursing facility residents with hearing impairment is supported by 175 articles: 94 research articles (both experimental and descriptive) and 81 nonresearch articles (expert opinion). The full guideline includes the significance of hearing impairment, key definitions, individuals at risk, assessment criteria and tools, description of practice, and steps for evaluation and outcomes. We believe the implementation of this evidence-based practice guideline will improve the quality of life and quality of care of nursing facility residents.

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The results provide support for a reliable and valid instrument to measure nursing workload for standardized minimum data set assessments.