There are three types of nursing indicators that are essential in nursing care (Ausserhofer et al. 2013). Structural indicators demonstrate the quantity and quality of staff required to prevent burnout and ensure proper nursing training. This is to avoid mistakes when administering healthcare to a patient (Ausserhofer et al. 2013). In the case study of Mr. J, the caregiver has to have the skill to know how to handle issues and address them with complete professional and ethical conduct.
Process indicators emphasize importance of the nature of care given by a nurse. Nurses need to have assessment methods to know if what they are doing for patients is the right thing to do. Interventions by the hospitals and other caregivers should help a nurse acquitted of trends in healthcare (Ausserhofer et al. 2013). Job satisfaction and willingness to help a patient through it all makes a happy and healthy caregiver.
Outcome indicators address the need to prevent occurrence of issues regarding re-infection, falls and mishaps that might beget a patient who is admitted in a hospital. When Mr. J got a depressed area on his back due to long periods of lying down and not turning over, it was not only the hospital's fault but the caregiver as well. Addressing the small issues of negligence and knowing how to give optimal care to avoid the occurrence of accidents and infections in a hospital are crucial in ensuring minimum stays at hospitals for patients.
B. Advanced quality patient care through hospital data of nursing-sensitive indicators
Hospital data on pressure ulcer and restraints contains quality improvement models that can be used to prevent, treat and manage incidences of ulcers and reduce the use of restraints on patients. Data collected from the various risk assessment models provides vital information about the patient which can be used to determine the quality of care. Use of ulcer prediction tools increases nurses sensitivity to preventive measures. (The paragraphs below discuss the risk assessment models)
Risk assessment models help in identification of patients at a higher risk of developing ulcers. These include the Braden Scale that uses nutrition, sensory perception, moisture, mobility, activity and friction and shear for assessment. The Norton scale uses mental condition, physical condition, activity, incontinence, and mobility for assessment.
For restraints, proper assessment should be done to determine why a patient needs to be restrained and in what way. Minimization of restraints should be the overall goal when treating a patient with ulcers. This can be achieved through proper patient management.
Prevention includes interventions such as mechanical loading that involves turning patients, use of pressure reducing mattresses and education on preventative measure to nurses. Hospital data names procedures and methods of treating ulcers as cleansing, debridement, exudates management, good nutrition, and pain management practices. The management of pressure ulcers including treatment methods and prevention therapies are also essential in ensuring zero occurrences (Ausserhofer et al. 2013).
According to Ausserhofer et al. (2013), structural indicators include nursing knowledge and skill as well as additional education to ensure optimal care of the patient.
Process indicators that ensure patients are getting adequate time with nurses and quality healthcare are also essential to ensure that they are checked on and are in safe hands (Besner et al. 2013). In Mr. J case scenario, encouraging him to use an incentive spirometer would be a proactive approach to reducing his risk for hospital-acquired pneumonia. Also, the use of the turning schedule could also help alleviate some of the threat that Mr. J faces of developing Pneumonia. This is so because the Turn schedule will provide mobility. The nurse should even occasionally get Mr. J out of bed and into a chair for the better part of the day. This would lessen his risks too.
The prevalence of pressure ulcers, prevalence of restraints and the risks of nosocoial infection are the primary nursing-sensitive indicators to reflect in this scenario. It is essential to conduct a thorough skin assessment which includes a Braden scale assessment every time a patient is admitted to hospital (Gadd and Morris, 2014). Through the evaluation, it will be possible to identify any pre-existing pressure ulcers or skin problems in the patient. The use of a Braden scale assessment will help predict whether a patient is at a high risk for pressure ulcers or not (Gadd and Morris, 2014). Pressure ulcer prevention can be improved through the use of specialty mattress which can be used to screen the patient. The hospital should have a clear policy on the use of restraints which however should be considered as a last resort. The Pressure ulcers developed by Mr. J are as a result of the immobility. This can be prevented by the use of a turn schedule and a specialty air bed.
C. Resolving the Ethical Issue of Mr. J
Steps in solving ethical dilemmas
The first step is to determine whether the issue is a medical dilemma. The second step would be to seek additional information from the patient and the involved parties on the case. If the issue checks out, the hospital administration should explore legal and professional guidance and then launch investigations into the issue. Depending on the findings, it should be decided whether the hospital should issue an apology or not. The patients decision is important in deciding the next course of action. A decision should then be made that is justifiable with sound arguments. If the issue cannot be resolved, it is then necessary to seek court declarations to be able to move forward (Ausserhofer et al. 2013).
Mr Js scenario
In Mr Js case, the situation is a medical dilemma since he was fed with food he is not supposed to eat. The nursing supervisor should first notify the hospital administration about the situation. Next he/she should talk to Mr J to obtain more information on whether it is true he ate the said food and if any hospital staff saw him eat the food. The nursing supervisor should then apologize to the patient and his daughter and get feedback on the course of action from Mr J or his representative. It should be determined if Mr J can make a decision by himself. If Mr J is accepts the apologies and decides not to press charges, the case is thrown out and the hospital takes measures to curb the occurrence of a similar situation in future. However if they decide to press charges, the nursing supervisor should seek relevant professional and legal guidance moving forward. A critical analysis should be done by the hospital clinical ethics committees to come up with a plan to defend the charges or work on a compensation plan for Mr J. For the staff involved in the mix-up, if there is a cause for disciplinary action, the hospital chiefs in conjunction with a disciplinary committee should be able to come up with a course of action and take measures to avoid such an incident from happening again.
Ausserhofer D, Schubert M, Desmedt M, Blegen MA, De Geest S. Schwendimann R. (2013) The association of patient safety climate and nurse-related organizational factors with selected patient outcomes: a cross-sectional survey. International Journal of Nursing Studies.
Besner, J., Doran, D., McGillis Hall, L., Giovannetti, P., Girard, F., Hill, W., ... & Watson, L. (2005). A systematic approach to maximizing nursing scopes of practice. Ottawa, ON: Canadian Health Services Research Foundation.
Gadd, M. M., & Morris, S. M. (2014). Use of the Braden Scale for pressure ulcer risk assessment in a community hospital setting: The role of total score and individual subscale scores in triggering preventive interventions. Journal of Wound Ostomy & Continence Nursing, 41(6), 535-538.
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