Nursing Sensitive Indicators Essay
According to the American Nurses Association, nursing-sensitive indicators “reflect the structure, process and outcomes of nursing care.” (“Nursing Sensitive Indicators,” 2015) Understanding the indicators is an important piece of nursing, not only to assist the patient, but the patients loved ones as well, to ensure quality patient care. In this particular case, had the nurse understood the reasoning and data behind the Pressure Ulcer Rate and Restraint indicators, and communicated the necessity to report any pertinent findings the CNA may discover in the nurse’s absence, the CNA would not have dismissed the reddened area over the patient’s lower spine and would have immediately informed the nurse of the finding. Upon returning the patient to bed, the CNA would have also known not to place the patient back in bed on his back and re-apply the restraints. Instead, would have had the patient lay to one side and stressed the importance, to the patient and family member, of frequent turning, to reduce the chance of pressure ulcers. Quality patient care can only be achieved with teamwork and open communication. The discussion of pressure ulcers in hospitalized patients has become an increasing issue with more attention to the prevention of such since the early to mid-1990’s.
The Centers for Medicare and Medicaid Services (CMS) state that stage III and stage IV pressure ulcers occurring during admission are considered preventable (Zaratkiewicz et al., 2010). While the gentleman in our case scenario represented what would be considered a stage 1 pressure ulcer, with proper quality care and training, even this stage 1 ulcer could have been prevented or at the very least, the progression halted. If the nurse had a better understanding of nursing-sensitive indicators, or the theory behind them, then maybe he or she would take more ownership in the prevention of pressure ulcers. Harborview Medical Center in Seattle, Washington, conducted their own study regarding pressure ulcers and ways to prevent them. Their study was intended to track, prevent and improve skin-related outcomes (Zaratkiewicz et al., 2010). While the results of the study showed a large increase in minor pressure ulcers, it showed a huge decrease in stage III and IV ulcers, the most costly and reportable types. Education and staff reinforcement lead to early detection and improvement in practice, ultimately faring better for the patient.
Maybe if the hospital in the scenario had communicated such important figures or conducted their own study, the nursing staff and even the CNA’s would have a better understanding and ultimately provide better care. As far as ethical issues such as the request for a kosher meal that ended up not being kosher, we as nurses accept and agree to abide by a code of ethics. If I were the nursing shift supervisor and this case scenario occurred, there are a few different things I would use to discuss with my staff. First of all, I would remind all nursing staff of the code of ethics we all accepted the day we graduated nursing school and offer copies to each of them to serve as a reminder. Specifically, for this scenario, I would point out; “Human Dignity is respect for the inherent worth and uniqueness of individuals and populations.
In professional practice, concern for human dignity is reflected when the nurse values and respects all patients and colleagues” (“The Essentials,” 2008). While I am not Jewish and not receiving a kosher meal does not seem to be a big deal to me, I know that it is important to my patient and an acceptable request, so it should be a priority for me. Secondly, I would start a monthly ethical education series, choosing a different topic to better educate my staff. In the world we live in today, there are so many cultures and a necessity to be more aware of ethical treatment, that the staff should not be expected to “just know it.”
This knowledge comes from on-going education and it is up to the hospital and staff to make sure they are kept as up to date as possible regarding ethical treatment of patients. I would also involve my Board of Ethics or ethical expert from the hospital to intervene and sincerely apologize to the family. While we won’t be able to fix the meal that was already eaten, we can ensure the patient and family that steps have been taken to support special requests of patients from now on.
Nursing-Sensitive Indicators. (2015). Retrieved from http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursi
Nursing Sensitive Indicators Essay
The structure, processes, and outcome factors of nursing care are reflected in Nursing-Sensitive Indicators (NSIs). There are several things that the nurses in the provided scenario could have done to promote quality patient care. By being aware of restraint use as an NSI the hospital staff would be more likely to increase their focus and attention to its need and any development of complications. This increased focus and attention could have led to the development of educational opportunities for the hospital staff on the identification of pressure ulcer related complications. Had the nurse and nursing supervisor been aware of patient/family/caregiver satisfaction as an NSI they may have reacted differently in the situation. According to the physician in the scenario, there have been multiple complaints by Jewish patients about the disregard for their dietary requests. Having this data and information available can aid in developing and educational session for hospital staff including dietary workers, nurses, and certified nursing assistants about the importance of respecting patient’s cultural requests.
It is possible that some of the problems identified in the scenario were a related to the structure of the system and a result of inadequate staffing, educational, or experience levels. Being able to collect data on these NSIs can aid in identifying issues within this organization structure and make appropriate changes to ensure better quality patient care outcomes. For example, some issues may be related to there not being an adequate number of nursing on the unit. Collecting relevant data would help to identify this as an issue, possibly a recurring issue, which would lead to the assigning of more nurses to that particular unit.
Quality Patient Care
Nursing-sensitive indicators can provide data to help identify needs and diminish risks. Part of the reason why nursing-sensitive indicators are used is to be able to make changes and adjustments to policies and procedures of a hospital, if necessary. Quality patient care can be advanced in this situation by collecting data on specific nursing-sensitive indicators. Data on the prevalence of restraint use and consequential complications (e.g. pressure ulcers, contractions, anxiety, incontinence, and other complications) can aid in maintaining awareness of risks and allowing the nurse to take proper steps to limit their occurrence.
Data on patient/family/caregiver satisfaction can help illustrate whether the quantity and quality of nursing care needs to be improved. Data on nursing satisfaction and staffing can help to assess whether changes need to be made to staffing numbers, whether more experienced nurses are needed, whether more educational opportunities are need for the hospital staff, for example.
System Resources, Referrals, or Colleagues
There are a few ethical issues that in the provided scenario which need addressing from the nursing shift supervisor. The first occurs when the Certified Nursing Assistant (CNA) fails to appropriately address the possibility of a developing pressure ulcer. A wound care team can be consulted about developing an educational program about pressure ulcers for hospital staff. Also, there is the issue of restraints. The ordering physician should be contacted about the necessity of restraint use. Along with the wound care team, data could be collected about the use of restraints and the subsequent development of pressure ulcers. In the scenario, the patient was not served a “kosher” diet as the order indicated. The physician could be contacted to illicit more information about the several dietary complaints. The hospital administrator can, also, be contacted to inquire about any other dietary complaints before contacting the kitchen supervisor. The hospital ethics committee is a valuable resource when a need for education arises. The daughter was not told of the dietary mistake and was later inadvertently informed by a dietary worker. Members of the Ethics committee may be able to conduct an educational session for hospital workers about being patient advocates.