Understanding of nursing quality indicators

Understanding of nursing quality indicators
Nursing quality indicators are instruments used to determine the quality of healthcare by identifying faults or mistakes in the nursing process. They are a critical part of the establishment of evidence-based practice standards. It is an ethical requirement to measure these indicators, in an effort to evaluate and enhance the quality of nursing profession. Silveira et al. (2015) explain that nursing quality indicators “can be used as a guide for monitoring and evaluating care and the activities of a service.” There are three major aspects of nursing that are considered when establishing the quality indicators. These are the structure, the process, and the outcomes (Silveira et al., 2015). In this scenario, the most applicable nursing quality indicator is the process indicators. Process indicators measure the methods of assessing patients and administering nursing interventions.

In this scenario, pressure ulcer prevention is one of the most significant process indicators. The timely measurement and evaluation of this indicator is critical in identifying issues that may interfere with patient care such as the development of a pressure ulcer which comes with additional treatment regimen. The registered nurse can apply process quality indicator by performing a risk assessment for developing pressure ulcers for Mr. J. being a geriatric patient, there is a high risk of developing pressure sores, which can be confirmed using the Braden and the Norton scales (Lee et al., 2019). Braden scale helps nurses predict the risk for developing pressure ulcers by assessing the following major areas: sensory perception, moisture, activity, mobility, nutrition, and friction and tear. A higher score translates to lower risk for pressure ulcers and vice versa. The Norton scale also uses five criteria: physical condition, activity, mobility, mental condition, and incontinence to establish the risk of pressure ulcers in patients. Additionally, the registered nurse can develop an individualized plan for preventing the sores (Lee et al., 2019). This can include two-hourly turning of the patient, and regular monitoring of the pressure ulcer areas. The patient can be provided with alternating pressure mattress which have a significant effect in preventing pressure sores.

Advancing quality patient care

Hospital data regarding process and outcome indicators are useful in developing better strategies to achieve quality patient care. The indicators detect sub-standard care in the nursing process or outcome, and inform the necessary improvements that can be made to ensure quality healthcare. The data obtained from these indicators inform the management of the areas they should put in more effort, such as the staffing and supervision. It also provides information on the degree to which particular nursing interventions are administered. According to Kottner et al. (2018), regular monitoring of healthcare quality contributes to higher hospital transparency to physicians, other hospitals and patients. In this scenario, the data on nursing quality indicators include the incidence of pressure ulcers and the prevalence of restraints.

Through effective communication strategies between the staff and management, quality indicators can be implemented effectively and lead to better patient outcomes (Amestoy et al., 2019). Communication among staff, through proper documentation, can also lead to better patient care. Proper documentation of nursing interventions prevents mix-up and miscommunications among the different teams providing health care to the patient (Amestoy et al., 2019). In this scenario, the mix-up on patient’s diet was probably due to failure to confirm the actual documentation and implement the orders. Using the data on incidence of pressure ulcer sores, the management can organize quality improvement initiatives such as continuous medical education programs and simulation trainings to equip the nursing staff with the necessary knowledge and skills for prevention of pressure ulcers in patients. The certified nurse assistants can benefit from the trainings on how to prevent pressure ulcers, and implement the relevant instructions. Other studies have confirmed the effect of regular monitoring of quality indicator data to enhance quality improvement, hence patient care (Aestoy et al., 2019).

From the scenario, it is evident that the nurse does not take accountability for the incidence of the diet mix-up. She responds, “half a pork cutlet never killed anyone”. This further indicates that she does not seriously regard patients religious and cultural beliefs. Ideally, she should have apologized. Therefore, as part of the training, it is important to stress the significance of respecting the patient’s beliefs and honoring their wishes. This contributes to patient satisfaction, which is one of the quality indicators, and directly affects the hospital.

Resolution of ethical issues

The ethical principle that has been violated in this scenario is beneficence. This principle obligates healthcare providers to be kind and perform their actions in the best interest of the patient (Ganz, Wagner & Toren, 2015). In this scenario, the nurse was not remorseful even after learning that there was a mix-up in the diet of the patient, and goes ahead to throw it in his face that “half a pork cutlet never killed anyone.” This is despite the knowledge of the Jewish culture that forbids them to take pork. As a nursing supervisor, I would, follow up with the kitchen supervisor to ensure that whoever served the meal is summoned. Together with the nurse who was on shift at the time of the incidence, I would then let them know the mistake they did, and the repercussions that should follow them. This would be the first verbal warning to this staff regarding the incidence, since it is a grievous mistake. To make peace with the patient, the nurse would have to apologize for crossing their religious boundaries in that manner.

References

Báo, A. C. P., Amestoy, S. C., Moura, G. M. S. S. D., & Trindade, L. D. L. (2019). Quality indicators: tools for the management of best practices in Health. Revista brasileira de enfermagem, 72(2), 360-366.

Ganz, F. D., Wagner, N., & Toren, O. (2015). Nurse middle manager ethical dilemmas and moral distress. Nursing ethics, 22(1), 43-51.

Kottner, J., Hahnel, E., Lichterfeld‐Kottner, A., Blume‐Peytavi, U., & Büscher, A. (2018). Measuring the quality of pressure ulcer prevention: A systematic mapping review of quality indicators. International wound journal, 15(2), 218-224.

Lee, Y. J., Kim, J. Y., Dong, C. B., & Park, O. K. (2019). Developing risk‐adjusted quality indicators for pressure ulcers in long‐term care hospitals in the Republic of Korea. International wound journal, 16, 43-50.

Silveira, T. V. L., Prado Júnior, P. P. D., Siman, A. G., & Amaro, M. D. O. F. (2015). The importance of using quality indicators in nursing care. Revista gaucha de enfermagem, 36(2), 82-88.

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