Importance of Understanding of Nursing-Quality Indicators
The three nursing-quality indicators include; process indicators, structural indicators, and patient outcome indicators. Structural indicators are comprised of education of the nursing staff; skills set required in nursing practice, the supply staff as well as the various certification levels of nursing staff. These indicators demonstrate the quantity and quality of staff required to ensure that nurses are trained to acquire the necessary skills in patient care to prevent burnout. In Mr. J's case, the nurses should pose the skills needed to ensure that he/she provide care professionally and along the ethical standards.
Process indicators, on the other hand, include measure methods of patient assessment and nursing interventions as well as the job satisfaction derived by the nurses. Nurses are required to possess assessment methods to determine whether the care there are giving the patients is the best care or not. According to Ausserhofer et al. (2013) nurses required interventions from the hospital's management as well as other caregivers to get more acquitted of the emerging trends in the healthcare sector.
Outcome indicators, on the other hand, reflect patient's outcomes. The quality and quantity of nursing care that is offered to the patient while at the healthcare facility determines the patient's results. They include, mishaps, falls, re-infection, pressure ulcers, etc. Other patient outcomes such as cardiac failure, hospital readmission are not considered to be nursing-sensitive since they are related to other elements of medical care.
Advancing Quality Patient Care using Hospital Data
Hospital data can be used to improve the quality of the care which in turn reduces the adverse patient outcomes which result from inadequate quality care. Data on restraints and pressure ulcers could be used to develop quality improvement models. These models could be used to prevent, manage as well as treat the various incidences of restraints and pressure ulcers occurring in patients. Nurse's sensitivity to ulcers preventive measures can be increased through the use of ulcer prediction tools.
Patients who have a higher risk of developing ulcers can be identified through the use of risk assessment models. This will ensure that the nurses concentrate and utilize measures to reduce the chances of developing ulcers specifically to these patients as opposed to focus on the entirely on all patients. The various risks assessment models which can be used include; the Norton scale and the Braden scale. The Norton scale utilizes the physical condition, mental condition, incontinence, and mobility for assessment as well as the patient's activity. The Braden scale, on the other hand, utilizes patient's moisture, friction, and shear for evaluation, sensory perception, nutrition, exercise as well as mobility.
The proper assessment also requires being carried out to determine patients that need to be restrained and those that do not require restraining. In the case of patients with ulcers, the nurses should ensure that they minimize restraints. Proper management of the patient is necessary to ensure that restrictions for patients with ulcers are reduced.
According to Ausserhofer et al. (2013), nurses should ensure that they implement prevention measures while taking care of the patients. These include interventions measures such as the use of mechanical loading. This involves the use of pressure reducing mattresses, turning patients in bed often as well as educating nurses on the various preventative measures. The different methods of treating ulcers according to the available hospital data include; debridement, cleansing, proper nutrition, pain management practices as well as exudates management.
According to Besner et al., (2013) process indicators are essential in ensuring that patients are checked on and that they are okay. This is achieved by providing that patients are offered quality health care and are getting quality time with the nurses.
Lastly, structural indicators can also be used to improve the quality of patient health care. The various structural indicators include; knowledge and skills possessed by the nurses and the additional education on the trends in patient health care (Ausserhofer et al., 2013)
Solving Mr. J Ethical Issue
Stages of Solving an Ethical Dilemma
While addressing an ethical dilemma, the first step is to identify the ethical dilemma. After identification of the moral issue, the second step is information gathering. Gather information about the patient the nurses as well as the problem. The hospital administration then should explore the professional and legal guidance in solving the identified issue. After, the administration then launches investigations into the matter. Depending on the findings, it should decide whether the hospital should issue an apology or not. While determining the next cause of action, it is essential for the hospital to consider the patient's decision. A patient may consider an apology by the management or in other cases decide to file a case against the hospital management for negligence. In the case of acceptance of an apology, the hospital management should conduct an internal quality improvement to resolve the ethical dilemma. Ausserhofer et al., (2013), states that in a case whereby the issue cannot be resolved internally, the hospital management could seek court declarations on the way forward.
Solving Mr. J's Case
In Mr. J's case, the nurses fed him a diet he was not supposed to eat. This presents an ethical dilemma which requires the attention of the hospital management. The first step that should be carried out is notification of the moral issue to the administration of the hospital. The Nursing supervisor in charge of the nurses should notify the hospital management on Mr. J's issue. Second, is information gathering, the nursing supervisor should talk to the patient, i.e., Mr. J to determine whether it is right he ate the said food. Also, nurses on duty need to provide information about the incident. After gathering information about the case, the next step is for the supervisor to offer an apology to Mr. J. Also it is essential to provide an apology to Mr. J's daughter. The next step is to seek the course of action from Mr. J, daughter or his representative. In the case whereby Mr. J agrees to accept the apology, the hospital administration should then thank the patient. The administration then should embark on introducing measures to ensure that such a scenario doesn't re-occur. Introduction of stringent quality control healthcare measures should be the next step for the administration. In a situation whereby Mr. J or his representatives decide to sue the hospital for negligence, the administration should seek legal assistance from the hospital lawyer. The hospital ethics committee then should carry out an analysis on Mr. J's case to come up with a plan to defend the organization as well as a compensation plan to the patient. The ethics committee also should be responsible for any punitive actions against the hospital staff whom efforts resulted in the ethical dilemma.
Ausserhofer D, Schubert M, Desmedt M, Blegen MA, De Geest S. Schwendimann R. (2013) The association of patient safety climate and nurse-related organizational factors with selected patient outcomes: a cross-sectional survey. International Journal of Nursing Studies.
Besner, J., Doran, D., McGillis Hall, L., Giovannetti, P., Girard, F., Hill, W., ... & Watson, L. (2005). A systematic approach to maximizing nursing scopes of practice. Ottawa, ON: Canadian Health Services Research Foundation.
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