Nursing Sensitive Indicators

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on the assessment plus having a one on one aide assigned to the patient. According to Montalvo and Dunton (2007) one facility developed a quality improvement process that required a wound specialist to be available to help improve their hospital acquired pressure ulcer rate. Their rate dropped significantly after implementing this new process. (p.4) Hospitals may also want to put into place safe guards to prevent nursing staff burn out such as, limit on number of days and hours that may be worked per week. This can improve the nursing-sensitive indicators RN Satisfaction Survey Options and Voluntary Nurse Turnover. Hospitals that have nurses that are satisfied with their job, high retention rates, and good work practice environment, patients will receive higher quality care.

It is one thing to collect the data and analyze it. Another to put new policies, goals safe guards and practices into place. However, if no one is following up to ensure the changes were implemented on the effectiveness of the changes then the quality in care will never improve. Hospitals cannot wait until the next quarterly report to realize that nothing has changed. A timeframe should be set for implementation and a system developed to ensure that implementation has occurred. There should be a follow up method in place to review with management, staff, and administration. Previous quarterly results should be compared to upcoming quarterly results over a set timeframe for evaluation of effectiveness. If it is determined to not be effective, then revisions will need to be made until improvements in patient outcomes are seen. For example, HR reports can be reviewed to ensure nurses are not working over a certain number of hours or days per week. The nursing-sensitive indicator data should reflect an improvement in RN Satisfaction Survey Options and Voluntary Nurse Turnover.

C. System Resources, Referrals, or Colleagues

The primary ethical issue that stands out is the disregard for the patient’s values and beliefs in his Jewish Culture. The RN’s lack of compassion and integrity in regards to the half-eaten non-kosher meal needs to be addressed. As nurses, we are ethically bound to respect the cultural needs and preferences of our patients at the same time provide compassionate competent care. (Slate, 2015)

The first thing I would need to do is speak with the patient and the patient’s daughter. As nursing shift supervisor, it is my responsibility to reassure her that this issue is being addressed and at all levels to ensure it will not happen again. I would offer my sincere apology. I would also offer to make referral to appropriate religious affiliation to come and speak with the patient and daughter. I would also have a dietary consult done so that she could speak with them directly regard specific requirements for the patients Kosher diet.

The second step would be to determine where the system failure occurred in order to prevent the error from reoccurring. If it was an informatics error, I would need to communicate with the hospitals IT department to determine a work around until a resolution is found. If the problem was not found to be related to the information getting into the electronic system, then I would speak with the kitchen supervisor. I would verify that the supervisor is aware that the patient is to continue receiving a Kosher diet and dietary staff could then verify correct diet when delivering the meal.

Regardless if I discover a system error, I have a culturally sensitive issue with my nursing staff that needs to be addressed. I would implement a mandatory training for all unit staff on Patient Centered Care that emphasized cultural competency. (Flowers, August 2004) I would remind the nurses of their duty in the ANA Code of Ethics according to Slate (2015), “Respect for human dignity. In the provision of care, the nurse respects the beliefs and customs of the individual, family, or community” (p.2). The key would be not only to resolve this one issue but to ensure that it does not happen with another patient regardless of their cultural beliefs.

Finally, I would get with my nurse manager to set up an Interdisciplinary meeting including hospital administration to determine if this is a hospital wide issue that needs to be addressed. If it is determined to be a large-scale issue, then a committee needs to be formed to investigate the problem so a plan of action can be developed to resolve the issue. This is where nursing sensitive indicators may show what the exact problem creating the issue is such as, RN Satisfaction Survey Options. (Montalvo, 2007) Regardless of the cause, it is an issue that needs to be resolved for improved patient outcomes and patient satisfaction.

References

Flowers, D. L. (August 2004). Culturally Competent Nursing Care: A Challenge for the 21st Century. Crit Care Nurse, 24, 48-52.

Foulkes, M. (2011). Nursing metrics: measuring quality in patient car. Nursing Standard, 25 (42), 40-45.

Jack Needleman, P. P., Buerhaus, P., Mattke, S., Stewart, M., & Zelevinsky, K. (2002). Nurse-Staffing Levels and the Quality of Care in Hospitals. New England Journal of Medicine, 346, 1715-1722, http://DOI: 10.1056/NEJMsa012247.

Montalvo, I. (2007). "The National Database of Nursing Quality IndicatorsTM (NDNQI®)". OJIN: The Online Journal of Issues in Nursing. 12 (3), http://DOI: 10.3912/OJIN.Vol12No03Man02.

Slate, M. K. (2015, December). Nurses Code of Ethics. Retrieved from RN.ORG: http://www.rn.org/courses/coursematerial-177.pdf