Nursing Sensitive Indicators
Nursing-sensitive indicators can be an important tool in identifying patient care issues that could potentially arise during a hospital stay. By analyzing the data on specific nursing-sensitive indicators, the quality of patient care can be optimized and patient satisfaction can be improved. The American Nurses Association (ANA) and the National Database of Nursing Quality Indicators (NDNQI) are two sources of information and guidelines for nurses and nurse managers to use in planning patient care and workloads for each nursing unit.
The use of available resources, staffing by acuity and patient needs, appropriate referral indicators, and cooperation among colleagues are all necessary components in providing ethical, safe, and patient-centered care in the hospital setting. Care of the patient should always center on the individual needs, wishes and cultural practices, within the framework of evidence-based patient care interventions. Nursing Sensitive indicators “Nurses use theoretical and evidence-based knowledge of human experiences and responses to collaborate with healthcare consumers to assess, diagnose, identify outcomes, plan, implement, and evaluate care.
Nursing Sensitive Indicators Essay Example
Nursing interventions are intended to produce beneficial effects, contribute to quality outcomes, and above all, do no harm. ” (American Nurses Association, 2010) There are several nursing sensitive indicators that were either ignored or overruled in the case of Mr. J. Falls risk, dementia diagnosis, pain medications, immobility and cultural or religious values are all indicators that special steps must be taken in the care of this patient to avoid further harm and achieve quality patient care. Mild dementia can create problems in some patients with their ability to reason, make sound judgment,
and respond appropriately to requests and interventions. The simple fact that he fell, has mild dementia, and is drowsy does not, according to ANA standards and the Joint Commission, make him a candidate for use of restraints. Falls risk indicators should be assessed on admission and at least every 24 hours post admission. Optimally, the falls risk should be addressed each shift, as in some patients with dementia there can be marked differences in cognitive levels of function at different times of day, making them more susceptible to falls at night.
Unless a patient is in immediate danger of harming self or others, such as pulling out IV lines, trying to remove breathing or feeding tubes, or striking out at staff without being able to be redirected, there is no indication that restraints should be used. There are many restraint alternatives that can be employed in the care of patients who are at risk for falls, have cognitive issues, or are combative. Use of bed alarms, personal alarms, active listening, direct observation, one-to-one sitters, family visits, and redirection should all be attempted prior to obtaining a physician order for restraints.
Restraints should never be applied without the knowledge of the attending physician, and there are very strict guidelines in place for frequent skin checks, restraint-removal trials, and frequent vitals and welfare checks. All staff, whether licensed care professionals or unlicensed assistive personnel should be aware of the institutional policies regarding use of restraints. Likewise, the development of pressure ulcers while hospitalized is greatly increased by immobility.
It takes only two hours of lying in one position for skin to begin breakdown, especially over bony prominences such as the buttock/coccyx area. This can also be exacerbated by incontinence, whether the incontinence is due to lack of control or simply lack of staff to assist in toileting needs. Quality patient care in the case of Mr. J would have to include restraint alternatives, falls prevention care plans, frequent skin checks, and frequent (every two hours) turning or repositioning to avoid skin breakdown.
A toileting schedule would also be helpful in this case, to assure the patient and his family that basic needs will be met. My recommendation for the care plan of Mr. J would include restraint alternatives consisting of bed alarm, active listening, rounding at least hourly by nurse or CNA, toileting assistance and repositioning every two hours, and reassurance or redirection as needed if confused. I would encourage family visits if possible, and even suggest that if a family member felt comfortable rooming in with patient for reassurance all effort would be made to accomplish that scenario.
It is common for patients with dementia to become more confused and distressed in the later evening hours, so having family or a one-to-one sitter would be a very effective way to reduce the chance of fall and to reassure and redirect as needed. Also, the CNA should not have ignored the growing sign of skin breakdown on Mr. J’s lower spine. The depressed, reddened area is a precursor to a stage one pressure ulcer. Due to his age, injury, and lack of mobility, a pressure ulcer prevention care plan should have been initiated on admission.
When the evidence was brought to the attention of the CNA , she should have immediately informed the primary care nurse of her findings. Following the evidence-based practice of frequent repositioning, padding bony prominences, and the use of products designed specifically for prevention and healing of compromised skin areas will dramatically reduced the incidence of hospital-acquired pressure ulcers. Research and use of data on prevention and avoidance of falls and pressure ulcers can make a remarkable difference in the cost of patient care.
Reimbursement to hospitals by Medicare often depends on the use of proper care planning and documented use of nursing sensitive outcome indicators. A second very important rule of quality patient care was violated with the incident of Mr. J receiving the wrong type of meal on his tray. When it was discovered by the nurse that the pork had been given to and eaten by the patient, the nurse did the right thing by notifying her supervisor. However after that, the cascade of events was a dismal failure as far as transparency, customer service, and patient satisfaction are concerned.
The supervisor was negligent in telling the staff to “keep it quiet”. Although she did the right thing by notifying the kitchen supervisor, she should have immediately apologized to the patient himself, and then informed the patient’s daughter of the incident. An apology to the family, along with an outlined plan of how such a mistake would be avoided in the future would have most likely helped to avoid the hard feelings and complaints that followed. What the nurse later said to the patient’s daughter was not therapeutic, in fact it was belittling of the religious and cultural beliefs held by this family.
Culturally sensitive care dictates that even if healthcare workers do not agree with or fully understand the religious and cultural beliefs of the patient, they must still honor and accommodate whenever possible within the confines of sound medical practice. Failure to provide meals that are culturally appropriate was apparently an ongoing problem at that hospital. Resources, Referrals and Colleagues “Nursing practice respects diversity and is individualized to meet the needs of the healthcare consumer or situation.
Healthcare consumer is defined to be the patient, client, family, group, community, or population who is the focus of attention and to whom the registered nurse is providing services” (American Nurses Association, 2010) As a nursing shift supervisor, there are many resources available to assist in achieving quality, culturally appropriate care for patients. In the case of Mr. J, there are many online resources that could have been used to familiarize staff with the dietary requirements of Jewish who keep kosher.
Also, the dietician should have been consulted to set up kosher menus, and kitchen staff should be educated on kosher dietary requirements. The entire facility could benefit from education regarding dietary differences of different cultures and religions, and about cultural practices that may affect care interventions at all levels of care. Perhaps the nursing supervisor could facilitate training and education for all staff, with the help of the Jewish physician that would improve the level of satisfaction for the Jewish patients and their families.
Other resources that the nursing supervisor could employ would be to coordinate with the attending physician to obtain consultation and/or treatment for physical therapy, occupational therapy, wound care nurse, dietician, palliative care nurse, chaplain, and social worker. For immediate resolution of the issues with Mr. J, a personal apology from hospital administration, along with assurance that the complaints are being taken seriously and plans are being made to avoid such problems in the future would be a good start.
As for future patients, creating and following policies, care plans, and evidence-based guidelines for patients with dementia, patients at risk for pressure ulcers, patients at risk for falls, and patients with special dietary needs are a necessary step to insuring quality patient care. All staff, at every level of care, needs to be held accountable for following policies and guidelines, with clear expectations and consequences for deviation from policy.
It seems that there were many opportunities to provide quality patient care that were either overlooked or ignored in the case of Mr. J. Identifying risk for falls, risk for pressure ulcers, and risk for culturally inappropriate care at time of admission and addressing in advance possible issues that could arise could have resulted in a much safer and acceptable patient stay. Early use of assessment tools, referrals, and ancillary resources is essential to ensuring the safety and quality care of all patients.
Communication between colleagues and communication with patients and families is paramount and transparency when errors do occur is necessary to create the trust that is so essential between patient and all care providers. According to the ANA, “nurses must be as proficient in communication skills as they are in clinical skills”, and “must be relentless in pursuing and fostering a sense of team and partnership across all disciplines”. (American Nurses Association, 2010). It is only by becoming true collaborators that nurses can be seen as effective, valued, and committed partners in healthcare.