...Nursing-sensitive indicators represent nursing’s contributions to patient care. Nursing-sensitive indicators represent nursing’s contributions to patient care. RTT1 Task 1 RTT1 Task 1 Nursing-sensitive indicators reflect the structure, process and outcomes of nursing care (American Nurses Association, Inc., 2014). Patient outcomes that are determined to be nursing sensitive are those that improve if there is a greater quantity or quality of nursing care (American Nurses Association, Inc., 2014). One nursing-sensitive indicator is the development of pressure ulcers. Nursing-sensitive indicators represent nursing’s contribution to patient care. The primary nurse caring for Mr. J did not appear to have a great understanding of this nursing-sensitive indicator as demonstrated by the patient laying in restraints for extended periods of time without justification as to why. Patients at an increased risk of pressure ulcers either from age, mobility and/or nutritional status should have measures in place for monitoring and preventing breakdown. When the CNA ambulated the patient to the bathroom the family noticed a reddened area to the patients back and due to the lack of education of the CNA, this was not taken seriously. If the RN was assisting the patient, a skin assessment should have been done and prevention processes put in place to prevent any further breakdown. The condition of the patient’s skin at the time the patient was ambulated to the bathroom should have...
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...Running head: NURSING SENSITIVE INDICATORS 1 Nursing Sensitive Indicators Organizational Systems and Quality Leadership RTT 1 Task 1 August 29, 2014 NURSING SENSITIVE INDICATORS Nursing Sensitive Indicators To analyze the given scenario one must first have a foundational understanding of what nursing sensitive indicators are and how they could have been used to significantly improve patient care. Next the analysis will determine how the hospital will use these indicators to improve overall patient care. The analysis will conclude by identifying specific resources that could be used to resolve the ethical issue in this scenario. It wasn’t until 1996 that the term Nursing Sensitive Indicators was used. Nursing sensitive indicators are by definition,” elements of patient care that are directly affected by 2 nursing practice.”(American Sentinel University - Healthcare, 2011, para. 1) These elements can be further broken down into: Structure - This includes staffing levels, staffing mix, staff education level and the staff experience level. Processes – This includes methods of assessment, methods of care, and types of interventions. Outcomes – these are directly related to quality and quantity of nursing care. With the given scenario, many nursing specific indicators could have been observed to significantly improve Mr. J’s hospital experience. Restraint prevalence is the first issue that could be addressed. If the nurse was more aware of this he or she would...
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...include a decrease in the number of nurses to provide direct patient care and shorter lengths of stay due to reimbursement changes. This means fewer nurses caring for sicker patients putting patient care in jeopardy (ANA, 2015). Indicators are measured to monitor safety and quality of care. Nursing-sensitive indicators gauge aspects of patient care directly related to the quality and quantity of nursing care. Nursing-sensitive indicators measure the process of care, the structure of care, and patient focused outcomes. Process indicators measure methods of assessment, intervention, and nurse job satisfaction. Structure indicators include the supply of nursing staff, skill level, and education. Outcome indicators are those that improve if there is a greater quantity or quality of nursing care. These indicators help determine links between patient outcomes and the nursing care provided (American Sentinel University, 2015). Since 1998, indicators have been reported to the National Database of Nursing Quality Indicators (NDNQI). That data has been used to evaluate nursing care at the unit level (Montalvo, 2007). In this scenario, Mr. J was restrained, developed a pressure ulcer, and his daughter had a negative experience. It is difficult to answer why these developments occurred because the scenario is limited in details. However, if the nurses caring for Mr. J were aware that the use of restraints is a nursing-sensitive indicator perhaps more alternative interventions...
