When a nurse is hired to work in a facility they are expected to follow various policies and procedures set forth by the facility and to abide by practice regulations set forth by the governing body that issued their nursing license. Nurses can utilize nursing-sensitive indicators in their daily practice to promote safe and quality care to their patients, resulting in positive outcomes. A. Nursing-Sensitive Indicators
In this scenario the patient is a 72 year old retired rabbi with mild dementia who is admitted to the hospital for a broken right hip due to a fall at home and is receiving pain medication. After a week of being admitted the patients daughter visits her father and finds him restrained. She also notices a red depressed area over her fathers’ lower back when her father is being assisted to the bathroom and was later informed by the dietary worker about her father receiving a pork cutlet on his dinner tray. The daughter was upset with the care being provided and complained to the physician.
Nursing- Sensitive Indicators are factors that can be used by nurses to directly impact the outcome for the patients they serve (Sauls, 2013). If the nurse had used what was known about nursing-sensitive indicators the outcome would have been positive for the patient and family. Nursing-Sensitive Indicators use structure, process, and outcomes to develop nursing care geared for the patient and directs the nurse to carry out the care needed for that patient. The structure of nursing-sensitive indicators looks at various aspects of nursing such as staffing levels, mix, experience, and education level (Sauls, 2013). Structure looks at the number of Registered Nurses (RN), Licensed Practical Nurses (LPN), and Certified Nursing Assistants (CAN) involved in the care of the patient along with the skill, education, and experience level of the staff. The more nursing staff available and the more educated the staff is all works toward the goal of a positive outcome for the patient (Sauls, 2013). The processes to nursing-sensitive indicators look at assessment, intervention and staff satisfaction as aspects of obtaining good outcome for the patient (Sauls, 2013).
If the nurse did a good assessment of the patient and took into consideration the age and the fact the patient had mild dementia an alternate form of pain medication might have been prescribed for the patient, lessening the deterioration of his cognitive abilities. The CNA may not have been educated on pressure ulcers in order to recognize the red depressed area on the patients’ lower spine therefore requiring the nurse to assess the area and to initiate frequent repositioning of the patient to reduce pressure spots and further formation of a worsening ulcer. The nurse may not be satisfied with their job and when assessing the patient did not take note of the patients’ cultural background therefore not ensuring the correct diet was ordered. The scenario states the patient as being sleepy and drowsy; there was no mention of the patient becoming violent or causing harm to self so an alternate method could have been used instead of restraining the patient.
There are other methods to use such as having a sitter or placing the patient closer to the nurse’s station. The next aspect of nursing-sensitive indicators is outcome. The outcome of nursing-sensitive indicators looks at nursing care outcomes and how directly related quantity and quality of nursing care is to the positive outcome for the patient. A nurse who has a good understanding of nursing-sensitive indicators will be aware of the factors and utilize them to make a difference. In this scenario the nurse is aware that nursing has an impact on pressure ulcers so the nurse may pay closer attention to the signs, symptoms, and risks of pressure ulcers and initiate the steps to help prevent the formation of pressure ulcers or the further deterioration of one.
B. Quality Patient Care
The quality of patient care in a hospital can be improved upon by making the nursing-sensitive indicators data known to all staff in all areas of the hospital so they are able to see if improvements are being made to the quality of care provided to the patients. This data allows the hospital to see where further staff education or development is needed and can be used when making decisions regarding the hiring of more nurses (Sauls, 2013).
Making this data available, both negative and positive outcomes, to all staff can be motivating to the staff and provide incentive for units to increase their quality of care. The data is shared nationally in the National Database of Nursing Quality Indicators (NDNQI) so staff will want to work hard at improving quality care so they can see how they compare nationally compared to other facilities. Patients also use this information when deciding which facility to go to when having surgical procedures; they will choose a place that has a low post surgical infection rate and good quality of nursing care rate. C. Systems Resources, Referrals, or Colleagues
In this scenario the nurse could have consulted with pharmacy for recommendations about alternate pain medication for the patient to lessen the deterioration of his cognitive abilities and make him less drowsy, sleepy. The nurse could have given the nursing assistant some education regarding pressure ulcer and when to notify the nurse to assess the area. The wound care nurse could have been consulted to assess the patient and provide any further recommendations other than frequent reposition and reducing pressure points. Before placing the patient in restraints less restrictive methods should have been used and asking colleagues for advice would have benefited the patient more. The kitchen supervisor should have been up to the patients’ room to apologize for the meal mix up and to ensure the proper diet was ordered for the patient. Quality care to the patient is the responsibility of everyone involved in the patients care and the goal for that patient is to have a positive outcome.