Nursing-sensitive indicators are defined by the American Nurses Association as indicators that “reflect the structure, process and outcomes of nursing care. The structure of nursing care is indicated by the supply of nursing staff, the skill level of the nursing staff, and the education/certification of nursing staff” (ANA, 2015). These indicators are outcomes that increase the quality and safety in patient care. Some indicators are patient falls, surgical complications such as infection and pulmonary failure, restraint prevalence, patient satisfaction, nurse satisfaction and staffing, complications such as urinary tract infections and pressure ulcers. The National Database of Nursing Quality Indicators (NDNQI) provides a guideline for nurses and nurse managers for direction in patient care and how to use patient acuity, patient needs, and referral indicators to provide good, safe, quality patient care. Nursing-sensitive indicators that could be identified as possible interference with patient care in Mr. J’s case are his being drowsy from pain medications, his mild dementia diagnosis, his being restrained, and his cultural and religious values preferences.
Mr. J is said to answer simple questions but with the diagnosis of mild dementia and the pain medication given, any information given by Mr. J may not be accurate. The nurses and staff should have recognized this immediately and gotten with a caregiver or family who knows Mr. J to ask healthcare questions so staff could establish care appropriately from that information. The reason the patient is being restrained is never revealed but patients should never be restrained to the bed. There are more useful and humane ways to monitor a patient who may be at risk for falls with mild dementia such as bed alarm/chair alarm or a sitter. The patient, admitted with a fractured hip and restrained to a bed, is at high risk for pressure ulcers. The CNA should be well educated on the need to turn patients and make sure pressure points are well monitored to prevent skin breakdown. The lack of cultural respect and understanding regarding Mr. J dietary requests as a retired Jewish rabbi are a nursing-sensitive indicator which can lead to patient dissatisfaction, maybe not realized by the patient with mild dementia but certainly by his daughter.
The hospital acquiring data on the above indicators of pressure ulcer incidence, prevalence of restraints, patient and family satisfaction could go a long way to advance the quality of patient care throughout the hospital. This hospital is a 65-bed rural hospital but it is the job of every hospital to give the best patient care possible. With a pressure ulcer developing while in the hospital and Medicare not reimbursing for the cost of the care of that ulcer, it is important to make sure for the patients and the financial aspect that these do not happen. The care of a pressure ulcer can take many weeks and be very costly. The development of this in the hospital is uncalled for and does not bring patient satisfaction. I think too often hospitals forget they are treating not just their patients but their families as well. Evidence-based practice could be used to see what could have been done to prevent pressure ulcers, education for the staff on what signs to look for concerning pressure ulcers as well as education on the laws and when it is appropriate to use restraints on patients.
Care of the patient should always be on the individual needs and cultural practice of the patients. As the nursing shift supervisor, I see several issues that need to be addressed. I would first ask who restrained this patient and why they felt this was needed. Evidence-based practice shows us that restraints are usually more dangerous to the patient than not being restrained. Restraints are to be used only in an emergency. In our book it states, “Restraint of any kind is a form of imprisonment, and the reasonable and prudent nurse will closely adhere to all laws, rules, and policies pertaining to the use of restraints” (Cherry, 2008). Furthermore, restraint” (Cherry, 2008). Policy and procedure needs to be addressed hospital wide with education and clear instructions given to prevent this in the future.
The supervisor should not have ignored the dietary error nor told her staff to “keep it quiet.” “Each culture has a value system that dictates behavior directly or indirectly by setting norms and teaching that those norms are right. Health beliefs and practices tend to reflect a culture’s value system. Nurses must understand the patient’s value system to foster health promotion (Cherry, 2008).” As nurses, we must recognize and respect the cultures and beliefs of our patients. This hospital may have a small population of Jewish residents but what hospital can afford to lose patients to a hospital 20 miles away? There needs to be education from administration down on how to value each culture and how we as healthcare members must understand the different values to promote health.
Education on the ability of practicing the health beliefs and practices of each patient can and will help the patient get better. I think we get into the mind-set that we are healthcare providers and people have to come to us, they need us, but what some don’t understand is we are a business as well. We need to respect our patients and put our patients first. They can go somewhere else. Someone else out there wants their business, wants to show them what kind of quality care they can receive, and will show them just that.
Cherry, B., & Jacob, S. (2008). CHAPTER 8 Legal Issues in Nursing and Health Care. In Contemporary Nursing: Issues, Trends & Management (5th ed., p. 185, p. 222). St. Louis, Mo.: Mosby/Elsevier. Nursing-Sensitive Indicators. (2015, January 1). Retrieved April 25, 2015, from http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/PatientSafetyQuality/Research-Measurement/The-National-Database/Nursing-Sensitive-Indicators_1.aspx