All nurses begin with the strong intention to improve conditions within health care facilities and thus improve the outcomes associated. We often think of this notion as a way of dirty living and unsanitary conditions. This does not only apply to the hygiene concerns but emotional concerns as well. When one walks into a hospital and hands over the responsibility of their livelihood bad safety, their last concern may be that the professional personnel treating them may not be qualified for the job.

Structural indicators have one consider not only the demand and need for appropriate staff is adequate but also that the education is up to par for those individuals (Savitz, 2005). Do these professionals hold the degree but not the special certification to preform a specific task or duty? In this scenario, it begs to differ as to why the CNA came to remove the restraints. Was this a direct command from the RN? Is the RN burned out and understaffed causing the CNA to be the only one available to respond to this patients needs? In addition, this CNA is preforming an assessment of a potential skin breakdown/ulcer and furthermore educated the patient's family on the matter. It does not seem clear that the RN assigned to patient is in full communication and authority with the health care team causing delays or misses in identifying and treating a problem.

This sheds light on process indicators which include recognition, assessment, and nursing intervention methods (Savitz, 2005). This scenario includes several situations where negative physical and emotional problems were arising without proper identification and intervention. All of which contribute to a negative outcome. Outcome indicators here leave the quality and quantity of nursing care in question. The patient is most likely suffering from a pressure ulcer that will go without being addressed and undoubtedly