RTT1 - Organizational Systems and Quality Leadership Task 1 WGU

RTT1 - Organizational Systems and Quality Leadership Task 1 WGU Western Governors University

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TASK 1

1.     A.     Understanding Nursing Sensitive Indicators

Nursing sensitive indicators reflect the structure, process and outcomes of nursing care. The structure of nursing care is indicated by the supply of nursing staff, the skill level of the nursing staff, and the education/certification of nursing staff. Process indicators measure aspects of nursing care such as assessment, intervention, and RN job satisfaction. Patient outcomes that are determined to be nursing sensitive are those that improve if there is a greater quantity or quality of nursing care. ("Nursing world," 2013) Knowledge of these indicators could have assisted the nurses in several ways involving this case. Knowledge of pressure ulcer prevalence could have helped the nurse prevent one in this patient.  The nurse and CNA would have known to reposition the patient to prevent them, and would have recognized the red area as the first stage of a pressure ulcer. The CNA would not have put the patient back on his back when he got back to bed.  Restraint prevalence could also have assisted the nurse’s understanding of when restraints should be applied, and the proper way of managing a patient on restraints.  Patient satisfaction is another nursing sensitive indicator that was obviously not taken into account here. If it were, the nurse would not have dismissed the wrong diet being delivered so easily, and would have kept the daughter aware of what happened. The nurse would also have not made an inappropriate comment to the daughter if she had patient and family satisfaction in mind.

1.     B.     How Hospital Data Could Advance Quality Care

If the hospital in this case kept data on nursing sensitive indicators and distributed it to staff, it would raise awareness of the issues that need to be addressed and that were a documented problem. It would empower the nurses because these indicators are something they can have a direct impact on.  It would advance quality patient care because the staff would be educated to be on the lookout for potential issues. In this case restraint use, pressure ulcers, and patient satisfaction could have been dealt with in a better way to improve patient outcomes and satisfaction. The pressure ulcer could have been prevented, the restraints could have maybe been avoided and the patient and family would have felt like the hospital cared about their needs.

1.     C.     Resources Available

Fortunately, there are several resources in the hospital for the nurse to partner with to address nursing sensitive indicators. To help resolve the ethical issues in this scenario, I could partner with dietary to come up with a solution to make sure the correct trays are delivered.  I could personally approach the patient and the daughter and apologize for the incident. I would speak to the nurse regarding her inappropriate comment to the daughter. I would also contact the doctor to further discuss the incident and what could have been done to prevent it. I could also discuss the need for restraints with the doctor. I could consult my nurse manager for advice in dealing with the situation.  I could provide education to the CNA regarding the importance of noticing the first signs of a pressure ulcer. I could use the lift team to help reposition the patient.  I could request a wound care consult from our wound care nurse to address the developing pressure ulcer. I could make a referral to social work to address any issues the family may have after discharge. For more complex ethical issues I could consult my hospital’s ethics committee and have the case reviewed by them.