RTT1 TASK 1 RTT1 TASK 1 A. Discuss how an understanding of nursing-sensitive indicators could assist the nurses in this case in identifying issues that may interfere with patient care. Nursing-sensitive indicators are determinations used to delineate the excellence of nursing interventions and positive patient outcomes. This is not a new concept. In the 1800’s, Florence Nightingale, a promoter of outcomes, revealed such indicators when she revealed her statistical findings of soldier’s mortality rate associated to environmental conditions during the Crimean War (Fee & Garofalo, 2010). Over the past decades, various studies world-wide have been conducted on the connection of nursing quality indicators and their outcomes. The …show more content…
That being stated, if a patient must be placed on restraints, qualified professionals must have a comprehensive understanding of patient outcomes that correspond with the use of restraints. First and foremost, skin integrity is placed at risk if proper placement and management of patient care while in restraints is not implemented as with the case of Mr. J. There is numerous evidence based research studies conducted that correlate the use of restrains with an increase in pressure ulcers (Baumgarten, Margolis, Localio, Kagan, Lowe, Kinosian, Abbuhi & Abbuhi, 2010). Mr. J.’s daughter noticed a red mark on her father who then reported this to the nursing assistant and her concerns were immediately dismissed. If the nursing assistant was properly trained in the use of restraints and had knowledge of patient outcomes, this patient would not have developed a pressure ulcer. The nursing assistant should have immediately informed the nurse and measurements should have been taken to prevent further breakdown of the patient’s skin which was not done. It is evident in reading this case that Mr. J developed a Stage I pressure ulcer from being retrained in one position with no assessment or release for an undetermined amount of time. A second nursing-sensitive indicator that was clearly overlooked was patient satisfaction with overall care. Defined by the ANA, this is a measure of patient
By carrying out an assessment nurses can identify the causes of problems that require medical involvement. Nettina (2006)
However, only 10% of nurses actually complete accurate inspections of the skin during their initial physical assessments of the patients (Lahmann et al., 2010). As a result, patients who are at risk of developing pressure ulcers are often overlooked by nursing staff.
b. Restraints should be used as a last resort on patients that are at a high risk for hurting either themselves or others. If this particular hospital is found to be overusing their restraints, they should look into why this is happening and where it is happening most often. What is the patient to staff ratio? Are acuities being considered when staffing the unit? If restraints are being overused, maybe a shortage of staff could be to blame.
The negligence of this incident had a negative impact on the patient’s family members. Approximately 25% of cases involving medical negligence involve poor nursing care. Another negative aspect was patient’s family follow up was poor resulting in lack of importance highlighted on the pressure wounds. Ashley (2003) states nurses can be sued for malpractice, this means he or she is being sued for “negligence”. Furthermore, the nursing health professionals can lose its credibility among a community as they failed to provide a holistic care for the patient. However, a positive outcome was nurses were able to reflect among this evidence based practice to assist in better quality in patient
Not all patients are capable of independently identifying and articulate their care needs, so the nurse also adapts the role as an advocate. Clarity and continuity in a trusting environment enables good communication. Progressive identification of needs takes place as nurse and patient communicate with one another in the interpersonal relationship (Peplau 1988, p. 84). Being considerate to the needs and vulnerability of patients is a moral attribute, as nurses are accountable for the care they deliver.
A. Nurse sensitive indicators are factors that are directly impacted by nursing. There indicators fall into three categories; structure, process and outcomes of nursing care. The structure indicators are the organizational piece of nursing care. These relates to the amount of staff on duty at a given time, how many RN's are on duty and experience level of the staff. For example, evidence indicates institutions with a higher number of RN’s possessing a Bachelor Degree in nursing result in improved patient outcomes. The process indicators measure nursing care such as patient assessment, patient care and intervention. These are the organizational policies and procedures of nursing. The patient outcomes are indicators directly related to
The knowledge of nursing sensitive indicator can be helpful in providing the patient care which meets the quality and ethical standards. Nursing sensitive indicators rely on evidence to take patient care decisions (Patrician, 2010). According to Patrician (2010), Evidence Based Nursing is the use of personal expertise and research to take decisions on patient care. In case of Mr. J, there is a clear lack of evidence based nursing. Mr. J was kept in restraint without considering that Mr. J was not trying to get out of bed by himself. When the pressure ulcer was identified, the nurse
Pressure ulcers during a hospital admission are preventable. Assessment and early intervention can stop skin breakdown before it begins. Many factors regarding Mr. J’s condition placed him at a high risk regarding nursing indicators. Mild dementia, recent fall and a fractured hip all require a high level of nursing care and indicates preventative practice. Upon assessment, precautions should be in place to deter further complications. The elderly are more
are a nursing-sensitive indicator which can lead to patient dissatisfaction, maybe not realized by the patient with
By measuring nursing sensitive indicators hospital wide and collecting this information, quality patient care in hospitals can be advanced due to the administrators knowing which areas of practice nurses need to improve. All organizations, including hospitals have institutional cultures, these cultures can potentially have a positive or negative effect on desired outcomes. In the case of hospitals this would be the quality of patient care. If the institutional culture of nurses in the hospital promotes negligence in care, lack of respect for patient autonomy, or poor prioritization, the nursing sensitive indicators should reveal it as for example: negligent care would lead to higher rates of falls and complications acquired during the patient stay.
Any of these issues have the potential to extend the patients length of stay in the hospital. The restraints have the potential to make the patient more agitated, thus increasing his risk of injury. Understanding the nursing-sensitive indicators can greatly contribute to a better outcome for all patients.
The nursing supervisor has multiple issues to address in this scenario, the use of restraints and formation of a pressure ulcer are of a great concern, but I believe these are easily rectified with training and follow-up audits to ensure
with recommendations for changes needed in nursing. This was a response for the need to assess
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
Dr. Avedis Donabedian developed a model for categorizing and measuring the quality of healthcare providing a framework that conceptualized quality in broad terms and classification to measure and assess different aspects of quality in nursing care (Sollecito & Johnson, 2013). In the footsteps of Donabedian’s framework, Dr. Beatrice Kalisch developed a model conceptualizing missed nursing care otherwise known as “unfinished nursing care” or “care left undone”. Missed nursing care as defined in the Missed Nursing Care Model is any aspect of required patient care that is omitted, either in part or whole, or delayed (Kalisch, Landstrom, & Hinshaw, 2009). The structural aspects Kalisch’s model include labor resources, nursing staff, competency level of staff, education and experience, material resources, teamwork and communication. Kalisch model indicates that nurses with recent restricted resources in the nursing process determining clinical priorities is costly making decisions either to delay or omit certain care and is heavily influenced by team perception, nurse judgment, ("Missed Nursing Care AHRQ," 2015).