Essay Sample: Analyzing Nursing Quality Indicators and Ethical Considerations in Patient Care

A. Understanding of Nursing Quality Indicators

Nursing indicators are essential tools in evaluating the quality of patient care. Assessing the quality of nursing practice started when Florence Nightingale recognized the role of nursing staff in the delivery of health care and began assessing patient outcomes. She used statistics to generate studies to compare patient outcomes with environmental factors. Over the years, several healthcare initiatives have been described as healthcare quality guides (Montalvo, 2007). Nursing quality indicators identify nursing structures, procedures, and processes that impact patient outcomes and patient satisfaction. As a profession, nursing has a responsibility to measure, evaluate, and improve practice by using the best evidence-based practice available (Montalvo, 2007). These quality indicators are specific to nursing and are influenced by the care nurses provide.

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In the synopsis provided, the quality of patient care comes under scrutiny. The nurses showed complacency in the delivery of care to Mr. J. and his family. In this scenario, the quality indicator is the lack of knowledge of pressure ulcer prevention and procedures for restraints and restraint use. The nurse should have been assessing the integrity of Mr. J’s skin frequently, if she had, she would have noticed that he was acquiring a pressure area. Instead, it was Mr. J’s daughter who alerted the nurse assistant about the redness on Mr. J’s skin. Furthermore, the nurse did not seem alarmed by the redness on his skin and appeared to shrug off the daughter's concerns. The pressure ulcers could have been avoided had Mr. J has been turned and repositioned frequently since he was bedbound. Besides, a simple physical assessment could have enabled the nurse to discover the redness and thus act accordingly. Furthermore, the nurse should have been assessing the need for the restraints as it sounds as if he should have been released from them sooner as he was able to be toileted safely. Patient satisfaction should be a top priority in ensuring that healthcare delivery is patient-centered. In this scenario, the use of nursing-sensitive indicators could have prompted the nurse to recognize the need to discuss arising issues with patient care. In utilizing these guidelines, the nurse could have avoided adverse patient outcomes, thus enhancing the quality of care.

B. Advancing Quality Patient Care

Tracking data relating to important nursing measures can recognize appropriate best practices and improve the quality of patient care and outcomes. These indicators recognize patient care problems and provide the ability to train workers in healthcare systems. Identifying areas of nursing care that need improvement will help to change those behaviors in the whole hospital by preventing those behaviors in other areas. In this scenario, the relevant data include nursing hours per patient day, patient falls, patient falls with injury, pressure ulcer likelihood, and restraint prevalence. Recording the relevant data helps to compare the given-size facility with national standards. The process measures associated with each indicator are collected and reported in quarterly reports.

Nursing leaders can utilize this information to seek ways to advance quality patient care based on comparison with similar facilities nationwide. Based on the comparison, the institution should record any progress or regression made regarding the quality of care and patient satisfaction. Using the data and nursing quality indicators, the hospital can undertake measures to increase nursing hours per patient day, reduce patient falls, and minimize the likelihood of pressure ulcers by reducing the prevalence of restraints. Tracking progress is essential in measuring the essence of the intervention taken in the area requiring improvement. Nurse leaders within the unit should advocate for more nursing staff in order to increase staffing supply and reduce hours worked per shift, which improves job satisfaction and enhances motivation to provide quality patient care.

C. Resolution of Ethical Issues

Within the scenario, an ethical issue identified is the incorrect dietary order. According to the synopsis provided, Mr. J received an incorrect dietary order, which consisted of pork. In this scenario, the quality indicators are the lack of knowledge the staff shows the cultural importance of foods. Different cultures have strong beliefs about the foods they eat, and nursing staff should be aware and compassionate about providing culturally specific care. The nurse could greatly improve the quality of care she provided by showing the daughter respect, letting her know about the mistake with her father's food, apologizing for it, and then doing what she could to fix the issue. These nurses can benefit their patients with education on these things to better help their patients in the future.

As a nursing shift supervisor, I would seek corrective measures to help me resolve the issue. Firstly, I would engage the kitchen supervisor who can train staff on the limitations of cultural preferences and why they are important. The kitchen supervisor would also be able to identify the problem areas of how trays are getting mixed up. They could add steps to identify mix-ups and train staff on them before the trays reach the patient. Together, we would develop an action plan to ensure that patients receive the correct meal orders as per their requests. Secondly, I would consult the Hospital Chaplains, this team of Hospital staff is educated on religions and their beliefs and preferences and would be able to help educate staff, and they would also be able to comfort the patient and family. This education would allow staff to incorporate culture into their care easily. This training would help staff be more compassionate with patients and family members and deter them from being inconsiderate of their beliefs.

References

Montalvo, I. (2007). The national database of nursing quality indicators TM (NDNQI®). OJIN: The Online Journal of Issues in Nursing, 12(3), 112-214.