Opinion piece: Australian residential aged care and the quality of nursing care provision.

The Australian government and aged care industry uphold the standard of care for persons who require high care and reside in residential aged care facilities. The residential aged care system is extremely complex and through research conducted at the micro level it is argued that the macro level of policy can be exposed for the effects on the ground. A case study methodology in the qualitative paradigm used a discourse analysis of the nursing care for three highly dependent residents in one accredited aged care facility. Detailed data were collected through interviews, non-participant observations and document analyses concerning the nursing care these residents received. A comparative analysis of the discourses revealed this facility to be functioning in an environment of neglect. Nursing care provision was rushed and untimely and the residents were at risk of unsafe practices and negligence. The documentation of nursing care was found to be fraudulent, demeaning and out of date. Environmental considerations, continence management and the social and activity needs of residents were contradictory to their quality of life. The autonomy of the residents and advocacy by relatives were misinterpreted and unethical discourses were apparent with relatives having to be constantly vigilant. The nursing care provided by nurses (and non-nurses) failed to meet professional nursing standards and competencies, which adversely affected the residents' health compromising their safety. This situation is attributed to residential aged care policies, whereby nurses and nursing practice have been silenced and made invisible resulting in a substandard level of nursing care provision in this accredited facility that may be transferable to other facilities.