...RTT1 Task 1 Eric M. Lunsford Western Governors University Organizational Systems and Quality Leadership January 11, 2015 RTT1 Task 1 A. Nursing Sensitive Indicator Since Florence Nightingale’s work over one hundred years ago, researchers have tried to define nursing’s role on patient health outcomes. Nursing Sensitive Indicators (NSI) have been developed through the National Database of Nursing Quality Indicators (NDNQI) to address this need. The NDNQI provides nursing specific indicators that help evaluate nursing care at the unit level. NSI are nursing specific structures and processes that have a direct impact on patient outcomes. Through the NDNQI, reporting standards are developed for nursing performance. Over eleven hundred facilities nationwide provide data based on these indicators to NDNQI ("The National Database," 2014). NSI are used in several ways. First, NSI data can be reviewed so facilities can identify problems in patient care related to nursing in their units. A relationship between NSI patient outcomes and processes can be identified. After improvements have been implemented facilities can measure their effectiveness by reanalyzing this data. Second, because NSI measure nursing at the unit level, facilities can compare their nurses’ performances to similar units. These comparisons can be used to identify best practices other facilities have implemented to incorporate them in their hospital. Lastly, facilities with higher NSI can use...
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...Organizational Systems and Quality Leadership Task 1 Western Governors University Organizational Systems and Quality Leadership RTT1 Task 1 Organizational Systems and 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...
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...Organizational Systems & Quality Leadership RTT1 Task 1 Willem Botha Western Governors University Texas Nursing-sensitive indicators consist out of three categories that include the following: Structure, process and outcome. Structure refers to the organizational aspect of nursing that is made up of staffing levels; experience vs inexperience; educational levels or the make-up staffing at any point on the unit or facility. The Process is aspect of policies and procedures at the facility and Outcomes are determined when greater levels of nursing care and quantity are involved with better patient outcomes (ANA, 2015). Nursing-Sensitive Indicators The scenario paints a picture of multiple areas that should be approved on and addressed by management. The use of restraints, as described by the scenario, indicates a clear lack of knowledge in regards to nursing-sensitive indicators, the use of restraints and subsequent pressure ulcer formation is directly related and reflects on all 3 aspects of the indicators. The American Nurses Association, ANA, recommends that restraints only be used when no other viable options are available and this is also the case with the organization that I am involved with as a RN, Seton Health. While reading the scenario, it did not mention patient behavior that would justify the use of restraints; there is no mention of medical or behavioral interference that could possibly require the need to use restraints. The patient is elderly, has a history...
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...RTT1 TASK 1 In this scenario several hospital employees provide care for a 72 year-old male retired rabbi patient. The patient was admitted with a broken hip, he is restrained and during his stay he was given the wrong meal tray. Nursing-sensitive indicators such as pressure ulcers and patient satisfaction will be addressed. These indicators can be addressed and measured by the hospital through collecting data pertaining to pressure ulcer prevention and Press Ganey scores for patient satisfaction. The ethical issue of the wrong food tray will be addressed by using the appropriate referrals and resources. Nursing-Sensitive Indicators A CNA is called into the patients’ room to assist the patient to the bathroom, when the patient’s daughter notices and points out a red, depressed area over the patient’s lower spine and the CNA tells the daughter that the red area should go away on its own. The nursing sensitive indicator of pressure ulcer should be used in this case. The CNA needs to be educated in identifying what the preventative steps for avoiding pressure ulcers are by using the Braden Scale which should of been implemented upon this patient being admitted (Fosco, 2012). When the scale is used it can trigger the appropriate interventions before a pressure ulcer forms or gets worse, for example the CNA can pass on to other care team members if this pressure ulcer was prior to admission or formed during the patients hospital stay (Fosco, 2012). Educating...
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...Organizational Systems and Quality Leadership Task 1 It is critical to have an understanding of nursing-sensitive indicators in order to provide safe, quality, compassionate and satisfactory patient care. In this scenario, applying restraints to Mr. J, a demented patient with hip fracture seems appropriate. However, it is standard practice that restraints are to be removed as soon as possible, and the patient in restraints may need assistance to change position every two hours. In Mr. J’s scenario, there should have been a bedside commode, and a urinal for him to use at the bedside so he does not have to walk very far to the restroom. As for the CNA, if she was well trained, she would have been able to recognize the marks on his spine are potential pressure sores. Her knowledge of pressure ulcer would have prevented her from putting Mr. J back to bed in a supine position. Regarding the wrong meal being provided to the patient, it could have been a transcription error of the person taking the meal order, or it could have been a few other reasons, but either way, an error has occurred and it cannot be undone. However, every staff members involved in the care of this patient owe him and his family an explanation and apology. Patients have the right to know about every aspect of their care, and as professionals we need to protect and respect those rights. In this scenario, the nursing supervisor had compromised the principle of integrity when she made the decision to dismiss...
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...Analysis of Nursing Indicators Related to Lapses in Nursing Care name name Western Governors University Nursing-sensitive indicators are areas of data collection which have been empirically shown to correspond to patient outcomes; “NSI reflect the structure, process and outcomes of nursing care.” (Nursing World, 2015). These data are collected in many types and locations of medical and nursing facilities and nursing units, which report their data to The National Database of Nursing Quality Indicators (Nursing World, 2015). Units and facilities which submit to and participate with the NDNQI have a means to compare their Nursing Sensitive Indicator data to national data standards. Nurses who have an understanding of NSI in this case may be more attuned to NSI that relate to the care of their patients; ie, the rate of use of restraints, patient fall rate, and pressure ulcer rate at their facility versus national standards and goals (Nursing World, 2015). Nurses and CNAs who understand that nursing indicators are reflective of good nursing care and good patient outcomes can more effectively focus their efforts in the care of patients. In the case of Mr J, issues in the narrative describe a CNA who does not recognize signs of a pressure ulcer, does not implement repositioning, and a RN/CNA team who do not advocate for the discontinuation of restraints in an oriented patient. Further, the concerns of Mr J’s daughter for the condition of his skin as well as a dietary mistake...
