Nursing sensitive indicators allow facilities to determine the link between patient outcomes and the nursing care the facility provides. Initially, the American Nurses’ Association developed three categories for Nursing Sensitive Indicators. First, the process of care, which determines nurse satisfaction and daily completion of assigned tasks. Second, the structure of care, which is the education, skill, certification and experience of the nurses at the facility.
Third, is patient focused outcomes, which include the overall care of the patients and frequency of hospital acquired infections, pressure ulcers, falls, restraint use, etc… (American Sentinel University Blog, 2011). Nurses who are knowledgeable about NSI’s are more likely to have better job satisfaction, healthier patients and better overall outcomes and satisfaction scores. In regards to the scenario, there are several NSI’s that if they had been addressed earlier, would have prevented many unfavorable outcomes. Mr. J. was restrained in this scenario. The reason why was not explained, but after a trip to the bathroom, the CNA placed Mr. J. on his back, in the same position, and re-applied the restraints.
If the nurse had a better understanding of NSI’s, she would have completed a thorough skin assessment of the patient and realized the pressure ulcer that was beginning to develop and take action. The patient needed to be turned more often and special attention paid to the reddened area on his spine. Also, the restraint use needed to be re- assessed. Did the patient require continued restraint use? Was the patient repositioned and checked while bound by the restraints? Could the patient reach his call light? Was his daughter informed of why her father was in restraints?
These are all questions that need to be answered to show a better understanding of NSI’s and prevent unneeded restraint usage, pressure ulcers, falls and improve overall patient satisfaction. If the nurses in the facility in this scenario had an understanding of how the NSI’s reflected on their performance as a nurse and the overall patient satisfaction and outcome, the patient in this scenario could have had a more pleasant, shorter stay in this facility. The comment about the wrong diet and delivery of food to the patient was unnecessary and unprofessional.
An experienced nurse would understand that respecting a patient’s religious and diet preferences plays an important role in the overall satisfaction of the patient’s stay in the hospital. If the patient feels like their requests are not met, sometimes they can see that as neglect or lack of care by the nurse and the hospital. Understanding and implementing the Nursing Sensitive Indicators in the workplace can help nurses identify any issues that could interfere with patient care. Thus, improving patient outcomes and satisfaction scores.
A hospital having higher satisfaction scores will also receive the amount of reimbursements they deserve for providing proper care to the patients in their community. B. How Hospital Data Could Advance Quality Care Today, all hospitals are always collecting data on every patient and any events that occur during their stay. For example, the prevalence of pressure ulcers during a hospital stay is important data that could be collected and distributed to staff. All staff could attend an in-service discussing trends in wound care and prevention, posters could be displayed in break rooms and on the units discussing how to treat and prevent pressure ulcers. During these same in-services, restraint use could be discussed.
Proper usage of restraints can easily be linked with skin care of the patients. There is an abundance of technology in the medical field, and nurses have access to it all. The more education the staff nurses receive on proper assessment and prevention of pressure ulcers, restraint use and all other NSI’s, will be beneficial for the improvement of patient care throughout the hospital. Education is the key to empower nurses to give better care to their patients. C. Resources Available There are numerous resources in every hospital for a nurse to use to address the issues in this scenario.
Dietary would need to be consulted to make sure Mr. J. receives the proper diet. The nurse who made the comment about the wrong food being delivered needs to be educated on the importance of a patient’s dietary requests and on how to be more professional in her comments. The patient and their family deserve an apology from that nurse for her comments. The need for and use of restraints could be discussed with the physician. The nurse manager/director is also an excellent resource for deciding how to better educate staff on how to make sure patients are receiving the best care possible at our hospital.
The CNA is an extra pair of eyes for the nurse and would benefit from additional education about pressure ulcers and restraint usage. PT can be consulted to help create a schedule to keep the patient repositioned. A lift team, if available and needed, can assist in repositioning the patient according to schedule. The Chaplain can be consulted to talk with the patient to ensure their religious needs are being met. The wound care nurse could assess the patient’s skin and decide, along with the doctor, how to treat the possible pressure ulcer.
A referral to a social worker to plan for care after discharge could also be utilized. The resources available at most hospitals are numerous, and sometimes, not used enough. All nurses should be educated on what resources are available to them and their patients. Using the resources listed above would help resolve the ethical issues in this scenario. References American Sentinel University Blog (2011, November 7). What are nursing sensitive indicators anyway? Retrieved from http://www. americansentinel. edu/blog/2011/11/02/what-are-nursing- sensitive-quality-indicators-anyway/.