ASSIGNMENT HELP | SAT TASK 1: NURSING-QUALITY INDICATORS

INTRODUCTION
National initiatives driven by the American Nurses Association have determined nursing-quality outcome indicators that are intended to focus plans and programs to increase quality and safety in patient care. The following outcomes are commonly used nursing-quality indicators:

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• complications such as urinary tract infections, pressure ulcers, hospital-acquired pneumonia, and DVT

• patient falls

• surgical patient complications, including infection, pulmonary failure, and metabolic derangement

• length of patient hospital stay

• restraint prevalence

• incidence of failure to rescue, which could potentially result in increased morbidity or mortality

• patient satisfaction

• nurse satisfaction and staffing

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SCENARIO
Mr. J is a 72-year-old retired rabbi with a diagnosis of mild dementia. He was admitted for treatment of a fractured right hip after falling in his home. He has received pain medication and is drowsy, but he answers simple questions appropriately.

A week after Mr. J was admitted to the hospital, his daughter, who lives eight hours away, came to visit. She found him restrained in bed. While Mr. J was slightly sleepy, he recognized his daughter and was able to ask her to remove the restraints so he could be helped to the bathroom. His daughter went to get a certified nursing assistant (CNA) to remove the restraints and help her father to the bathroom. When the CNA was in the process of helping Mr. J sit up in bed, his daughter noticed a red, depressed area over Mr. J’s lower spine, similar to a severe sunburn. She reported the incident to the CNA who replied, “Oh, that is not anything to worry about. It will go away as soon as he gets up.” The CNA helped Mr. J to the bathroom and then returned him to bed where she had him lie on his back so she could reapply the restraints.

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The diet order for Mr. J was “regular, kosher, chopped meat.” The day after his daughter arrived, Mr. J was alone in his room when his meal tray was delivered. The nurse entered the room 30 minutes later and observed that Mr. J had eaten approximately 75% of the meal. The meal served was labeled, “regular, chopped meat.” The tray contained the remains of a chopped pork cutlet.

The nurse notified the supervisor, who said, “Just keep it quiet. It will be okay.” The nursing supervisor then notified the kitchen supervisor of the error. The kitchen supervisor told the staff on duty what had happened.

When the patient’s daughter visited later that night, she was not told of the incident.

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The next night, the daughter was present at suppertime when the tray was delivered by a dietary worker. The worker said to the patient’s daughter, “I’m so sorry about the pork cutlet last night.” The daughter asked what had happened and was told that there had been “a mix up in the order.” The daughter then asked the nurse about the incident. The nurse, while confirming the incident, told the daughter, “Half a pork cutlet never killed anyone.”

The daughter then called the physician, who called the hospital administrator. The physician, who is also Jewish, told the administrator that he has had several complaints over the past six months from his hospitalized Jewish patients who felt that their dietary requests were not taken seriously by the hospital employees.

The hospital is a 65-bed rural hospital in a town of few Jewish residents. The town’s few Jewish members usually receive care from a Jewish hospital 20 miles away in a larger city.

REQUIREMENTS
Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

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Analyze the scenario (suggested length of 2–3 pages) by doing the following:

A. Discuss how the application of nursing-quality indicators could assist the nurses in this case in identifying issues that may interfere with patient care.

B. Analyze how hospital data of specific nursing-quality indicators (such as incidence of pressure ulcers and prevalence of restraints) could advance quality patient care throughout the hospital.

C. Analyze the specific system resources, referrals, or colleagues that you, as the nursing shift supervisor, could use to resolve an ethical issue in this scenario.

D. Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.