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...ORGANIZATIONAL SYSTEMS & QUALITY LEADERSHIP 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...
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...Organizational Systems & Quality Leadership Rtt1 Task Currently, the most critical issues in health care are safety and quality of patient care due to changes in health care delivery. Facilities have an emphasis on the bottom line and finding areas to cut costs. Cost cutting measures 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...
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...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. An understanding of nursing sensitive indicators would assist all nurses in identifying the underlying problem that has the potential to cause patient harm and a negative patient outcome. In this case, the redden area was an indication that the patient is at risk for developing a pressure ulcer in that area. Actions such as repositioning the patient to relive pressure to the area would prevent further development of bed sores or pressure ulcers. Range of motion would be increased and prevent strain on the patient and decrease the likelihood of a pressure ulcer if the restraints were removed. The CNA replaced the restraints while the daughter was in the room which was not necessarily appropriate. If there is family at bedside and able to reorient the patient and prevent them from getting out of bed, there is no need to place the restraints on them when family is a bedside. Nursing sensitive indicators also including staffing, skill level of those nurses, as well as the nurse’s job satisfaction. The skill level of nurses on staff greatly affect the care patients receive. If the staffing is full of new nurses without experience small details may be missed that may be indicators for underlying problems. Understaffing may result in patients’ needs being delayed and put patients at higher risk. IF there is no staff to help...
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...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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...RTT1 TASK 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...
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...RTT1 Task 3 Juanita Mortensen Western Governors University RTT1 Task 3 A1. Country comparison The healthcare systems of Switzerland and the United States are quite similar in some aspects and vastly different in others. In Switzerland, the healthcare is universal and available to all. It is provided by private individual insurance companies and subsidized by the government when needed. Basic health insurance is required to be purchased within 3 months of residency or after birth and is an individual’s choice as to what carrier they choose. Of course, there are exceptions to this mandate but they are very few.("Healthcare in Switzerland," “n.d.”, para. 1) Because of this requirement, 99.5% of the population in Switzerland has healthcare coverage.(Roy, 2011, para. 13) The basic health insurance is purchased by the consumer with the option of purchasing supplemental plans to the basic health plan. The supplemental plans are how the insurance companies make a profit.("Healthcare in Switzerland," “n.d.”, para. 12) A few commodities that are covered by the basic health plan are: outpatient and emergency treatment, medications that are on an official government list, maternity care including childbirth, and abortions up to 12weeks gestation. The supplemental plans have a wide range with some consisting of private or semi-private beds, dental care, and eye care.("The Swiss Healthcare System," “n.d.”, para. 7 & ll) The price and benefits of medical treatment, hospitalizations...
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...RTT1 Task 1 Nursing-sensitive indicators reflect the structure, process and outcomes of nursing care. These are measurable indicators of the quality of care provided to patients. Quality and/or quantity of nursing care can and does affect patient outcomes and the understanding of these measurements can assist in the planning and implementation of nursing care so that appropriate, quality health care with positive outcomes can be achieved. Poor performance on these indicators means not only is the quality of the care provided not good enough, but also they lead to longer, much more expensive hospital stays with poorer outcomes for the patient. Use of restraints for safety is, unfortunately, sometimes necessary. Options to explore first should be: Is there a family member that can come and sit with the patient to keep calm and safe? Does the hospital itself provide sitters in the room for safety? Can the patient be moved to a room closer to the nurse’s station so they can be monitored by staff? Does the hospital have a “niche” cart to keep their confused patients busy? When restraints are used, it is of utmost importance to release the restraints every hour for range of motion exercise and to turn the patient hourly to prevent pressure ulcer and DVT occurrence. More importantly, if a pressure ulcer is starting to form, it must be documented per institution protocol and the patient must be turned and kept off the site so the pressure ulcer does not progress. Although not addressed...
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...RTT1 Organizational Systems and Quality Leadership Task 1 WGU ALLEN SMITH A. Understanding Nursing Sensitive Indicators Nursing sensitive indicators include the configuration, process and outcomes of nursing care. The configuration of nursing care concludes the nursing staff, their nursing skills, and the level of education that each nurse holds. The process of nursing care concludes the nursing assessments, intervention and implimentation. The outcome of nursing care either positive or negative depends on the quantity and quality of the care provided to the patients by the nursing staff ("Nursing world," 2013) Each nurse should hold proper information and knowledge of nursing care such as knowledge of pressure ulcers. In this scenario every nursing personnel should provide the ultimate nursing care in dealing with pressure ulcers. In order to prevent any pressure ulcer each nursing personnel should be aware of the pressure ulcer concept, their prevention and the correct technique of reducing any other complication related to pressure ulcers. In this case the nurse and the CNA should use their knowledge of preventing any pressure ulcer. The first action is to assess completely the patient for any sign of pressure ulcer such as any erythema or bruising. It is essential that the nursing staff know to reposition the patient and reasses the out of sight sites parts of the body for any sign and symptoms of...
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...Toni Johnson 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...
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