Hospital mission statements provide a statement of purpose. They inspire employees to provide quality care. Remembering your mission statement in crucial situations can help stakeholders refocus and think more critically. In Nursing, there are many resources available, to which nurses can refer, to obtain information and education to assist them in providing quality care, based on scientific knowledge. This paper is an analysis of the Task 1 scenario involving Mr. J. in the RTT1 course. After assessing the scenario involving Mr. J. , several nursing sensitive indicators are apparent.
He is at risk for falls due to drowsiness, an altered cognitive status, a fractured hip and a history of falling. He is inappropriately restrained, there is an ethical issue that affects patient satisfaction, and he is at risk for pressure ulcers. When nurses and nursing staff are aware of the guidelines set forth by their organization, state licensing agencies and regulatory agencies, they can better serve their clients and offer an improved quality of care. Some state licensing agencies and regulatory agencies require hospitals to meet certain quality standards.
The Joint Commission (TJC), is a regulatory agency that is used by many hospitals. They survey hospitals to evaluate whether they meet accreditation requirements. Hospitals must show evidence of high quality and safe care. Hospitals with TJC accreditation, collect data on their performance, which is evaluated and measured against other accredited hospitals. TJC has standardized goal sets for hospitals, such as Quality Improvement goals and National Patient Safety Goals. (TJC, 2000). Accredited hospitals are expected to act in accordance with these goals.
Nurses should understand some of the history of the urgent call for quality improvement in healthcare and how to reduce preventable errors. In 2000, a book entitled, “To Err Is Human: Building a Safer Health System”, was published. In this report by the Institute of Medicine (IOM), experts reveals statistics of medical errors that occur in hospitals, and presents recommendations for improving patient safety. The report has widespread implications that assist regulatory agencies, nursing associations and government agencies to collaborate and implement new processes to improve patient care and safety (IOM, 2000).
In 1998, the American Nurses Association developed the National Database of Nursing Quality Indicators, (NDNQI). (Montalvo, 2007). NDNQI is used by hospitals to help improve patient care outcomes. NDNQI has a set of quality measures that hospitals use for collection and submission of their data. In the scenario with Mr. J. , he has several nurse sensitive indicators that warrant documentation as reportable quality measures such as fall risk, physical restraint prevalence, pressure ulcer prevalence and patient satisfaction. These indicators suggest that the patient needs a higher quality of care.
With the advent of electronic health records, nurses can document their findings in a more standardized manner. Aggregate data is more easily obtained with electronic records. When the data is submitted, it can be compared to other hospitals and it can be compared nationally. The process promotes performance improvement. Nurses must be well informed about nurse sensitive indicators, so that they can more effectively manage the bedside care, collaborate with the treatment team, make changes to the plan of care, monitor the effectiveness of the nursing interventions and evaluate the outcomes.
The measurement of these outcomes will assist the nurse in having knowledge about the effectiveness of the care they provide. In regard to the ethical issues in the scenario with Mr. J. , the supervisor should utilize problem solving skills. A tried and true measure, is the nursing process. When problematic situations arise, the nurse should assess, analyze and diagnose, plan, implement and evaluate. This process helps the nurse to think more critically to arrive at a quality resolution.
Even though the patient is confused at times, he should be notified of the error and assessed for any gastrointestinal discomfort and any spiritual upset. A meeting should occur with the staff involved, including the kitchen supervisor. After conferring with a nurse manager, the supervisor should utilize effective empathetic communication to notify the daughter and to apologize.
The daughter should also be informed of measures that will be implemented to prevent another occurrence of wrong diet. The supervisor should instruct the RN to document an incident report to be used internally by nursing managers, and administrative staff, to help put processes in place to prevent reoccurrences. The incident should be discussed by the patients’ treatment team, including the nurse, the doctor, the dietitian, and social worker. When new processes are to be implemented, the people involved require adequate education and training. Employees should be fully informed about the processes and systems in place to assist them with delivering high quality patient care.
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