The nursing process is a decision-making tool that can be used by nurses in any situation. Nurses are expected to use the nursing process when caring for patients. The cyclic nature of its components of assessment, diagnosis, planning, implementation and evaluation creates a standard for quality patient care. It is very important that nurses evaluate the outcome of their nursing interventions. By doing such, one can be assured of the effectiveness of nursing interventions.
Defining and measuring quality of care are essential for health care providers to demonstrate accountability to insurers, patients, and legislative and regulatory bodies ( Marquis & Huston, 2009). Nursing sensitive outcome indicators are intended to draw correlations between nursing interventions patients have received and their resulting health status (International Council for Nurses, 2010). By using nursing sensitive indicators, one can assess the progress of a patient’s condition as well as evaluate the quality of care.
In the situation presented, there are numerous nursing sensitive indicators that should have been noticed by the health care providers. If these indicators were given attention, the patient would not develop other complications that may impede his/her healing. Mr. J’s developing pressure ulcers resulted from decreased blood flow in the area and skin friction against the beddings. This could have been prevented by nurses if there was regular body turning and prevention of severe skin friction. Use of restraints should also be monitored in the scenario.
Hospital policy regarding the use of restraints should have been considered. According to the case, the patient was slightly sleepy and can recognize his daughter. The Joint Commission on the Accreditation of Health care Organization (JCAHO) generally require the restraint to be used for only a specified period of time. Mr. J’s restraints should have been only applied in a certain period of time and his condition should have been reassessed by a physician so as to determine the need for further restraints.
Health care providers should also build rapport with patients and their relatives. They should take time to listen to their concerns and attend to it. In the situation, clearly, the health care providers ignored Mr. J’s daughter’s inquiry about his pressure ulcers. The nursing staff as well as their colleagues in health care should also be considerate upon the cultural beliefs of the patient. In this case, Mr. J’s diet regimen should have been strictly followed and any mistakes should be addressed to the relatives. The mistake regarding Mr.
J’s accidental ingestion of the wrong diet should have been related to the relatives to show respect and acknowledgement of the mistake. In this case, after the incident, the daughter was not informed by the nurse. The nurse also did not apologize and made an inappropriate remark. If the nursing staff took into understanding the importance of nursing sensitive indicators, quality health care could have been achieved and complaints could not have been raised. Achieving quality health care in a facility requires great effort from the whole health care team.
Measurement of health care quality is a challenging task. To make the process more effective and efficient, the collection of both quantitative and qualitative data is used as well as a specific and systematic process (Marquis ; Huston, 2009). Gathering hospital data on specific nursing sensitive indicators is one step in the quality control process. It is an important step to achieve the whole course of quality control. Nursing sensitive indicators are used as criteria to assess the quality of nursing care rendered in the hospital.
The presence of pressure ulcers among bed-ridden patients could be considered as poor nursing management. The use of restraints in accordance to the hospital policy could serve as a criterion in doing process audit that can identify if there are deviations from accepted best practice process standards. According to Bennet, research by Heater, Becker, and Olsen suggest that patients who receive care based on evidence from well-designed studies have nearly 30% better outcomes (Marquis ; Huston, 2009).
Bennett suggests that “evidence-based practice, a problem solving approach to using best evidence in making decisions about patient care, is no longer an option for staff nurses. Patient care must be based on evidence of optimal outcomes” (Marquis ; Huston, 2009). If a structure approach to problem solving is used, data gathering is adequate and multiple alternatives are analyzed even with a poor outcome, the manager should accept that the best possible decision was made at that time with the information and resources available (Marquis ; Huston, 2009).
The nursing supervisor should use problem-solving approach in facing the ethical issue. Jormsri posits that using collaboration and integrating the knowledge and training of various professionals when solving ethical problems will lead to more effective problem solving (cited in Marquis ; Huston, 2009, p. 86). One thing the nursing supervisor could do is to collaborate with colleagues involved in the scenario. One should talk to the hospital administrator to verify the complaint and to assure him/her that the issue is to be attended.
Another collaboration should be made between the nursing staff and the dietary department. The nursing supervisor should remind the nurses to strictly follow and monitor patients’ diet regimen, especially those with religious or cultural preferences. Lastly, the complainant should be addressed with utmost apology and an assurance that better health care would be provided. One should assure the daughter that evaluation of the quality of care rendered would be done. The nursing supervisor could conduct concurrent audits that can help assess if there would be changes in the nursing care.
This could also help the nursing supervisor to decide what improvements to do on the nursing care system. Unit policies could also be created and implemented to further deliver quality nursing care. References International Council of Nurses (ICN) (2010, May) Nursing Sensitive Outcome Indicators. Retrieved May 18, 2010 from http://209. 61. 232. 65/matters_indicators. html Marquis, B. L, & Huston, C. J. (2009) Leadership Roles and Management Functions in Nursing. Philadelphia, PA: Wolters Kluwer Health/ Lippincott Williams & Wilkins.