According to the American Nurses Association, nursing-sensitive indicators “reflect the structure, process and outcomes of nursing care.” (“Nursing Sensitive Indicators,” 2015) Understanding the indicators is an important piece of nursing, not only to assist the patient, but the patients loved ones as well, to ensure quality patient care. In this particular case, had the nurse understood the reasoning and data behind the Pressure Ulcer Rate and Restraint indicators, and communicated the necessity to report any pertinent findings the CNA may discover in the nurse’s absence, the CNA would not have dismissed the reddened area over the patient’s lower spine and would have immediately informed the nurse of the finding.
Upon returning the patient to bed, the CNA would have also known not to place the patient back in bed on his back and re-apply the restraints. Instead, would have had the patient lay to one side and stressed the importance, to the patient and family member, of frequent turning, to reduce the chance of pressure ulcers.
Quality patient care can only be achieved with teamwork and open communication. The discussion of pressure ulcers in hospitalized patients has become an increasing issue with more attention to the prevention of such since the early to mid-1990’s.
The Centers for Medicare and Medicaid Services (CMS) state that stage III and stage IV pressure ulcers occurring during admission are considered preventable (Zaratkiewicz et al., 2010). While the gentleman in our case scenario represented what would be considered a stage 1 pressure ulcer, with proper quality care and training, even this stage 1 ulcer could have been prevented or at the very least, the progression halted. If the nurse had a better understanding of nursing-sensitive indicators, or the theory behind them, then maybe he or she would take more ownership in the prevention of pressure ulcers. Harborview Medical Center in Seattle, Washington, conducted their own study regarding pressure ulcers and ways to prevent them. Their study was intended to track, prevent and improve skin-related outcomes (Zaratkiewicz et al., 2010). While the results of the study showed a large increase in minor pressure ulcers, it showed a huge decrease in stage III and IV ulcers, the most costly and reportable types. Education and staff reinforcement lead to early detection and improvement in practice, ultimately faring better for the patient.
Maybe if the hospital in the scenario had communicated such important figures or conducted their own study, the nursing staff and even the CNA’s would have a better understanding and ultimately provide better care. As far as ethical issues such as the request for a kosher meal that ended up not being kosher, we as nurses accept and agree to abide by a code of ethics. If I were the nursing shift supervisor and this case scenario occurred, there are a few different things I would use to discuss with my staff. First of all, I would remind all nursing staff of the code of ethics we all accepted the day we graduated nursing school and offer copies to each of them to serve as a reminder. Specifically, for this scenario, I would point out; “Human Dignity is respect for the inherent worth and uniqueness of individuals and populations.
In professional practice, concern for human dignity is reflected when the nurse values and respects all patients and colleagues” (“The Essentials,” 2008). While I am not Jewish and not receiving a kosher meal does not seem to be a big deal to me, I know that it is important to my patient and an acceptable request, so it should be a priority for me. Secondly, I would start a monthly ethical education series, choosing a different topic to better educate my staff. In the world we live in today, there are so many cultures and a necessity to be more aware of ethical treatment, that the staff should not be expected to “just know it.”
This knowledge comes from on-going education and it is up to the hospital and staff to make sure they are kept as up to date as possible regarding ethical treatment of patients. I would also involve my Board of Ethics or ethical expert from the hospital to intervene and sincerely apologize to the family. While we won’t be able to fix the meal that was already eaten, we can ensure the patient and family that steps have been taken to support special requests of patients from now on.
Nursing-Sensitive Indicators. (2015). Retrieved from http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursi