Quality in nursing is an important aspect of care that has a major impact on patient outcomes. Evaluating the quality of nursing care serves to identify how nurses perform in various areas of quality and processes that can be used to improve service delivery to patients. Nursing-sensitive indicators identify structures and care processes that determine patient outcomes (Lockhart, 2018). These outcomes are defined in the nurses’ scope and standards of practice and emphasized in the code of ethics. For instance, the code of ethics requires nurses to promote, advocate, and strive to protect the health, safety, and rights of patients. Ensuring the prevention of patient falls, pressure ulcers, restraint rates, and physical assault demonstrates quality in nursing (Moorhead et al., 2018). This discussion analyzes the application of nursing quality indicators in Mr. J’s case and how his care can be advanced throughout his hospital stay.
Understanding of Nursing Quality Indicators
Nursing quality indicators are distinct and specific to the nursing profession because they focus on the nursing activities that influence patient outcomes. An example is the number of nursing hours spent on a patient and how this impacts quality service delivery (Moorhead et al., 2018). The identified case study highlights some areas in nursing care that are faulty and how they impact the overall outcome of Mr. J. Pressure ulcers have long been used as quality indicators of nursing care because they depend on nursing activities like turning and pressure area care. When patients develop pressure ulcers during hospitalization, their outcomes are impaired and they may suffer increased costs, decreased quality of life, and prolonged hospitalization. The recognition of pressure ulcers as a measure of quality can help nurses plan for proper care of Mr. J. In the identified case, the nurse fails to recognize the effect the pressure area Mr. J has on his lower spine could have.
Restraining a patient is considered a high-risk intervention by many international agencies because of its effect on patients. For example, the Joint Commission and the Centers for Medicare & Medicaid Services require nurses and other healthcare providers to carefully assess and document the patient’s condition during restraint application (American Nurses Association (ANA), 2015). According to the description given in the case, Mr. J appears to be calm and cooperative. Although he has dementia, the patient’s behavior does not seem violent enough to require the use of restraints. Restraining the patient is definitely the reason why he has developed a pressure ulcer on his lower spine. While on restraints, the patient ought to have been turned from side to side and given regular breaks from the restraints to avoid staying in one position.
Registered nurse education/certification is a structural quality indicator that determines how nurses behave during care delivery and the impact of decisions they make. Nurses are supposed to possess knowledge on how to communicate care, solve a conflict, and provide culturally-competent care to patients (Moorhead et al., 2018). In the provided case, the nurse supervisor and the certified nurse assistant (CNA) demonstrate a poor understanding of cultural competence and its application during care delivery. Mr. J is a Jewish whose religious rights do not accept taking pork. With respect to these values, the nurse supervisor and CNA should have ensured he was served a proper meal and his daughter was informed about the error leading serving of pork. Cultural and linguistic differences can result in miscommunication and service user mistrust as observed in the case (Jongen et al., 2018). The nurse was also rude when stating that a half pork cutlet cannot kill someone and this indicates disrespect to the cultural beliefs of the patient.
Advancing Quality Patient Care
Healthcare data on certain quality indicators can help providers to make important decisions that can affect patient outcomes. The information on pressure ulcers can help nurses to know the patients at risk of developing the condition, the early signs of the condition, and interventions to address the healthcare issue (ANA, 2015). The CNA fails to recognize that the red depressed area on the patient’s spine is an indicator of a pressure ulcer and only thinks that it can go away as soon as the patient gets up. Hospital data on the use of restraints can help healthcare providers to assess patients for the need for restraints and understand its effects on patients like the elderly (Moorhead et al., 2018). Having data on the use of restraints could help the nurse know the number of days to restrain a patient, when to give intermittent breaks, and how to assess for effects like pressure ulcers that come with restraining patients for long.
Resolution of Ethical Issues
During care delivery, the nurse should be a proactive team player, focused on the result, compassionate with the patient, and wholly involved in the therapeutic process. The nursing shift supervisor should review the code of ethics to offer guidance to their professional behavior in this situation. For example, working with integrity will ensure the nurse is honest and accepts their mistakes. The nursing shift supervisor should involve Mr. J and his daughter in deciding the most effective course after realizing that there was a mix-up in serving meals. Another resource that I would use is the head of religious practices in the hospital to elaborate on the issue of eating pork. This individual is in a better position to explain to the nurse and the patient’s daughter the effects of going against the Jewish tradition of not eating pork.
American Nurses Association. (2015). Assessing and documenting patient restraint incidents. https://www.myamericannurse.com/assessment-documentation/
Jongen, C., McCalman, J., & Bainbridge, R. (2018). Health workforce cultural competency interventions: A systematic scoping review. BMC Health Services Research, 18(1), 232. https://doi.org/10.1186/s12913-018-3001-5
Lockhart, L. (2018). Measuring nursing’s impact. Nursing Made Incredibly Easy, 16(2), 55. doi: 10.1097/01.NME.0000529956.73785.23
Moorehead, S., Swanson, E. A., Johnson, M., & Maas, M. (Eds.). (2018). Nursing outcomes classification (NOC): Measurement of health outcomes. Elsevier.
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