Pressure Ulcer Q and A

Dignity F 241

Minnesota Department of Health

Nursing Home Surveyor Training Resource

The purpose of this document is to provide a training resource for surveyors regarding reviewing dignity during the nursing home survey process.

Definition : In interactions with residents, staff carries out activities, which assist the resident to maintain and enhance self-esteem and self-worth. If potential privacy issues refer to F164.

F241 : The facility must promote care for residents in a manner and in an environment that maintains or enhances each resident's dignity and respect in full recognition of his/her individuality.

On tour observe how residents are treated and observe the total environment. Expand observations beyond the sample .

  • Does staff show respect for residents?
  • Are residents on pureed diets getting the same food as other residents?
  • Does staff talk to residents during meals or do they talk to other staff instead?
  • Does the staff sit at the resident's level when feeding?
  • Is independence promoted with dining?
  • Does staff pay attention to the resident as an individual or are staff distracted?
  • Does staff focus attention on all residents in a group activity or do they pay attention to only one individual?
  • Do residents attend activities of their choice?
  • Is clothing labeled so that it is respectful to the resident?
  • Is there respect for the resident's personal space?
  • Does staff knock before entering?
  • Does staff respond timely to resident requests?
  • Are call lights answered timely?
  • Is the resident well groomed?
  • Is the resident dressed in the resident's own clothes?
  • Is the resident's personal possessions moved without asking?
  • Is there respect for the resident's social status?
  • Does staff speak respectfully and listen carefully to the resident?
  • Are residents addressed as individuals when staff communicate with them?
  • What is the resident's preference in their life style? Do not assume there is a deficient practice because you didn't like what you saw.

Team information gathering: ALL areas of concern identified at the pre-survey meeting should be brought to the meeting after the tour. Discuss if additional residents are needed for the sample or if substitutions need to be made.

Observe dining, activities, personal care of the resident. Look at the actions and omissions of staff, the uniqueness of the resident and their needs and preference. If concern areas identified, then continue investigation. If no concerns identified, end investigation, however, be aware of staff/resident interactions around you throughout the survey.

Interview the resident/family group, individual residents and family to identify any concern areas and to determine the resident's likes and dislikes. Interview nursing assistants, dietary, social service, activity department, nursing, and housekeeping to obtain additional information and/or verify observations. If concerns brought up at group or with individual resident/family interviews, continue to observe and investigate areas of concern.

Review the record to confirm findings. Have the resident's likes and dislikes been identified? Review care plan, dietary notes, activity notes, social service. Has staff been trained to treat residents in a dignified and respectful manner?

Documentation : Who, what, when, where, why? Who was involved, who was interviewed? What happened, what did the facility fail to do? When did it happen, when was the observation, when was the interview, when was the record review? (Date, time) Where did it happen? Why did it happen? (Staff unaware, not on care plan, staff not trained). Identify what was undignified. If harm occurred, what constituted the harm?

December 2005