RTT 1- Task 1
Michael Jackson
Western Governors University
Nursing-Sensitive Indicators
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
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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
Developing positive relationships is important within most situations in life, a good way of ensuring these positive relationships progress is to ensure you have effective communication. When working with children if you complicate things it can lead to the child becoming confused as to what is expected of them. Make sure the language that you use is age appropriate to avoid confusion. You may be able to see if the child has understood your request by either checking that your instructions have been carried out or simply by asking the child "do you understand?" and asking them to relay back what you have asked. Communication is a two way thing and to have a positive relationship with somebody you will also
Quality improvement issues in healthcare focus on the care that patients receive and the outcomes that patients experience. Nurses play a major advocacy role for ensuring safe and quality care to all patients. Also, nurses share the responsibility in leading the efforts in improving patient care in all settings (Berwick, 2002). One of the ongoing problems plaguing hospitals and nursing homes is the development of new pressure ulcers in patients after admission. A pressure ulcer can be defined as a localized area of necrotic tissue that is likely to occur after soft tissue is compressed between a bony prominence and a surface for prolonged periods of time (Andrychuk, 1998). According to the Centers for Medicare and Medicaid,
Mulloy, D. F., & Hughes, R. G. (2008). Patient safety & quality: an evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from http://www.nlm.nih.gov/books/NBK2678/
The healthcare systems of Switzerland and the United States are quite similar in some aspects and vastly different in others. In Switzerland, the healthcare is universal and available to all. It is provided by private individual insurance companies and subsidized by the government when needed. Basic health insurance is required to be purchased within 3 months of residency or after birth and is an individual’s choice as to what carrier they choose. Of course, there are exceptions to this mandate but they are very few.("Healthcare in Switzerland," “n.d.”, para. 1) Because of this requirement, 99.5% of the population in Switzerland has
Fortunately, according to Chan et al., (2008), 95% of pressure ulcers can be prevented and nursing care is believed to be a primary method of preventing pressure ulcer development. Research was conducted on accredited search databases such as CINAHL, Nursing Resource Center and OvidSP on prevention measures for pressure ulcers. A number of credible evidence based research was found that supported the nursing intervention of
Nursing sensitive indicators reflect the structure, process and outcomes of nursing care. The structure of nursing care is indicated by many factors such as supply of staff, education level and quality of care provided. Process indicators measure aspects of nursing care such as assessment, intervention, and RN job satisfaction. Patient outcomes that are determined to be nursing sensitive are those that improve if there is a greater quantity or quality of nursing care (Nursing world, 2013). In 1999, the American Nursing Association recognized a total of 10 indicators that apply to hospital based nursing care (Americansentinel.edu, 2017). Indicator such as pressure ulcers, patient falls and nosocomial infections are recognized in this list and are considered preventable with proper nursing action. Knowledge of these indicators could have assisted the nurses in several ways involving this case study involving Mr. J.
are a nursing-sensitive indicator which can lead to patient dissatisfaction, maybe not realized by the patient with
Take each bag of popped popcorn and count the individual kernels that did not pop and record the data on the chart. Perform this for each
Now, the quality improvement department will need to determine what processes can be modified to improve outcomes. For example, if they see an increase in pressure sores and prevalence of restraints. They could use computerized charting and order entry, along with the evidence-based guidelines, to identify specific groups of patients who are vulnerable to developing pressure ulcers or closely monitoring use of restraints. With early identification, automatic orders for preventive interventions can be implemented quickly. With the assistance of the automated consults and orders, the appropriate equipment, the interdisciplinary task force, continuing education, and monitoring, the hospital system would be able to reduce unnecessary use of restraints and hospital-acquired pressure ulcer prevalence rate (Cherry & Jacob, 2010).
Type of event, training, or exercise: (actual event, table top, functional or full-scale exercise, pre-identified planned event, training, seminar, workshop, drill, game, etc.)
mitigate these points assessments will be made in how to best mitigate the failure and what would need to be done to
Nightingale Community Hospital is a 180-bed acute care hospital that is a not-for profit entity. The hospital is community based and provides leadership in quality health services in which they provide. Their vision is to be the hospital that people choose, the place employees, physicians and volunteers want to work and a hospital of choice for the community. They are committed to providing a healing environment to their patients with a compassionate commitment to healthcare excellence.
20). Further, the presence of pressure ulcers places a burden on patients and their family (Grinspun, 2005, p.21). As recommended by Grinspun (2005), pillows and foam wedges to separate prominences of the body and lifting devices have been beneficial to avoid friction (p. 32). Research suggests that the majority of pressure ulcers can be avoided. Although, the population at risk likely suffers from the possible contributors, as stated repositioning at least every 2 hours or sooner was effective (Grinspun, 2005, p. 32). When practicing I will reposition patients at appropriate times to reduce the risk of damage to the skin. Additionally, when moving a patient up in bed, I will request adequate assistance from other nursing staff to use a lifting device. This will help to avoid friction while the patient is being moved, ultimately reducing the development of pressure
Studies have pointed out that nurses possess a significant role and extensive knowledge in pressure ulcer prevention. Instructive programs in the hospitals give great learning to nurses about the preventive and treatment techniques for
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.