In health care, nursing sensitive indicators are used to improve the quality of patient care. These indicators reflect the institutions procedures and resources that are used to deliver patient care (Patrician et al. 2010). In the case study presented, nursing sensitive indicators can be utilized in determining the concerns that interfered with the delivery patient care.
Understanding Nursing-Sensitive Indicators
A solid comprehension of nursing-sensitive indicators can aid health care providers in determining the factors that interrupt delivery of care to Mr. J. Heslop & Lu, (2014) point out that knowledge of proper restraint use and the type of care required when caring for patients in restraints as well as knowledge on how to prevent pressure ulcers can have been applied in preventing some of the issues in the cases study. For instance, the health care providers should have given Mr. J frequent breaks from the restraints, helped him to use the restroom regularly, and also helped him to turn from side to side changing positions at least after every hour. From the scenario, it is evident that Mr. J was given a meal that was not recommended for him. This is because Mr. Js order was kosher, but then he was served a pork chop cutlet. It is sad to note that the nursing supervisor was aware of what had happened but told the caregiver not to talk about the mix-up. As a result, the nurse neither informed Mr. J nor his family about the mistake. This is insensitive and can have an undesirable effect on Mr. Js satisfaction. Usually, mix-ups and mistakes do occur, and when they do, it is imperative for the responsible care givers to not only address them but also inform the patient and his family about the mistake. It can also be noted that the caregiver was also insensitive by saying that half a pork cutlet cannot kill anyone. If she understood the nursing-sensitive indicators, she could not have made such a reckless statement that is prone to affect patient outcomes.
Hospital Data and Nursing-Sensitive Indicators
Clinical data about certain nursing-sensitive indicators can be used in advancing the quality of patient care throughout clinical settings (Burston, Chaboyer & Gillespie, 2014). For instance, the data about the prevalence of pressure ulcers can be analyzed and be employed in determining best practices to decrease further occurrence of pressure ulcers. It is therefore advisable for health centers to have in place evidence based practice committees that study data about pressure ulcers. The committee should identify what factors trigger the occurrence of pressure ulcers in patients such as Mr. J. This will then provide room for developing standards of best practice to come up with strategies on how the occurrence can be prevented.
Also, hospital data about restraint use can be examined and help in promoting patient outcomes as well as satisfaction. The data can be dissected to identify if the restraints are warranted in certain situations, or if alternative methods could have been used. Documentation can also be assessed to identify whether the patients were cared for sufficiently during their hospital stay. It is recommended that patients should be freed from their restraints after approximately an hour, and be toileted. The health care providers should also do some range of motion exercises involving the extremities. The patients blood circulation and integrity of the skin are examined too. The practitioner should assess the pulses in the affected extremities after every hour. The documentation by the clinician should indicate all these examinations were carried out and necessary steps that were adopted.
Resources, referrals or colleagues that can be used to address the ethical issue in this scenario
In Mr.Js scenario, I would make use of various resources to solve the ethical concern. For instance, when informed about the mix-up of the meal, I would have sought the attention of Mr. Js daughter and inform her about the mistake. I would also have brought it to the attention of the dietary department about it. Also, I would have also informed the staff about the serving of the non-kosher meal and request them that in future they should counter-check and ensure that appropriate meals are served. As the supervisor, I would also talk to the family and assure that plans are underway to prevent such incidents in the facility. It is my belief that family members should be involved in making clinical decisions about their patients. Gallo et al. (2015) highlight that no family member should be lied to or omitted from some information as this could serve to undermine the trust and respect that the family members accord to the health care providers.
Another ethical concern that was noted in the case study was pressure ulcer development and the use of restraints. In the scenario, it is not clear if alternative methods were used before initiation of restraints. As the nursing supervisor, I would request the physician, physical therapist, the nurse, and the family to meet and discuss other methods that will warrant Mr. J safety other than the restraints. Proper auditing, documentation, and analysis should also be conducted to find out if restraints were warranted in this scenario. An ethics committee should also be established to examine the situation. Mr. J developed a pressure ulcer on his lower back which should have been prevented in the hospital setting. The clinical staff can prevent pressure ulcers by ensuring that the patient repositions after every two hours, there is proper, timely cleaning, proper cushioning of bony prominences as well as the use of bed mattresses. As the supervisor, I would also examine if the patient was cared for properly based on the above criteria. I would refer this case to the ethics committee as well. I would also organize for a training session to be carried out and refresh the knowledge of the nurses about caring for patients in restraints and prevention of pressure ulcers. A wound care nurse be will consult so that the practitioners can learn about the methods for reducing pressure formation in such patients.
In conclusion, Mr. Js scenario teems with ethical dilemmas. Proper use and understanding of nursing-sensitive indicators would have been beneficial in preventing the presented concerns. The health care providers should use the collected data from this case to avoid the occurrence of similar issues. Finally, as the nursing supervisor, I believe there are numerous approaches that can be implemented to solve the presented ethical concerns. There are also several resources at disposal whose expertise can be sought when addressing the ethical issues. Adoption of family centered care is also an important approach that practitioners should use regularly.
Burston, S., Chaboyer, W., & Gillespie, B. (2014). Nurse sensitive indicators suitable to reflect nursing care quality: a review and discussion of issues. Journal of clinical nursing, 23(13-14), 1785-1795.
Gallo, K. P., Hill, L. C., Hoagwood, K. E., & Olin, S. C. S. (2016). A narrative synthesis of the components of and evidence for patient-and family-centered care. Clinical pediatrics, 55(4), 333-346.
Heslop, L., & Lu, S. (2014). Nursing sensitive indicators: a concept analysis. Journal of Advanced Nursing, 70(11), 2469-2482.
Patrician, P. A., Loan, L., McCarthy, M., Brosch, L. R., & Davey, K. S. (2010). Towards Evidence-based Management: Creating an Informative Database of NursingSensitive Indicators. Journal of Nursing Scholarship, 42(4), 358-366.
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