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...Nursing Sensitive Indicators Nursing sensitive indicators are define as those indicators that capture nursing care or its outcomes most affected by nursing care (Medscape). These indicators have been defined due to the necessity for data to show proven links between nursing interventions performed, nurse staffing levels and patient outcomes. These nursing sensitive indicators help to identify the structures of care and care processes to which both influence and have major impacts on patient outcomes (Nursing). Nursing sensitive indicators are specific to the nursing process. Some examples are Patient satisfaction, Nurse Satisfaction, and quality of care (Medscape). The structure of nursing care can be reflected by the nurse/patient ratio and staffing needs and also by the education of that nursing staff. Process indicators are those such as nursing assessment, those interventions set into play as well as how satisfied an RN is with his/her job. Nursing sensitive patient outcomes are those that improve because of a higher quality of nursing care (Nursing). There are many ways in which an understanding of nursing sensitive indicators could assist the nurses in this scenario. Firstly, I believe education to be the main issue. Everyone who provides patient care must be aware of all nursing sensitive indicators and what impact it can have on patient outcomes. If the CNA was aware of the risk of pressure ulcers with the use of restraints, she could have informed the nurse and possibly...
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...Melonie Miller Organizational Systems and Quality Leadership Task 1 A: Delivering quality care is the priority of the nursing profession as an institution and in order to facilitate this, data driven indicators are employed to measure how effective the care environment is. These nursing sensitive indicators include complications such as urinary tract infection, patient falls, surgical complications, length of hospital stay, restraint prevalence, incidences of failure to rescue, patient satisfaction, pressure ulcers and nursing satisfaction. In the case of Mr. J, the demented rabbi, who as a nurse supervisor I am responsible for, nursing sensitive indicators are crucial in monitoring the level of care and making adjustments so that the patient will recover as quickly as possible. Modern nursing, aided by linear flowcharts uses the Pareto principle that states 80% of process or system problems come from 20% of the possible causal factors (Cherry, 2011). This means that by identifying the key and most obnoxious causal factors and focusing effort on relieving them, the problems can have viable solutions. An example of the need to focus on nursing sensitive indicators is the fact that restraints were used on the patient despite only having mild dementia and no previous incident as well as the restraints causing a pressure ulcer would indicate that the patient isn’t receiving the care he deserves. From these two metrics I would assign a CNA to watch over him periodically and release...
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...Quality Leadership Task 1 A. Nursing-Sensitive Indicators Nursing-sensitive indicators 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. Process indicators measure aspects of nursing care such as assessment, intervention, and RN job satisfaction. Patient outcomes that are determined to be nursing sensitive are those that improve if there is a greater quantity or quality of nursing care (e.g., pressure ulcers, falls, and intravenous infiltrations). (Nursing, 2014, para. 1) In the instance of Mr. J’s hospitalization there are many areas for improvement as it applies to nursing-sensitive indicators. Some of these areas can be improved by implementing new protocols or by simply educating the staff about specific indicators. Other areas that need improvement such as staff communication as well as attitudes may be a little more difficult to correct. Patient restraints can be an effective intervention to promote patient safety only if used when appropriate. Restraints can have a negative effect on patient safety, morbidity, and mortality if used inappropriately. The story of Mr. J isn’t really clear on the rationale for the restraints but one is lead to believe that they were placed due to the fact that he has dementia and had fractured his hip due to a fall. The nurse may need to be educated on all of...
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...RTT1- Organization Systems and Quality Leadership Task 1 Nursing sensitive indicators developed by the American Nurses Association “reflect the structure, process, and outcomes of nursing care.” (American Nurses Association). To further understand the American Nurses Association definition a breakdown of each section is appropriate. To address the structure of nursing care it is important to access the skill level of the nursing staff, the availability of nursing staff, and the education level/certification level of the nursing staff. The process portion of nursing sensitive indicators measures assessments performed by nurses, appropriate nursing interventions and job satisfaction of nurses. (American Nurses Association). Finally, outcomes of nursing care according to the American Nurses Association, measures the quantity and quality of nursing care, for example, prevention of pressure ulcers, prevention of patient falls, and IV infiltration to name a few. Given the scenario in this case, there were several nursing sensitive indicators present that could have been prevented provided that the staff involved received proper training and had a strong foundational understanding of nursing-sensitive indicators. To begin the case of Mr. J, there was no definite explanation of why the restraints were applied. This is an appropriate opportunity for education related to restraint use. Although Mr. J was given pain medication, he obviously knew where he was...
