...Nursing Sensitive Indicators: Organizational Systems Gleidis Angeles Western Governors University Nursing Sensitive Indicators: Organizational Systems The knowledge of nursing sensitive indicator can be helpful in providing the patient care which meets the quality and ethical standards. Nursing sensitive indicators rely on evidence to take patient care decisions (Patrician, 2010). According to Patrician (2010), Evidence Based Nursing is the use of personal expertise and research to take decisions on patient care. In case of Mr. J, there is a clear lack of evidence based nursing. Mr. J was kept in restraint without considering that Mr. J was not trying to get out of bed by himself. When the pressure ulcer was identified, the nurse neglected evidence which should have been a basis of removing restraint. Even if the risk of falling was high, a sound alarm could have been placed at the bedside, which Mr. J could have used when he wanted to use the bathroom. The body of Mr. J was in unnecessary discomfort due to restraint and constant pressure was causing ulcer in the back. Mr. J was diagnosed with mild dementia and was drowsy, so the nursing staff had put him in restraint. Although, there are very flexible guidelines for the use of restraint in the National Quality Forum (2004), but, in case of Mr. J, the nurse is rigidly focused on keeping the patient in restraint to reduce risk of falling. The restraint makes the patient’s body immobile and can also make the patient feel...
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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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...Running head: NURSING-SENSITIVE INDICATORS 1 Nursing-Sensitive Indicators Christen Steele Western Governors University NURSING-SENSITIVE INDICATORS Nursing-Sensitive Indicators The ANA has formulated a list of aspects of patient care that are impacted by nurses. These are called nursing-sensitive indicators (Sauls, 2013). . A knowledge of nursing-sensitive indicators is a way for nursing staff to impact the care that they give to patients and also a way that nursing can impact policy and procedure at the facilities that employ them. Identifying Issues With Nursing-Sensitive Indicators In the case of Mr. J, an understanding of nursing-sensitive indicators by the nursing staff is important in assisting those caregivers to identify issues that are interfering with Mr. J’s care. In this case, the nurses having knowledge that Mr. J’s decreased mental status due to receiving pain meds and being restrained to the bed increase his risk of acquiring a pressure ulcer on his bony prominences. With this knowledge, changes in Mr. J’s care, including regular position changes and perhaps changes in pain medications to decrease lethargy would be key in decreasing his risk of developing a hospital acquired pressure ulcer. Advancing Quality Patient Care With Nursing-Sensitive Indicators In the hospital setting, collecting data on specific nursing-sensitive indicators and reporting those results to the staff, can empower the staff to improve patient outcomes. Committees can be formed to...
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...Nursing-Sensitive Indicators Frances Westlake WGU Nursing-Sensitive Indicators Having knowledge and understanding of nursing-sensitive indicators assist the nurse with providing quality, ethical and safe care to the patient. In Mr, J’s case, the plan of care was not evidence based; otherwise they would not have applied restraints. The restraints only impeded his care by restricting movement which resulted in him having a pressure ulcer. By Mr.J being drowsy and having some dementia he was a high fall risk. The nurses could have used a bed alarm or staffed a sitter at his bedside. The nurse providing care to Mr. J should have immediately provided him the correct diet according to his religious beliefs. Family involvement also increases better outcomes for the patient; however, the Mr. J’s daughter was not included in the plan of care or notified of the use of restraints or the change in his diet. The nursing-sensitive indicators analyze the quality and patient outcomes of nursing care provided to patients. The information can be used to look at the nursing practice and processes, as well as how changes have influenced patient care and outcomes throughout the hospital. The measures are used for quality improvement in areas that have scored high or that could become potential issues. For example, if the pressure ulcer rate was high throughout the hospital, a pressure ulcer prevention program would be implemented. Staff would be educated on the program, and then nurse managers...
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...Lesson 03 Exercise 1-1 Interview a nurse manager. Discuss nursing-sensitive indicators and how they are measured and evaluated. How are these data used to improve nursing care? Interview a nurse manager or executive in a non-union environment regarding the signs and symptoms of increased vulnerability to collective bargaining activity. What strategies have been implemented when any of these symptoms appear? Based on an interview with a clinical manger of a medical unit, nursing sensitive indicators that are monitored on the unit are the following: 1. Restraint use, which is audited by a RN in the ICU. She looks at hours of use, documentation compliance with our hospital’s policy, and if death occurred within 24 hours of restraint use. 2. CAUTI (catheter associated urinary tract infections), which is monitored by infection prevention. 3. CLABSI (Central Line-Associated Bloodstream Infection), which is also monitored by infection prevention....
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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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...A. Nursing Sensitive Indicators Nursing-sensitive indicators are broken down into three categories; structure, process, and outcome (Montalvo, 2007). Structures of indicators are the organization pieces of nursing care which may include; staffing levels, educational levels, experience level, and staffing mix. The process of nursing sensitive indicators includes; the methods of assessments, type of interventions, and methods of care. The outcomes of nursing sensitive indicators are directly relatable to the qualitative and quantitative nursing measures (Sauls, 2013). Pressure ulcers, infections rates, and patient satisfactions are examples of outcomes. Understanding nursing-sensitive indicators could assist the nurses with measures for prevention that could lead to an improved patient outcome. Nursing-sensitive indicators identify structures of care and care processes, both of which in turn influence care outcomes (Montalvo, 2007). There are several nursing-sensitive processes and outcome indicators in this case which include; an increased risk for pressure ulcers, length of hospital stay, restraint prevalence, risk for falls, and patient satisfaction. The patient is at risk for pressure ulcers due to his decreased mobility from his hip fracture. By understanding this risk, the nurse should be more aware of the need to frequently reposition the patient. Being educated on this risk would also possibly decrease the length of hospital stay. If a pressure ulcer occurs, the patient...
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...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 and it is taken...
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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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...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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...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 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...
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...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 would have been attempted. If the nurses knew that a nosocomial pressure ulcer is a nursing-sensitive...
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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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...Head: 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....
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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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