Nursing-sensitive indicators play a large role in bedside nursing today. They encompass the care given to patients, how it is given, policies, procedures, and different levels of staffing, education, and experience (ANA). They also provide a means to measure patient satisfaction. Not all involved with patient care will share the same knowledge and experience as can be seen in the scenario of Mr. J. How could nursing-sensitive indicators have changed his outcome? How can data collected on nursing-sensitive indicators advance quality care for all patients?
One of the risk factors for acquiring a pressure ulcer, a deep vein thrombosis, or hospital acquired pneumonia is immobility. There can be several causes of immobility and in this case it is the use of restraints. Mr. J has developed a pressure ulcer due to lying flat on his back in bed restrained. When the nurse’s aide assisted him back to bed, lying on his back again, she showed she did not have a clear understanding of a pressure ulcer as a nursing-sensitive indicator. She should have propped him up with pillows so the reddened area was relieved of pressure. Had she or the nurse possessed that knowledge they would have been assessing his skin frequently and repositioning him in bed often enough so as to prevent such an event from occurring.
The patient’s need for restraints could be reassessed as well. Is he trying to get out of bed unassisted and is considered a fall risk due to his hip fracture and mild dementia? Perhaps a bed alarm or a sitter would have been better alternatives. Either would have allowed Mr. J to move independently in bed and he would have been less likely to develop a pressure ulcer. Restraints are often used without considering alternatives first. They can cause more injury than good and decrease patient satisfaction. In this case, it may be difficult to gauge Mr. J’s satisfaction but his daughter certainly wasn’t satisfied with his care. It is possible his hospital length of stay has been increased by the staff’s lack of knowledge regarding nursing-sensitive indicators. At this point the staff must take action to correct the situation and hopefully heal the pressure ulcer.
How can hospitals use data collected based on nursing-sensitive indicators to increase the quality of patient care? Hospitals measure certain occurrences such as falls and pressure ulcers. Nursing care directly impacts these. If the number is higher than the national average, for example, a hospital may perform a study to determine the cause and then implement interventions to try to reduce the occurrence of falls or pressure ulcers. By analyzing data collected after an intervention was applied, the hospital can determine if the outcome was achieved or not. Once an intervention proves successful a new policy can be implemented throughout the hospital, decreasing falls or pressure ulcers, leading to improved quality care for all patients and greater patient satisfaction (AmericanSentinelUniversityBlog).
Another nursing-sensitive indicator is patient satisfaction with overall care. In Mr. J’s scenario I would say the patient’s family was completely dissatisfied. As a Jewish rabbi he requested a kosher meal and was served pork cutlet due to an error with his order. Were he not mildly demented he may have noticed what he had been served, but he did not and ate it. When the daughter was notified the next evening she discovered the nursing staff had kept it from her and that the nurse was not sensitive to the needs of her father. This was just another complaint in several that had occurred over the last six months. The physician and administrator were notified. This is a serious offense and may prompt the Jewish community to seek care at another hospital.
In order to resolve this issue and keep Mr. J’s trust and that of his daughter, several things must take place. The nurse and physician caring for the patient should acknowledge the error and offer a heartfelt apology. They should also assure the family, steps are being taken to prevent this from reoccurring. If the orders are entered through an electronic health record, IT may need to get involved to determine where the error is occurring in the order process in order to have it filled correctly.
The dietary supervisor should be notified and perhaps find a new way to indicate clearly if a tray contains a kosher meal. A sign on the patient’s door could indicate his meal preference so that all entering, whether it is a dietary tech, a nurse’s aide, or the nurse, will clearly see it. That way, even if the patient is confused and alone, as Mr. J was, there will be no mistake made. The issue here is patient satisfaction. Mr. J’s family may still leave dissatisfied but this event may help implement new policies respecting ethnic preferences and the incorporation of them in a patient’s care.
In healthcare today, nursing-sensitive indicators are important to hospitals in that they provide a gauge to measure the quality of care patient’s receive. The more knowledge a nurse has of nursing-sensitive indicators, the greater quality care she can provide to produce better outcomes for her patients, resulting in their improved satisfaction.
American Nurses Association. (2015, January). Nursing-Sensitive Indicators. Retrieved March 12, 2015, from Nursing World: http://www.nursingworld.org/mainmenucategories/ThePracticeofProfessionalNurses/Research-Measurement/The-National-Database/Nursing-Sensitive-Indicators_1 American Sentinel University Blog. (2011, November 02). Health Care On Call. Retrieved March 12, 2015, from American Sentinel University Blog: http://www.americansentinel.edu/blog/2011/11/02what-are-nursing-sensitive-quality-indicators-anyway/