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...ORGANIZATIONAL SYSTEMS 2 A). Nursing-sensitive indicators reflect the structure, process, and outcomes of nursing care. (Nursing-Sensitive, 2014.) The skill level of the nursing staff, the supply of nursing staff, and the education or certifications of the staff are all used to measure the structure of nursing care given to any given patient. Patient outcomes, which are improved by a greater quality of care, are said to be nursing sensitive. Some examples of these are: pressure ulcers, intravenous infiltrations, falls, nosocomial infections, restraints, the mix of RN’s, LPN’s and CNA’s, total nursing care hours provided per patient day, patient satisfaction with pain management, educational information, overall care, nursing care, and nursing saff satisfaction. (ANA, 2014.) Nurses need to know and understand these indicators in order to be able to care for their patient appropriately. For example, an elderly patient who is bed bound will be more prone to pressure ulcers than a young, mobile adult. The elderly or confused patient will also be more prone to falling than the young mobile adult. A confused patient might not notice when his IV infiltrates. In the scenario given, Mr. J. is an example of an elderly patient who will be at high risk for several of the nursing-sensitive indicators. He has dementia, he has been restrained in the bed, and his daughter notices a red area on his lower spine. The...
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...Organizational Systems and Quality Leadership Organizational Systems and Quality Leadership Task 1 A. Nursing Sensitive Indicators Nurses are integral key players in multidisciplinary teams caring for patients in complex healthcare systems. Hospitals, a primary care delivery portal within the health system, are inundated with patients requiring higher acuity care. Nurses must be prepared to recognize patients’ health care needs and provide quality patient care outcomes. The knowledge of nursing sensitive indicators can be helpful in providing the care which meets quality standards. Nursing sensitive indicators rely on evidence-based practice. The American Nurses Association created a repository for implementing, developing, and storing nursing sensitive indicators in the National Database of Nursing Quality Indicators, or NDNQI. The nursing sensitive indicators are a set of standardized performance measures intended to help hospitals assess the extent to which nursing interventions have an impact on patient safety, quality, and the professional work environment (Erickson, J. 2011). Nurses directly impact these measures and when evidence-based practices are adopted, patient care improves as shown in historical outcomes data. In the scenario of Mr. J there were multiple failures to recognize and use nursing procedural sensitive measures to improve his safety, quality of care, and patient satisfaction. Although Mr. J had mild dementia, he was appropriately responsive...
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...Running head: NURSING SENSITIVE INDICATORS 1 RTT1 Task 1 Krista Vandiver, RN, CEN Western Governors University NURSING SENSITIVE INDICATORS Nursing-Sensitive Indicators 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 2 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 reapply 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...
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...analyzing Mr. J’s situation it is important to consider nursing-sensitive indicators and how this is an indicator of quality patient care. It is also important to note how this creates an ethical issue and to learn from the situation companywide. Many situations like Mr. J’s happen every day and are swept under the rug. Patient care should always involve patient needs along with cultural considerations while maintaining consistency with evidence based medicine practices. Nursing sensitive indicators assist to identify potential issues related to quality that may come about during patient care. Identifying nursing sensitive indicators allows nurses to improve the quality of patient care which results in increased patient satisfaction and improved patient outcomes. The American Nurses Association (ANA) is a great resource and wealth of information to assist in identifying specific indicators to apply to patient care. Nursing sensitive indicators bring light to specific patient needs. In the case of Mr. J several nursing sensitive indicators can be identified; his recent fall resulting in a hip fracture, he has dementia, cultural and religious values, immobility, pressure ulcer risk, the use of restraints, and pain management techniques. The diagnosis of dementia identifies that Mr. J is unable or has limited ability to reason with sound judgment along with the added use of pain medications. All of these indicators can lead to quality patient care if nursing applies them correctly...
