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Task 1: Nursing-Quality Indicators
National initiatives driven by the American Nurses Association have determined nursing-quality 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-quality 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.
Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. Use the Turnitin Originality Report available in Taskstream as a guide for this measure of originality.
You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.
Analyze the scenario (suggested length of 2–3 pages) by doing the following:
- Discuss how the application of nursing-quality indicators could assist the nurses in this case in identifying issues that may interfere with patient care.
- Analyze how hospital data of specific nursing-quality indicators (such as incidence of pressure ulcers and prevalence of restraints) could advance quality patient care throughout the hospital.
- Analyze the specific system resources, referrals, or colleagues that you, as the nursing shift supervisor, could use to resolve an ethical issue in this scenario.
- Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.
- Demonstrate professional communication in the content and presentation of your submission.
A. Discuss how the application of nursing-quality indicators could assist the nurses in this case in identifying issues that may interfere with patient care.
The patient (i.e., Mr. J) in the presented scenario was evidently restrained in bed and affected with red skin depression over the lower spine. Restraint and seclusion prevalence vary reciprocally with the patient age, mental health, and safety requirements. Rational utilization of this nursing quality indicator assists the nurse professionals in terms of reducing the intensity of psychological and physical in the treated patient (Pogge, Pappalardo, Buccolo, & Harvey, 2013). The presented scenario indicates the incapacity of the treated patient in terms of undertaking the bathroom activity because of the sustained application of restraint across the bed. The nurse professional in the presented case could have correlated patient's difficulty in undertaking activities of daily living (ADL) with the irrational utilization of restraint. The careful assessment of the restraint requirement is based on evaluating the healthcare burden and safety-risk for the treated patient. The dementia patient in the existing scenario did not reportedly exhibit any suicidal or homicidal tendency. Therefore, the restraint requirement required systematically assessment by the treating nurse with the objective of evaluating the patient care barriers. Patients who exhibit aggressive activities are usually restrained in bed because of safety considerations (Beghi, Peroni, Gabola, Rossetti, & Cornaggia, 2013). The elderly patient in the presented scenario did not exhibit any such complication. This resultantly confirms the irrational use of restraint that could have challenged by the treating nurse for reducing the extent of patient's suffering in the hospital. The sustained utilization of restrictive devices elevates the risk of patient injury that proves to be the greatest safety concern for the treated patient (Kirk, McGlinsey, Beckett, Rudd, & Arbour, 2015). The nurse professional in the presented scenario could have evaluated this safety concern and attained approval for restraint elimination with the objective of facilitating patient's movements as well as activities of daily living and personal care.
Nosocomial pressure ulcer is regarded as a significant quality indicator in relation to the measurement of patient outcomes in nursing practice (Xue, Aiken, Freund, & Noyes, 2012). Pressure ulcer substantially increases the healthcare burden for the treated patient in the hospital setting. The development of a pressure ulcer during the hospital stay increases the discharge time and follow-up visits that considerably elevate the patient care cost and increase the risk of patient's disability and mortality (Nuru, Zewdu, Amsalu, & Mehretie, 2015). Therefore, the nurse professional in the presented clinical scenario could have evaluated patient's skin lesion to ascertain its ulcer origin and identified the risk of skin infection. Eventually, appropriate ulcer treatment interventions could have been configured with the objective of minimizing the risk of skin complications.
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