Organizational Systems and Quality Leadership
Applying nursing-quality indicators has been intended to focus on plans and programs to increase quality and safety in patient care by identifying issues that may interfere with patient care. In the scenario provided by Mr. J, nursing-sensitive indicators are analyzed for an understanding of the issues that interfere with patient care. Some commonly used nursing-sensitive indicators are complications such as pressure ulcers, restraint prevalence, and patient satisfaction outcomes. A few system resources could be used to resolve the ethical issue in regard to Mr. Js scenario.
A week after Mr. J was admitted to the hospital for treatment of a right hip fracture after falling in his home, his daughter came to visit. She found him restrained in bed and noticed a red, depressed area over Mr. Js lower spine, similar to a severe burn. When his daughter reported it to the certified nursing assistant (CAN), the CNA merely replied, Oh, that is not anything to worry about. It will go away as soon as he gets up. The use of restraints is the first issue. In this scenario, they have described Mr. J as having mild dementia and status post-fall resulting in a fracture. However, there is no mention of the nursing staff trying other less restrictive measures to keep Mr. J safe in bed. There are less restrictive measures that could have been attempted by the nursing staff before resorting to using of restraints. Nursing staff may have tried using a bed alarm to alert them when Mr. J tries to get up unassisted or moving his room closer to the nursing station for closer monitoring.
Another problem is hospital-acquired pressure ulcers. Due to Mr. Js current condition of being restrained in bed, the nursing staff needs to assess his skin integrity and assess his needs such as bathroom needs and hydration at least every 2 hours. Patients should check on patients hourly, and turn and reposition them every two hours to prevent skin breakdown. After helping Mr. J to the bathroom, the CAN assist Mr. back to the bed to reapply restraints. The restraints did not allow as much movement with Mr. J, which further decreased Mr. Js mobility, making him more prone to pressure ulcers. The CNA also should have reported the skin breakdown to the registered nurse (RN) and had Mr. J. lie on his side to prevent further pressure on his lower spine. The RN should have been notified by the CNA so the RN can assess the area, assess for any pain or discomfort that Mr. J might be experiencing, and to implement ways to treat the pressure ulcer and prevent it from getting worse. Skin treatment and pressure-relieving devices may be used to prevent further skin breakdown. Mr. J may also be referred for a dietary consult for his nutrition related to skin breakdown.
The third problem in this scenario is patient satisfaction. When the patient's daughter reported the pressure ulcer to the CNA, the CNA merely dismissed the daughte...