The structure, processes, and outcome factors of nursing care are reflected in Nursing-Sensitive Indicators (NSIs). There are several things that the nurses in the provided scenario could have done to promote quality patient care. By being aware of restraint use as an NSI the hospital staff would be more likely to increase their focus and attention to its need and any development of complications. This increased focus and attention could have led to the development of educational opportunities for the hospital staff on the identification of pressure ulcer related complications. Had the nurse and nursing supervisor been aware of patient/family/caregiver satisfaction as an NSI they may have reacted differently in the situation. According to the physician in the scenario, there have been multiple complaints by Jewish patients about the disregard for their dietary requests. Having this data and information available can aid in developing and educational session for hospital staff including dietary workers, nurses, and certified nursing assistants about the importance of respecting patient’s cultural requests.
It is possible that some of the problems identified in the scenario were a related to the structure of the system and a result of inadequate staffing, educational, or experience levels. Being able to collect data on these NSIs can aid in identifying issues within this organization structure and make appropriate changes to ensure better quality patient care outcomes. For example, some issues may be related to there not being an adequate number of nursing on the unit. Collecting relevant data would help to identify this as an issue, possibly a recurring issue, which would lead to the assigning of more nurses to that particular unit.
Quality Patient Care
Nursing-sensitive indicators can provide data to help identify needs and diminish risks. Part of the reason why nursing-sensitive indicators are used is to be able to make changes and adjustments to policies and procedures of a hospital, if necessary. Quality patient care can be advanced in this situation by collecting data on specific nursing-sensitive indicators. Data on the prevalence of restraint use and consequential complications (e.g. pressure ulcers, contractions, anxiety, incontinence, and other complications) can aid in maintaining awareness of risks and allowing the nurse to take proper steps to limit their occurrence.
Data on patient/family/caregiver satisfaction can help illustrate whether the quantity and quality of nursing care needs to be improved. Data on nursing satisfaction and staffing can help to assess whether changes need to be made to staffing numbers, whether more experienced nurses are needed, whether more educational opportunities are need for the hospital staff, for example.
System Resources, Referrals, or Colleagues
There are a few ethical issues that in the provided scenario which need addressing from the nursing shift supervisor. The first occurs when the Certified Nursing Assistant (CNA) fails to appropriately address the possibility of a developing pressure ulcer. A wound care team can be consulted about developing an educational program about pressure ulcers for hospital staff. Also, there is the issue of restraints. The ordering physician should be contacted about the necessity of restraint use. Along with the wound care team, data could be collected about the use of restraints and the subsequent development of pressure ulcers. In the scenario, the patient was not served a “kosher” diet as the order indicated. The physician could be contacted to illicit more information about the several dietary complaints. The hospital administrator can, also, be contacted to inquire about any other dietary complaints before contacting the kitchen supervisor. The hospital ethics committee is a valuable resource when a need for education arises. The daughter was not told of the dietary mistake and was later inadvertently informed by a dietary worker. Members of the Ethics committee may be able to conduct an educational session for hospital workers about being patient advocates.