SAT1 — SAT Task 1: Nursing Quality Indicators

Definition

The quality of nursing care is a longstanding concern for many healthcare settings. In the scenario, nurses can use the quality indicators to improve the care of Mr. J. The quality indicators signify three aspects of nursing care; process, structure, and outcome. The prevalence of restraints and the development of bedsores are indicators that nurses use to improve patient care (Kol et al. 2018). The use of restraints is a process nursing indicator. Restraints can affect the health of Mr. J, and its use is not recommended in this case.

Restraints are used to keep the patient in a proper position and prevent falling or movement (Estevez-Guerra et al., 2017). The nurses should only use restraints if it is clinically proven to be the only way to keep the patient safe. The use of restraints has both psychological and physical effects on the patients. Recent studies show that restraints are associated with the development of pressure ulcers and abrasions (Ha, 2021). The nurses, therefore, need to evaluate the restraint type and its potential to cause injury to patients.  The nurses should use restraints for the shortest time possible.

The decision to use restraints needs to be made by the multidisciplinary team, including doctors, physiotherapists, and occupational therapists. The application of restraint needs to be documented, and it needs the supervision of the nurses. Since Mr. J is restrained, he cannot provide for his basic needs, including toileting, drinking, turning, and eating. Nurses who provide care for this patient should be skilled in providing those services. The nurse needs to monitor the patient from time to time while providing the basic needs to him. In Mr. J, the patient was conscious and was able to recognize the daughter. The nurses were required to monitor and evaluate the patient as his current condition indicated that they should remove the restraints.

When assisting Mr. J  get up, his daughter noticed a red depressed area over his lower spine resembling  a sunburn. The patient had started developing a pressure ulcer. A pressure ulcer is an outcome nursing quality indicator (Razmus et al., 2017). The nurses needed to have conducted a pressure ulcer risk assessment and note that the patient had a higher risk of developing a pressure ulcer due to restraints. Nurses should apply patient interventions that address the pressure reduction and repositioning needs because reducing or eliminating the risk factors prevents pressure ulcer development. Since the patient has developed the pressure ulcer, the nurses need to assess the location, size, stage, and depth before coming up with interventions to promote healing and prevents it from developing into the next stage.

Advancing Quality Patient Care

Data of specific nursing quality indicators can advance quality patient care throughout the hospital. The data on quality indicators are used for quality improvement. Quality improvement is change-oriented, and the data is used in the healthcare setting to promote continuous efforts of nurses and the other multidisciplinary team to improve their performance (Kol et al., 2018). The data is used to inform policymakers in the healthcare settings on ways of motivating change in behavior and practices to reduce the incidences of pressure ulcers and the prevalence of restraints. Additionally, the data provides a basis for the pursuit of reliable care for the patients. The quality indicator data is used to define the strategies to reach desired goals in inpatient care. Continues measurement determines whether the instituted interventions are working or not (Dyess-Nugent et al., 2020). The quality indicator data are used constantly to improve care quality, strengthen user confidence, stimulate other professionals’ involvement, and reduce cost.

Resolving Ethical Issues

There are various system resources, referrals, or colleagues that I can use to resolve the ethical issue in the scenario. Nurses and other healthcare providers cannot use the code of ethics alone to resolve ethical issues (Van den Bulcke et al., 2018). Often other system resources are required to understand the complexity of the ethical dilemma. I can research the hospital policy and any legal information related to not following the Jewish patient’s dietary request from the hospital data system. I will review any similar case in healthcare similar to the case and how the organization managed it. Generally, an ethical consult exists in the healthcare setting. I would consider consulting an ethics consult service. The ethics consult service is a team of individuals who understand and resolve any complicated ethical issue involving dietary requests and mix-ups (Bressler et al., 2018). I would also consider all the levels of engagement when reviewing the ethical dilemma; societal level of biomedical ethics, the organizational level, and the clinical level. Finally, I would involve all the individuals involved in the ethical problems from the ward, the nutritional department, and the client to resolve the ethical issue.

Conclusion

Nursing quality indicators help nurses to identify issues that may interfere with patient care. Healthcare professionals can use data on quality indicators to improve the quality of care in healthcare settings. Nurses and other healthcare professionals need to use data on the quality indicator to assess, evaluate, and improve the quality of care. Legal information, health care policies, ethics consult services, and the nursing code of ethics are some of the resources that nurses can use to solve ethical dilemmas in healthcare settings.

References

Bressler, T., & Popp, B. (2018). Ethical challenges when caring for orthodox Jewish patients at the end of life. Journal of Hospice & Palliative Nursing, 20(1), 36-44.

Dyess-Nugent, P., Bouzid, J., Roberson, A., Quint-Bouzid, M., & Nelson, D. B. (2020). Development of a Quality Indicator to Measure Urgent Requests to the Bedside. Nursing for women’s health, 24(6), 404-412.

Estévez-Guerra, G. J., Fariña-López, E., Núñez-González, E., Gandoy-Crego, M., Calvo-Francés, F., & Capezuti, E. A. (2017). The use of physical restraints in long-term care in Spain: a multi-center cross-sectional study. BMC geriatrics, 17(1), 1-7.

Ha, S. M. (2021). Factors Influencing Nursing Practices of Physical Restraints Use by nursing students. Journal of the Korea Academia-Industrial cooperation Society, 22(4), 529-537.

Kol, E., Arıkan, F., Ilaslan, E., Akıncı, M. A., & Kocak, M. C. (2018). A quality indicator for the evaluation of nursing care: determination of patient satisfaction and related factors at a university hospital in the Mediterranean Region in Turkey. Collegian, 25(1), 51-56.

Razmus, I., & Bergquist-Beringer, S. (2017). Pressure Ulcer Risk and Prevention Practices in Pediatric Patients: A Secondary Analysis of Data from the National Database of Nursing Quality Indicators®. Ostomy/wound management, 63(2), 28-32.