Posted: May 25th, 2022

Organizational Systems and Quality Leadership

ORGANIZATIONAL SYSTEMS & QUALITY LEADERSHIP

Organizational Systems and Quality Leadership

Efforts to measure and improve the quality of nursing care provided to patients began with Florence Nightingale, who measured patient outcomes and worked towards the improvement of hospital conditions. Recently, studies linking nurses to patient outcomes have been given significant focus within healthcare. Efforts to measure the indicators of the quality of care dispensed by nurses have led to the phrase “nursing sensitive indicators,” which has become a buzzword in healthcare. These are “outcomes from patient care that reflect the nursing care provided” (Kelly, Vottero, & Christie-McAuliffe, 2014). These indicators reflect the structure, nursing care process, and nursing care outcomes (American Nurses Association, 2014). Structural indicators include nursing staff supply, skill level of nurses and certification. The process indicators include patient assessment measures of nursing interventions while outcome indicators include all patient experiences such as falls, pressure ulcers, and readmissions and reflect the quality and quantity of nursing care provided at the facilities (American Nurses Association, 2014). Understanding the concept of such indicators enables nurses to identify problems in healthcare delivery and indicate areas in which the quality of nursing care can be improved.

The nursing sensitive indicators confirm the association between nurses and patient outcomes like hospital-acquired nosocomial infections, patient falls, pressure ulcers, medication and feeding errors and other patient outcomes (Buerhaus, Staiger, & Auerbach, 2012). They explain the premise that nurses are responsible for dispensing good quality nursing care to patients. For example, falls portray patient’s neglect and the failure of nurses to ensure that their safety is guaranteed. However, dissatisfaction indicates is an indicator that portrays that the patient’s expectations are not met.

In the case of Mr. J, the error in feeding, the presence of pressure ulcers, the poor communication between nurses and the patient’s daughter, and the dissatisfaction of the daughter with the quality of care provided are helpful indicators determining the factors affecting nursing care in the facility. The understanding of these indicators requires nurses to work tirelessly for the betterment of services to the patient. In case the nurses were careful and had an understanding of the sensitive indicators relating to Mr. J, they would analyze the nursing problems and identify the possible solutions within the hospital.

For example, the nurses can examine the occurrence of errors in feeding of Mr. J and other patients. Besides, they can analyze the occurrence of pressure ulcers and their possible interference in with their prospect of offering high-quality care to patients. The factors interfering with quality of nursing care may include a shortage of nursing staff, poor nursing mix (RNs, LPNs, and nurse assistants), dissatisfaction of nurses with the working environment, and low education levels of nurses. The nurses would be able to identify nursing problems in the facility if they understood and developed the indicators.

The development of new indicators involves the identification of patient outcome issues via empirical researches (American Nurses Association, 2014). Data on patient outcomes and other nursing issues in hospitals is important in creating clear linkages between nursing contributions and nursing care outcomes. In the facility where Mr. J is receiving nursing care, hospital data on specific indicators can significantly lead to the formulation of appropriate strategies for the improvement of healthcare quality in the hospital. The data to be collected may include patient falls (the number of times that patients descend to the floor from their beds unexpectedly in 1000 days), the development of pressure ulcers by patients, and the occurrence of errors in drug administration or diet provision (Grove, Burns, & Gray, 2012).

The American Nurses Association has been lobbying state legislatures to include nursing sensitive indicator data collection in law and encouraging hospitals to collect data because it is useful in improving nursing care quality (ANA, 2014). In the case of Mr. J, the hospital can use data on nursing service indicators to examine the areas in which nursing care can be improved. For instance, if there is a high incidence of patient falls and pressure ulcers, it may indicate that nurses do not spend adequate time with patients. Data on nursing sensitive indicators also triggers secondary research on the staffing levels, efficiency of nurses, education levels among staff and other factors that may influence health care delivery. Collecting hospital data is henceforth vitally important to improvement of nursing practice and care delivery.

The scenario of Mr. J presents a case of unethical nursing practice. It is unethical for the nurses not to disclose errors to patients and their relatives. When such errors occur, nurses are expected to follow the accountability guidelines by reporting to supervisors who will take the necessary actions. The ANA code of ethics explains, “under no circumstances should the nurse participate in, or condone through silence, either an attempt to hide an error or a punitive response that serves only to fix blame rather than correct the conditions that led to the error” (American Nurses Association, 2013).

In this case, the ethical issue can be resolved through reporting to the nursing management in the hospital. Working together with the registered nurses and advanced practice nurses empowered with nursing leadership and problem-solving skills, a method for collecting data on the occurrence of errors in the hospital would be chosen and the data used to identify the nursing problem and the causes. The fact that Jewish patients have been opting to visit a facility 20 miles away indicates that errors in the hospital occur often. The most effective way of enhancing responsibility among nurses requires the adoption of effective ways of recording diet request errors and reporting to the patients/relatives. Once the problem is highlighted, adequate measures should be taken according to the research results.

References

American Nurses Association. (2013). Code of Ethics for Nurses with Interpretive Statements. Retrieved 2014, from Nursing World: http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf

American Nurses Association. (2014). Nursing-Sensitive Indicators. Retrieved 2014, from Nursing World: http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/PatientSafetyQuality/Research-Measurement/The-National-Database/Nursing-Sensitive-Indicators_1

ANA. (2014). ANA Indicator History. Retrieved 2014, from Nursing World: http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/PatientSafetyQuality/Research-Measurement/The-National-Database/Nursing-Sensitive-Indicators_1/ANA-Indicator-History

Buerhaus, P.L., Staiger, D.O., & Auerbach, D.I. (2012). Global Health Care: Issues and Policies. Sudbury, MA: Jones and Bartlett.

Grove, S.K., Burns, ?., & Gray, ?. (2012). The Practice of Nursing Research: Appraisal, Synthesis, and Generation of . St. Louis MO: Elsevier Health Sciences / Saunders.

Kelly, P., Vottero, B., & Christie-McAuliffe, C. (2014). Introduction to Quality and Safety Education for Nurses: Core Competencies. New York, NY: Springer Publishing Company.

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