Nursing Sensitive Indicators Essay Example

this failure to recognize, Mr. J developed a pressure ulcer because the nurse or the CNA did not reposition him at least every two hours. One nursing-sensitive indicator that was disregarded, which could have potentially improved the quality of care, was skill mix. The care providers for Mr. J included the RN and the CNA.

Mr. J’s care would have been better served by a LVN instead of a CNA due to its complexity. An LVN would have acknowledged the necessity of regularly releasing the patient from restraints and repositioning them. Moreover, the LVN would have possessed the nursing knowledge required to identify the redness as a pressure ulcer and take preventative measures. This highlights the significance of having a nurse directly caring for patients in high-risk situations where a higher skill level is necessary, surpassing the qualification of unlicensed assistive personnel.

B. Quality Patient Care: Although it is impossible to eliminate all negative outcomes, nurses must strive to understand nursing-sensitive indicators and deliver quality, safe nursing care. Therefore, it is crucial for hospitals to gather data on negative outcomes related to nursing-sensitive indicators. By having access to this data, the quality of care provided by nurses can be enhanced. For example, if data on Restraint Prevalence is available, it could lead to a committee examining the hospital's policy and procedure for restraint use.

A new training program for staff on restraints may be developed and implemented. The Risk Management Team can analyze data on Pressure Ulcer Prevalence to determine the factors leading to patients developing pressures ulcers while in the facility. Quality Improvement plans can be implemented by monitoring patient outcomes, collecting data, and analyzing

results. This continuous process is critical to ensuring quality patient care, and new processes must be tested for effectiveness or changed accordingly (Foulkes, 2011).

Capturing data throughout an entire hospital system can be challenging. Hospitals can use the National Database of Nursing Quality Indicators to collect and analyze data in order to demonstrate the correlation between nursing care and patient outcomes. Quarterly and annual reports are compiled for individual nursing units within the hospital. By conducting reports at a unit level rather than hospital-wide, it becomes easier to identify areas where negative nursing-sensitive indicator outcomes are occurring and where improvements need to be made.

Hospitals can enhance the quality of care provided by sharing this data with nurse managers and staff nurses on each unit. This enables them to actively contribute to the improvement process. Nurse managers can assess the staffing structure on their unit to determine if it aligns with the poor data. They may need to introduce new scheduling measures to ensure adequate staff is accessible. Moreover, each unit can set quarterly objectives for enhancing patient outcomes and participate in training programs to address areas of concern with negative outcomes.

As part of a broader approach, the hospital can share data with the Quality Improvement Team in order to establish a committee for reviewing processes that may result in negative outcomes. The policies and procedures should be revised to incorporate Evidence Based Practice and include safeguards. For instance, when a patient requires restraints, both the RN and Charge Nurse should assess and approve the use, and a one-on-one aide should be assigned to the patient.

According to Montalvo and Dunton (2007), a facility implemented a quality improvement

process that involved having a wound specialist readily available to improve their hospital acquired pressure ulcer rate. After implementing this process, their rate significantly decreased (p. 4). Hospitals may also consider implementing safeguards to prevent nursing staff burnout, such as setting limits on the number of days and hours that can be worked per week. This can positively impact nursing-sensitive indicators like RN Satisfaction Survey Options and Voluntary Nurse Turnover.

Hospitals that have contented nurses, high retention rates, and a favorable work practice environment can deliver superior care to patients. It is crucial to gather and evaluate data, but equally vital to put into action new policies, goals, safeguards, and practices. Nevertheless, if nobody guarantees the efficient execution of these modifications, the quality of care will not enhance. Hospitals should not postpone recognizing the absence of changes until the subsequent quarterly report. Instead, an allotted timeframe must be established for implementation along with the creation of a system to ensure its completion.

There should be a follow-up method in place to review with management, staff, and administration. Previous quarterly results should be compared to upcoming quarterly results over a set timeframe for evaluation of effectiveness. If it is determined to not be effective, then revisions will need to be made until improvements in patient outcomes are seen. For instance, HR reports can be examined to ensure nurses are not exceeding a specific number of hours or days per week. The nursing-sensitive indicator data should demonstrate an enhancement in RN Satisfaction Survey Options and Voluntary Nurse Turnover.

The primary ethical issue pertains to the RN's disregard for the patient's Jewish Culture and failure to respect their values and beliefs,

specifically regarding the partially consumed non-kosher meal. It is imperative that nurses demonstrate respect for patients' cultural needs and preferences while delivering compassionate and competent care. To tackle this matter, my initial action would involve engaging in a dialogue with both the patient and their daughter.

As the nursing shift supervisor, I have a responsibility to reassure her that we are taking action to effectively and comprehensively address this issue. I will offer a sincere apology and schedule a meeting between the patient, her daughter, and a representative from their religious affiliation. Additionally, I will arrange for a dietary consult so they can directly discuss the patient's specific requirements for her Kosher diet. Identifying where the system failed is important in order to prevent similar errors from happening again.

If it was an informatics error, I would need to communicate with the hospitals IT department to determine a work around until a resolution is found. If the problem was not found to be related to the information getting into the electronic system, then I would speak with the kitchen supervisor. I would verify that the supervisor is aware that the patient is to continue receiving a Kosher diet and dietary staff could then verify correct diet when delivering the meal. Regardless if I discover a system error, I have a culturally sensitive issue with my nursing staff that needs to be addressed.

Implementing a mandatory training for all unit staff on Patient Centered Care that focuses on cultural competency is crucial, as stated by Flowers (August 2004). Notably, Slate (2015) reminds nurses of their duty to respect human dignity as per the ANA Code of Ethics:

"Respect for human dignity. In the provision of care, the nurse respects the beliefs and customs of the individual, family, or community" (p. 2). The ultimate goal is not only to address the current issue, but also to prevent its occurrence with any future patients, regardless of their cultural beliefs.

In conclusion, I propose meeting with the nurse manager to organize an Interdisciplinary meeting with hospital administration. The purpose of this meeting would be to determine whether this problem is affecting the entire hospital and requires attention. If it is found to be a widespread issue, we should establish a committee tasked with investigating the problem and creating an action plan to address it. It may be helpful to utilize nursing sensitive indicators, such as the RN Satisfaction Survey Options, to identify the specific cause of the problem. Resolving this issue is crucial for improving patient outcomes and satisfaction. (Montalvo, 2007)