Task 1: Organizational Systems and Quality Leadership
C489 Task 1
A. Nursing Sensitive Indicators
Nurses are the front line of healthcare. Nurses are the bodies at the bedside, completing assessments, building bonds and relationships, and looking for improvements in patients. The majority of the responsibility for complete and competent care rests on the nurse and nursing staff. Nursing-sensitive indicators are indicators that reflect on three aspects of nursing care; structure, processes, and outcomes (Montalvo, I., 2007). Along with other factors such as experience, education, and environment play into the impact of nursing care and patient satisfaction.
In favor of Mr. J, the patient could have received better patient-centered, quality care. In this scenario, Mr. J is at risk for falls but does not need restraints, with only mild dementia. In this case, the patient would benefit from a close observation system, including being identified as a high fall risk, being placed in a room close to the nursing station, having bed and chair alarms, an hourly rounding schedule, and a regular toileting schedule. Mr. J would benefit from a 1:1 sitter if staffing allows. With a mild dementia diagnosis, nursing staff should provide Mr. J with diversional activities and use education reinforcement for use of call lights to limit the risks of falls.
In this scenario, Mr. J also experienced skin breakdown. The area was reported to the CNA, who should always report concerns to the registered nurse overseeing the patient. To further prevent complications with skin, the nurse should be completing a full skin assessment daily, with two RNs to verify a change in condition or no change. Along with regularly rounding and toileting to prevent falls, the nursing team should be turning the patient every two hours. The nursing team should always have closed-loop communication when providing care and observing new conditions, communication in this situation was broken.
Even though one nurse is typically assigned to care for a given patient, it is duty of the whole nursing staff and interdisciplinary teams to care for patients. Imagine if one nurse was responsible for a cardiac arrest situation. Each member of the staff team, from nursing, to housekeeping to dietary are accountable for providing safe, nursing care to patients, even if they are just passing by a room not assigned to them. The focus of care includes all patient preferences and religious observations. When Mr. J received a non-kosher dietary tray, it should have sent back for the proper dietary needs. In the case of the supervisor and nursing staff looking to keep the mishap quiet, and nurses snide remark of pork never killed anyone were both inappropriate and poor treatment to the patient. To help provide the right diet to patients, their chart and meal slips should be clearly marked with diet orders and preferences, this supports culturally sensitive and individualized care to each patient....
