Summary: Nursing Sensitive Indicators

Running Head: NURSING-SENSITIVE INDICATORS

Nursing-Sensitive Indicators
(my name)
Western Governors University

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Nursing-Sensitive Indicators
In 1994 the American Nurses Association began work to demonstrate that the profession of nursing has many unique opportunities in which the practice of nursing may impact patient care (ANA, 2014a). This paper analyzes Nursing-Sensitive Indicators (NSI) and how they may have impacted patient care in a scenario involving a 72-year-old patient, Mr. J, in a small local hospital. A. Nursing-Sensitive Indicators
In the case presented, Mr. J’s experience during his hospitalization brings to mind several
Nursing-Sensitive Indicators. One of the Nursing-Sensitive Indicators
that could impact the care of a patient such as Mr. J with a diagnosis of Mild Dementia could be “Restraints” (ANA,
2014b). In his case, Mr. J was administered pain medication that made him drowsy. The staff applied restraints to assure that Mr. J did not attempt to ambulate to the restroom alone. If the involved staff members had thorough understanding of the proper use of restraints, the unintended outcomes could be minimized and Patient safety could be optimized.
Mr. J is at risk for fall and re-injury to his right hip. “Patient Falls” or “Patient Falls with
Injury” are other Nursing-Sensitive Indicators that could be applied in this scenario (ANA,
2014b). Staff knowledge of and implementation of the proper methods of ambulation for a patient with a hip injury would optimize the outcome of this case.
The use of restraints may lead to prolonged inactivity. If the involved staff had an understanding the proper care of a restrained patient, complications such as pressure ulcers may be avoided. “Pressure Ulcer Rate” is another Nursing-Sensitive Indicator (ANA, 2014b). Even a minimal knowledge of prevention of pressure ulcers could make a dramatic impact in the

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possibility of Mr. J developing a pressure ulcer. It was noted in the scenario that Mr. J had physical indications that a pressure ulcer may be developing.
The certified nursing assistant’s (CNA) response to Mr. J’s daughter regarding this physical indicator may demonstrate a lack of understanding of the process of pressure ulcer stages of development. The Registered Nurse responsible for the care of Mr. J should use this as an opportunity to educate the CNA.
It could be argued that the Nursing-Sensitive Indicator of
“RN Education/Certification” could be applied here (ANA, 2014b).
As the scenario further develops, Mr. J is served an incorrect meal tray. This error had the potential to not only impact him physically due to his gastrointestinal tolerance, but it could inflict spiritual injury on Mr. J due to his religious beliefs. The Nursing-Sensitive Indicator of
“Patient Satisfaction” could be applied in this instance. If the staff were aware of communication methods for disclosing errors to patients, the level of satisfaction that Mr. J had with their care could be impacted. Being honest with the patient and family could exponentially impact patient satisfaction. If an error is made and it is honestly and remorsefully disclosed, patients/families often find it easier to forgive the error.
Although many things were done wrong regarding this occurrence, the additional errors will not be discussed in this paper.
B. Quality Patient Care
Empirical data and the analysis of that data have impacted patient care. Collecting data on nursing actions has proven that the professional nurse has the ability to change the outcome of
patient
care.

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Data collection regarding the use of restraints has changed the manner in which restraints are used. Restraints are no longer used with every geriatric patient with a fall risk or mild dementia. This data has proven that the use of restraints for these patients may not lead to optimal outcomes for these patients and that unintended patient injury may occur. The American
Nurses Association has issued a practice statement based on years of research findings that supports minimal use of patient restraints (Center for Ethics and Human Rights, 2012). Stringent adherence to local policy and nursing guidelines is mandatory at most hospitals. The quality department at most hospitals monitors this and collects local data to document adherence and patient outcomes.
Falls precautions were implemented out of the collection of data that indicated who, and under which circumstances a patient might be likely to fall. This is another data set that is collected at the local level. If the data documents that an individual unit or division has an increase in the incidence of falls, education can be directed at the staff on the particular unit(s).
The development of pressure ulcers can impact the length of stay for a patient as well as inflicting unwelcome complications on the patient. Wound care specialists along with the
Quality Department monitor the incidence and outcomes of any pressures that develop. The costs and complications of patient care increase with the development of pressure ulcers. The use of different techniques or tools are continually monitored and assessed to determine if changes can be made to improve patient outcomes. As a result of changing the type of beds at my hospital, the incidence of pressure ulcers decreased. This change was first made at a single inpatient unit level, but when local data demonstrated that outcomes were improved, the beds were then placed throughout our hospital system.

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C. System Resources, Referrals, or Colleagues
Acting as the Shift Supervisor in the presented scenario, several opportunities are offered in which referrals could be made or resources could be used. Regarding the use of restraints, the
CNA should be referred to the RN responsible for the care of Mr. J. Appropriate use of restraints and the care of a patient in restraints could be discussed. If the individual RN has a knowledge deficit in this area, the Unit Educator or Nurse Manager would be an appropriate resource for this education.
The Nursing Education Department would also be a reliable resource for the needed education.
Falls precautions could be addressed in a similar manner. The Unit Educator, Nurse
Manager, or the Nursing Education Department could provide educational materials or inservices. Another resource for falls prevention is the Physical Therapy Department. They could provide education regarding proper body mechanics and transfer techniques.
Serving the patient with an incorrect meal tray is an issue that impacts the patient at a spiritual level. Spiritual injury is not a commonly dealt-with problem. As the Shift Supervisor, it is appropriate to immediately notify the kitchen staff of the error. It would also be appropriate to acknowledge the error with the patient. If the patient does not have the mental capacity to fully understand and appreciate the situation being presented to him, it would be appropriate to notify the family member who is responsible for his care. This would be the daughter in Mr. J’s case. If the nursing staff does not fully understand the gravity of the meal tray error, it would
be appropriate to provide education to staff members, perhaps offering education at a unit or system-wide level. The chaplain’s office in many hospitals could provide this education. If outside resources were needed, it would be prudent to enlist the assistance of a local rabbi.

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Neglecting to address this error is disrespectful to the patient. Mr. J may not have suffered a physical injury because of the error, but certainly was spiritually injured. It would be in the best interest of the hospital for the Shift Supervisor to notify both Risk Management and
Hospital Administration.

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References
American Nurses Association, (2014a). ANA Indicator History. Retrieved from http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/P atientSafetyQuality/Research-Measurement/The-National-Database/Nursing-SensitiveIndicators_1/ANA-Indicator-History.
American Nurses Association, (2014b). Nursing-Sensitive Indicators. Retrieved from http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/P atientSafetyQuality/Research-Measurement/The-National-Database/Nursing-SensitiveIndicators_1.aspx
Center for Ethics and Human Rights, (2012, March 12). American Nurses Association Position
Statement: Reduction of Patient Restraint and Seclusion in Healthcare Settings.
http://www.nursingworld.org/restraintposition