E. Demonstrate professional communication in the content and presentation of your submission.

MODEL ANSWER

Nursing-Quality Indicators

1. How the Application of Quality Indicators could Advance Quality Care in Hospitals

In the provided scenario, the hospital neglected many things that they could have prevented by applying quality indicators in | PLACE YOUR ORDER NOW AT writtask.com | a 72-year-old rabbi diagnosed with mild dementia and admitted for a fractured right hip due to a fall in his home. He is receiving pain medication that makes him drowsy but capable of answering questions | PLACE YOUR ORDER NOW AT writtask.com | concerns the patients’ high-risk of falling. In-patient falls are a common avoidable problem that hospitals can prevent using quality indicators like fall armbands and bedside alarms to identify high-risk patients for | PLACE YOUR ORDER NOW AT writtask.com | nurse restrains Mr. J due to his dementia and risk of falling. However, the restraints can increase the risk of patient harm and lead to other complications such as pressure ulcers due to lack of mobility (MacDonald et al., 2018). Applying quality indicators could help in averting the use of | PLACE YOUR ORDER NOW AT writtask.com | recognized a red depressed area on Mr. J’s lower back, which is a symptom of pressure ulcers.

The other issue was the patient’s diet order, which was supposed to be “regular, kosher, chopped meat” due to the patient’s | PLACE YOUR ORDER NOW AT writtask.com | in the order caused the patient to consume chopped pork against his Jewish traditions. The daughter’s complaints and those from other patients could have indicated dissatisfaction and low-quality | PLACE YOUR ORDER NOW AT writtask.com | should set procedures that ensure high-quality care to patients and | PLACE YOUR ORDER NOW AT writtask.com | should make use of checklists with patients’ meal orders to avoid such confusion. Nosocomial complications such as pressure ulcers that develop require further investigation to prevent escalation. Applying quality indicators will help healthcare facilities to follow protocols to eliminate threats like malpractice lawsuits.

• Advancing Quality Care of Patients

The Quality Assurance (QA) unit gathers and keeps documentation on restraint | PLACE YOUR ORDER NOW AT writtask.com | gathering process helps healthcare institutions’ multidisciplinary teams analyze data, make a sound decision, and employ hospital procedures and policies to sensitive areas to enhance | PLACE YOUR ORDER NOW AT writtask.com | incidences reflect quality indicators occurring in three subdomains; unit acquired, nosocomial, and community-acquired. A high rate of pressure ulcer incidences in a specific hospital unit could indicate a problematic area requiring further investigation to identify possible solutions and | PLACE YOUR ORDER NOW AT writtask.com | pressure ulcers could have originated from hospital equipment or other factors such as the nurse’s neglect in the scenario. A root-cause evaluation could help in establishing why the incidences are occurring and formulating solutions.

• How to Resolve Ethical Issues

In the scenario, the first ethical issue is the avoidable use of restraints and dismissal of potential signs of pressure ulcers. The nurse should use ethical principles of nonmaleficence and beneficence while restraining patients from ensuring | PLACE YOUR ORDER NOW AT writtask.com | use restraints as the last recourse after trying low-tech solutions such as patient | PLACE YOUR ORDER NOW AT writtask.com | will cater to patient needs, such as bathroom visits, feeding, and diet orders. Moreover, the rehabilitation unit could help with the patient’s mobility to avoid | PLACE YOUR ORDER NOW AT writtask.com | is the unethical nurse’s behavior towards the patient and his daughter and disrespect for their cultural heritage. The nurse could have addressed the patient’s concerns instead of treating them as trivial. As the supervisor, I would use the ANA ethics code that provides guidelines for | PLACE YOUR ORDER NOW AT writtask.com | is using ethical teams in the risk management units to help talk with the family and apologize for the error. The objective …

References

MacDonald, V., Maher, A. B., Mainz, H., Meehan, A. J., Brent, L., Hommel, A., … & Sheehan, K. J. (2018). Developing and testing an international audit of nursing quality indicators for older adults with fragility hip fracture. 37(2), 115-121. https://doi.org/10.1097/NOR.0000000000000431

Mitchell, D., Panchisin, T., Seckel, M.  (2018, August). Critical care nurse: Reducing use of restraints in intensive care units: A Quality Improvement Project, 38(4). https://doi.org/10.4037/ccn2018211

Nora, C. R. D., Deodato, S., Vieira, M. M. D. S., & Zoboli, E. L. C. P. (2016). Elements and strategies for ethical decision-making in nursing. 25(2). https://doi.org/10.1590/0104-07072016004500014 

Passmore, S. (2018, December 13). What are nursing quality indicators? https://www.americansentinel.edu/blog/2011/11/02/what-are-nursing-sensitive-quality-indicators-anyway/