Understanding of Nursing Quality Indicators
The nursing sensitive indicators are widely used as a barometer of measuring the nursing standard. It can be defined as a set of standardized performance that are used by the hospitals for evaluating the extent of the nursing interventions (Neuman et al., 2014). The NSIs have been used in the hospital unit or portraying the reality of the nursing service. An evaluation at least requires the minimum number if indicators in order to recognize the nursing standard of a particular organization. As per the national initiatives driven by the American Nurses Association, indicators like pressure ulcers, metabolic derangement and patient dissatisfaction can be recognized as one of the quality indicators of the nursing standard (Neuman et al., 2014)..
The case study reveals the fact that the when Mr. J’s daughter visited the hospital to meet his father and was helping the certified nursing assistant to get her father to the bathroom, she found a red depressed area over the lower spine. The red depressed area was probably a pressure ulcer.
According to Jiang et al., (2013) the occurrence of a pressure ulcer has been considered as one of the indicators of health care quality and safety. Bedsores of pressure ulcers are mainly caused due to the prolonged pressure over a certain region of a skin that causes injuries to the underlying tissue of the skin. This occurs normally in the patients with limited mobility. Repositioning is an important way out for mitigating the chances of the pressure ulcers. Nurses should be responsible for shifting the weight of the patient to other sides. Occurrence of pressure ulcers even after clear guidance of patient mobilization indicates towards the breaching of the nursing guidelines.
It is also evident from the case study that the patient’s food was replaced by the food of another patient. Nutritional management is an essential aspect of patient care and occurrence of such negligence can directly indicate towards nursing malpractice.
Hospital food and nutrition plays an important role in the patient recovery and well being. The food service quality can impact upon the patient satisfaction with the overall hospital experiences. Provision of wrong diet to patients may cause adverse reactions like hypersensitivity reactions. Dementia patients should refrain from consuming high fat meats like pork, lamb, beef and hydrogenated vegetable oils, but it can be seen that the patient has been provided with a pork cutlet.
Advancing Quality Patient Care
The hospital data about the nursing quality indicators gives a clear picture of the current nursing standard of a particular clinical care setting, which would help the administrators to indentify the gaps left in the care delivery (Johnstone, 2015). Presence of pressure ulcers in patient with low immobilization indicates that the health care staffs are not accomplishing their duties. Higher the number of incidence of pressure ulcers or the application of restraints determines the quality of care provided by the health care staffs. The data would help to identify the intervening factors and revert the detected scenario. It helps out the managers by guiding them towards the key points that has to be reviewed (Johnstone, 2015). The data obtained from this information would help to determine, document or evaluate a given situation and support decision making in future scope of practice. It helps an organization to analyze what was working, what depended on the care, the proposed goal. It is necessary for the aged care homes to review the number of times the patient has to be put in restraints which can be a rationale for finding an alternative care for the elderly people, as there are several psychological, physical and ethical issues regarding the application of the restraints (Möhler & Meyer, 2014).
Resolution of Ethical Issues
Nursing encompasses provision of a safe health care delivery to the clients including application of correct medications, correct nutritional assessment, mobilizing the elderly patients, changing the catheter, preventing the occurrence of infections. As per the ANA codes of ethics the nurse’s primary commitment should be to the patient and his family and should be accountable for the type of care provided. Providing wrong food to the patient indicates the breaching of the nursing professional standards as it is the moral duty of a nurse to apply a person centered care and evidence based decisions. Applying restraints can destroy the integrity and dignity of an elderly patient and directly contradicts the ethics of beneficence in nursing. Furthermore restrained patients have greater risks of serious injury, functional decline, death or fall due to strangulation, poor circulation, skin breakdown and more (Berzlanovich et al., 2012). Applying restraints might reduce the workload of the staffs of continuous monitoring but can have serious harmful effect on the patient (Möhler & Meyer, 2014). The legal implication of the nursing practice is tied to licensure, federal laws and scope of practice. Nurses always posses legal and ethical obligation for responding to the needs of the clients. There are six ethical principles related to nursing; Beneficence, Non maleficience, justice, veracity and fidelity (Lachman, 2012). It is evident from the case study that the health care staffs have not adhered to the principle of beneficence as they were being negligent to the clients and are not addressing their needs. A health care staff should be accountable for any kind of harm done to the patient (Lo, 2012). In this case the wrong order for the patient could have been harmful for a dementia patient and such negligence can be related to the medication error which can be related to patient morbidity and the falling of the hospital reputation. Furthermore the information of his mistake was not disclosed to anybody (Johnstone, 2015). A health care professional should be responsible ensuring an effective and safe care. Incident reports should be a rule of thumb in any time a clinical error occurs. It is the incident report that enables the clinical mangers or the risk administrators to understand the actual flaws and act rapidly. This also helps to alert the hospital administrator against a particular mistake that has been occurring since long but is not being reported. Legal issues may arise due to the breaching of the nursing standards and the healthcare staffs can be allegedly accused of negligence in care. According to Lo, (2012), a patient posses the right to lodge complaint against any professional misconduct under the tort of negligence, that can cause heavy penalty or even cancellation of the licensure for severe cases.
In order to avoid these legal complications, a nurse supervisor should bring the incident under the notice of the medical manager and moreover under the knowledge of the higher authority in order to take prompt action against the health care staffs or department (Goethals et al., 2014).
The procedure should be initiated by proper scrutiny of the compliant and the identification of the person responsible for the action. In such a case the accused health care staffs can be provided with a warning to be careful for the next time. A close monitoring on the falling standard and continuous evaluation is necessary for avoiding repeated mistakes (Alspach, 2013). It is recommended to cross check the patient medication or the food orders to prevent any further mistakes. In case of the vulnerable patients, there should be a 24x7 supervisor present for helping the person in having meals, or by accompanying him to the bathroom or by helping the patient to shift to the other side.
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