Nursing-quality outcome indicators developed by national initiatives led by the American Nurses Association are designed to concentrate strategies and activities to improve patient care quality and safety. The following outcomes are commonly used as indicators of nursing quality:
• problems such as urinary tract infections, pressure ulcers, hospital-acquired pneumonia, and deep vein thrombosis (DVT).
• the patient collapses
• surgery patient problems such as infection, respiratory failure, and metabolic abnormalities
• the length of the patient’s hospital stay
• the prevalence of restraints
• the occurrence of failure to rescue, which may result in greater morbidity or fatality
• patient satisfaction
• nurse retention and staffing
SCENARIO
Mr. J, a 72-year-old retired rabbi, has been diagnosed with moderate dementia. He was brought to the hospital for treatment of a broken right hip after collapsing at home. He has been given pain medicine and is sleepy, but he responds adequately to basic inquiries.
Mr. J’s daughter, who lives eight hours away, came to see him a week after he was brought to the hospital. She discovered him bound in bed. Mr. J recognized his daughter and asked her to remove the handcuffs so he could be carried to the restroom while he was little asleep.
When the CNA was assisting Mr. J in sitting up in bed, his daughter saw a red, flattened region over Mr. J’s lower spine, which looked like a bad sunburn. She reported the event to the CNA, who said, “Oh, that’s nothing to be concerned about.” It will go away once he gets up.” The CNA assisted Mr. J to the restroom before returning him to bed and having him lie on his back so she could reapply the shackles.
Mr. J’s diet was “normal, kosher, chopped beef.” Mr. J was alone in his room the day after his daughter arrived when his supper tray was delivered.
Mr. J had eaten around 75% of the food when the nurse visited the room 30 minutes later. The plate containing the leftovers of a chopped pork cutlet was labeled “normal, chopped meat.”
“Just keep it quiet,” the supervisor advised the nurse. The nursing supervisor then informed the kitchen supervisor about the mistake. The kitchen supervisor informed the on-duty workers of what had occurred.
The patient’s daughter was not informed of the event when she arrived later that night.
The daughter was present the next night at suppertime when the tray was delivered by a dietary worker. “I’m very sorry about the pork cutlet last night,” the worker apologized to the patient’s daughter. When the daughter inquired about what had occurred, she was told that there had been “a mix-up in the order.” The daughter then inquired about the interaction with the nurse. While confirming the occurrence, the nurse assured the daughter, “Half a pork cutlet never killed anyone.”
The daughter then contacted the doctor, who contacted the hospital administration. The physician, who is also Jewish, informed the administrator that he had received multiple complaints in the previous six months from his hospitalized Jewish patients who felt that their dietary demands were not taken seriously by the hospital.
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.
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.
