Nursing Sensitive Indicators

It is important for nurses to understand that patient outcomes are directly impacted by the care they receive. Nursing Sensitive Indicators were developed to provide a national quantifying measured set as a way to measure outcomes against processes in relation to nursing care. (Montalvo, 2007) If nurses are able to recognize gaps in care, situations where poor quality of care tend to be more prevalent, or when high risk safety concerns affect care they may be able to prevent negative outcomes from occurring. Nurses have a duty to provide safe quality patient centered care and as an advocate must take action when that standard of care cannot be provided.

A. Nursing Sensitive Indicators

Understanding of the nursing-sensitive indicators can help the nurses in the case scenario to identify the issues that may have contributed to the interference in the delivery of quality care. There were three nursing-sensitive indicators that had a significant impact on the negative outcome of quality care in this scenario; Restraint Prevalence, Pressure Ulcer Prevalence, Skill Mix. (Montalvo, 2007) Knowledge on appropriate restraint use and the facility’s policy when providing care to Mr. J could have prevented some of the major issues, which have a significant impact in this case. Mr. should have been assessed to determine of the restraints were necessary. If found to be necessary, he should have been properly monitored, released from the restraints at appropriate intervals, and repositioned at least every two hours. The RN providing care for Mr. J should have recognized the nursing-sensitive indicator for Restraint Prevalence and taken these measures to correct the situation. She failed to in her duty to provide safe quality care to her patient. Another nursing-sensitive indicator the RN failed to recognize was for Pressure Ulcers Prevalence. This is especially important in patients that are placed in restraints since the patients are unable to change positions independently. This failure to recognize resulted in Mr. J developing a pressure ulcer from not being repositioned by the nurse or the CNA at least every two hours. One nursing-sensitive indicator that was neglected that may have led to better quality care was Skill Mix. The staffing of care providers for Mr. J consisted of the RN and the CNA. Due to the complexity of Mr. J’s care, a LVN would have been a more beneficial part of the care team than a CNA. The LVN would have recognized the need to release the patient from the restraints frequently as well as reposition the patient. The LVN would have also had the nursing knowledge to recognize the redness as a pressure ulcer and the need to take action to prevent further breakdown. This goes to show the importance of having a nurse providing more direct care for patients in high risk situations when the skill level is needed beyond what unlicensed assistive personnel is qualified to provide. (Jack Needleman, Buerhaus, Mattke, Stewart, & Zelevinsky, 2002)

B. Quality Patient Care

While it is important for nurses to understand nursing-sensitive indicators and provide quality safe nursing care, it is impossible to eliminate all negative outcomes. It is important for hospitals to collect data on negative outcomes resulting from nursing-sensitive indicators. The availability of the hospital data can help improve the quality of care given by the nurses. For instance, the availability of data on the Restraint Prevalence could result in a committee looking at the hospitals policy and procedure of restraint use. A new staff training program on restraints may be developed and implemented. The Risk Management Team may look at the data on Pressure Ulcer Prevalence to determine the factors leading to patients developing pressures ulcers while in the facility. Quality Improvement plans can be developed and implemented by monitoring patient outcomes, collecting the data and analyzing the results. This is a continuous process that is critical to quality patient care and new process must be tested for effectiveness or changed accordingly. (Foulkes, 2011)

Capturing data can be difficult especially throughout an entire hospital system. The National Database of Nursing Quality Indicators can be utilized by hospitals as a way to collect and analyze data to show a correlation between nursing care and patient outcomes. The reports are compiled quarterly and annually for the individual nursing units within the hospital. By having the reports done on a unit level instead on a hospital wide level, it is easier to determine where the nursing-sensitive indicator negative outcomes are occurring and improvements need to happen. (Montalvo, 2007) Hospitals can use this data to improve the quality of care throughout by making the data available to the nurse managers and staff nurses on each unit and allowing them to be a part of the improvement process. Nurse managers may need to look at staffing structure on their unit to see if this is a reflection of the poor data. They may need to implement new scheduling measures to ensure appropriate staff is available for the unit. Each unit could establish quarterly goals for improving patient outcomes and participate in training programs for areas where negative outcomes have been a concern. (Montalvo, 2007)

On a more widespread facility approach, the hospital could share the data with the Quality Improvement Team to develop a committee to review process that are in place for areas of negative outcomes. The policies and procedures may need to be updated to reflect Evidence Based Practice. They may need to consider process that have safe guards in place. For example, if a patient needs to be placed in restraints then having the RN and the Charge Nurse sign off