National initiatives driven by the American Nurses Association have determined nursing-sensitive outcome indicators that are intended to focus plans and programs to increase quality and safety in patient care. The following outcomes are commonly used nursing-sensitive indicators:
• Complications such as urinary tract infections, pressure ulcers, hospital acquired pneumonia, and DVT
• Patient falls
• Surgical patient complications, including infection, pulmonary failure, and metabolic derangement
• Length of patient hospital stay
• Restraint prevalence
• Incidence of failure to rescue, which could potentially result in increased morbidity or mortality
• Patient satisfaction
• Nurse satisfaction and staffing
Mr. J is a 72-year-old retired rabbi with a diagnosis of mild dementia. He was admitted for treatment of a fractured right hip after falling in his home. He has received pain medication and is drowsy, but he answers simple questions appropriately.
A week after Mr. J was admitted to the hospital, his daughter, who lives eight hours away, came to visit. She found him restrained in bed. While Mr. J was slightly sleepy, he recognized his daughter and was able to ask her to remove the restraints so he could be helped to the bathroom. His daughter went to get a certified nursing assistant (CNA) to remove the restraints and help her father to the bathroom. When the CNA was in the process of helping Mr. J sit up in bed, his daughter noticed a red, depressed area over Mr. J’s lower spine, similar to a severe sunburn. She reported the incident to the CNA who replied, “Oh, that is not anything to worry about. It will go away as soon as he gets up.” The CNA helped Mr. J to the bathroom and then returned him to bed where she had him lie on his back so she could reapply the restraints.
The diet order for Mr. J was “regular, kosher, chopped meat.” The day after his daughter arrived, Mr. J was alone in his room when his meal tray was delivered. The nurse entered the room 30 minutes later and observed that Mr. J had eaten approximately 75% of the meal. The meal served was labeled, “regular, chopped meat.” The tray contained the remains of a chopped pork cutlet.
The nurse notified the supervisor, who said, “Just keep it quiet. It will be okay.” The nursing supervisor then notified the kitchen supervisor of the error. The kitchen supervisor told the staff on duty what had happened.
When the patient’s daughter visited later that night, she was not told of the incident.
The next night, the daughter was present at suppertime when the tray was delivered by a dietary worker. The worker said to the patient’s daughter, “I’m so sorry about the pork cutlet last night.” The daughter asked what had happened and was told that there had been “a mix up in the order.” The daughter then asked the nurse about the incident. The nurse, while confirming the incident, told the daughter, “Half a pork cutlet never killed anyone.”
The daughter then called the physician, who called the hospital administrator. The physician, who is also Jewish, told the administrator that he has had several complaints over the past six months from his hospitalized Jewish patients who felt that their dietary requests were not taken seriously by the hospital employees.
The hospital is a 65-bed rural hospital in a town of few Jewish residents. The town’s few Jewish members usually receive care from a Jewish hospital 20 miles away in a larger city.
Analyze the scenario (suggested length of 2–3 pages) by doing the following:
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.
B. Analyze how hospital data on specific nursing-sensitive indicators (such as incidence of pressure ulcers and prevalence of restraints) could advance quality patient care throughout the hospital.
C. Analyze the specific system resources, referrals, or colleagues that you, as the nursing shift supervisor, could use to resolve the ethical issue in this scenario.
D. When you use sources to support ideas and elements in a paper or project, provide acknowledgement of source information for any content that is quoted, paraphrased or summarized. Acknowledgement of source information includes in-text citation noting specifically where in the submission the source is used and a corresponding reference, which includes:
• Location of information (e.g., publisher, journal, or website URL)
Nursing Sensitive Indicators
One of the major roles of a nursing professional is to ensure that patients receive comprehensive care. Nurses have a role of ensuring that they provide quality health care to their patients as per the hospital guidelines. Similarly, nurses must observe the ethical guidelines while making critical decision and when administering care. From the case study, it is evident that the management was unable to identify the importance of patient satisfaction in administration of various services. Lack of provision of quality services in the patient management system is an indicator of failure and incompetence on the part of management.
According to Montalvo (2007), a crucial role of the nursing sensitive indicators is to ensure that patients receive quality care and that the nursing outcomes are positive. In line with this, they ensure that patients give a higher satisfaction rating for the services provided and spend less time in the hospital. If the nurses had adhered to all the nursing sensitive indicators while examining Mr. J, the situation would have been better – as it is clear that the professionals did not take into consideration the varied needs of Mr. J. From the case study, the nurses employed restraints to put Mr. J under control owing to his dementia. Worse still, the nurses failed to provide Mr. J. the required attention. For instance, Mr. J. had to await his daughter in order to communicate to the nurses that he wished to visit the washroom. Mr. J was able to give verbal instructions to his daughter, meaning that he could be able to communicate to the nurses and express his wish had they been giving him close attention.
The red depression on the patient’s lower side of the side could also have acted as a sensitive indicator. This depression was a clear indication that Mr. J had developed a pressure ulcer due to maintain the same posture over a protracted period. Worse still, after helping him access the washrooms, the nurse lay the patient on the same posture as before. She was keener on reapplying the restraints instead of making sure that Mr. J felt comfortable. In addition, the nurse should have removed the restraints and allowed the patient some movement, albeit with close supervision. The patient’s food tray comprised of pork cutlet among other items. This is despite Mr. J being Jewish; whose members avoid consuming pork as a religious belief. The nurse included a cutlet of pork in his tray, which shows some degree of irresponsibility on her part. The nurse also ignored Mr. J’s daughter when she inquired about the food, which indicates arrogance and insensitivity towards other people’s feelings.
A number of resources, referrals, or colleagues can be used to resolve the ethical issue in this scenario. Cooperation of the different practitioners within the health facility can be important in resolving the ethical issue (Ulrich et al., 2010). For instance, the nursing in charge could cooperate better with the kitchen supervisor to ensure that there were no diet errors. With regard to the certified nursing assistant, it is important to ensure that she performs crucial functions such as ensuring that all patient needs are addressed. There is need to inculcate professionalism among all nurses when performing their duties to ensure that patient outcomes are achieved. There is need for the kitchen supervisor to ensure that he/she counterchecks the patient’s dietary requirements with that provided. This can reduce cases of a mix-up of the patient orders.
Montalvo, I. (2007). The National Database of Nursing Quality Indicators® (NDNQI®). Retrieved June 10, 2016, from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No3Sept07/NursingQualityIndicators.html
Ulrich, C. M., Taylor, C., Soeken, K., O’Donnell, P., Farrar, A., Danis, M., & Grady, C. (2010). Everyday Ethics: Ethical Issues and Stress in Nursing Practice. Retrieved June 10, 2016, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865804/