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...Nursing Sensitive Indicators The American Nurses Association established national initiatives called nursing-sensitive outcome indicators that focus plans/programs to increase quality and safety in patient care. They gauge aspects of direct patient care related to quality of nursing care by reflecting on structure, process and outcomes of nursing care. Structure in regard to staffing and the skill, education and certification of staff; process in regards to measuring aspects of nursing care related to assessment, intervention and RN job satisfaction, and outcomes by improving the rates of specifics in relation to patient outcomes such as in this particular case preventing hospital acquired pressure ulcers, improving patient satisfaction and restraint prevalence. Nursing Sensitive indicators are only specific to nursing and in 1998, ANA developed a National Data base of nursing quality indicators (NDNQI) so they could continue to collect and build on data from studies to expand nursing knowledge related to factors that influence the quality of nursing care. Why is this important? The nursing profession has the responsibility to measure, evaluate and continually improve practice. NDNQI identify where and how the staff is needed and show the need to increase staff in particular areas of nursing care that need improvement. The NDNQI mission is to help the RN in patient safety and quality improvements by providing research based national and comparative data on nursing care...
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...1 RTT1 TASK 1 A. Discuss how an understanding of nursing-sensitive indicators could assist the nurses in this case in identifying issues that may interfere with patient care. Nursing-sensitive indicators are determinations used to delineate the excellence of nursing interventions and positive patient outcomes. This is not a new concept. In the 1800’s, Florence Nightingale, a promoter of outcomes, revealed such indicators when she revealed her statistical findings of soldier’s mortality rate associated to environmental conditions during the Crimean War (Fee & Garofalo, 2010). Over the past decades, various studies world-wide have been conducted on the connection of nursing quality indicators and their outcomes. The American Nurses Association (ANA) recognized these studies were an important focus in evidenced-based practice among the nursing profession; and in 1998, they established a program for implementing, developing and storing these nursing-sensitive indicators, known as the National Database of Nursing Quality Indicators (NDNQI) (ANA, 2014). The NDNQI serves as a valuable resource for hospitals nationwide at the acute level for administrators and nurses alike to compare various indicators and outcomes with that of other facilities to determine best practices for patients and staff. In the case of Mr. J, it is clear the nurse caring for this patient had little or no knowledge of indicators of restraint prevalence. However, my initial concern after reading...
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...RTT1 Task 1 November 4, 2014 A. Nursing Sensitive Indicators One important element of working in the medical field is understanding nursing sensitive indicators. These indicators reflect the structure, the process and the outcomes of nursing care. Structure indicators include the number of nurses on staff as well as the education and skills of the nursing staff. Process indicators measure aspects of nursing care such as assessment, intervention and nurse job satisfaction. Outcome indicators measure the quality and quantity of nursing care, which include satisfaction with pain management, falls and pressure ulcers. (American Nursing Association 2014) In the case of Mr J sensitive structures would include understanding by the nurse and CNA that leaving Mr J in his bed while on his back could lead to skin breakdown. This knowledge would prompt the CNA to avoid positioning the patient on his back and the CNA would know to reposition him frequently to avoid pressure ulcers. The knowledge would also allow the CNA to recognize the reddened area as a stage one pressure ulcer and the information would then be passed on to the RN for needed intervention. Knowledge would allow the nurses to assess whether the use of restraints were appropriate for the patient as well as the proper use of the restraints. Outcome indicators for patient satisfaction would have been improved had the nurses insured a correct diet and if the nurse had not minimized the situation to Mr J’s daughter...
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...how an understanding of nursing-sensitive indicators could assist the nurses in this case in identifying issues that may interfere with patient care. Nursing-sensitive indicators reflect elements of patient care that are directly affected by nursing practice, specifically three aspects of nursing care which include: structure, process, and outcomes. Structural indicators include the supply of nursing staff, the skill level of nursing staff, and the education and certification levels of nursing staff. Process indicators measure methods of patient assessment and nursing interventions. Nursing job satisfaction is also considered a process indicator. Outcome indicators reflect patient outcomes that are determined to be nursing-sensitive because they depend on the quantity or quality of nursing care. These include things like pressure ulcers and falls. When understanding the above, this could greatly assist the nurses in the case of Mr. J in identifying issues that may interfere with patient care in a number of ways. In the first sentence of the scenario, it states that Mr. J is a retired rabbi, with that statement we are informed of Mr. J’s religious beliefs and background of Jewish faith. Structural indicators, specifically the education level of the nursing staff would benefit the certain beliefs and customs members of the Jewish community follow. Having a high level of education would aide in the nurses quality of care. Process indicators would also be of assistance when...
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