RTT Task 1
Western Governor’s University
RTT Task 1
Nursing-sensitive indicators can be an important tool in identifying patient care issues that could potentially arise during a hospital stay. By analyzing the data on specific nursing-sensitive indicators, the quality of patient care can be optimized and patient satisfaction can be improved. The American Nurses Association (ANA) and the National Database of Nursing Quality Indicators (NDNQI) are two sources of information and guidelines for nurses and nurse managers to use in planning patient care and workloads for each nursing unit. The use of available resources, staffing by acuity and patient needs, appropriate referral indicators, and cooperation among colleagues are all necessary components in providing ethical, safe, and patient-centered care in the hospital setting. Care of the patient should always center on the individual needs, wishes and cultural practices, within the framework of evidence-based patient care interventions. Nursing Sensitive indicators
“Nurses use theoretical and evidence-based knowledge of human experiences and responses to collaborate with healthcare consumers to assess, diagnose, identify outcomes, plan, implement, and evaluate care. Nursing interventions are intended to produce beneficial effects, contribute to quality outcomes, and above all, do no harm.” (American Nurses Association, 2010)
There are several nursing sensitive indicators that were either ignored or overruled in the case of Mr. J. Falls risk, dementia diagnosis, pain medications, immobility and cultural or religious values are all indicators that special steps must be taken in the care of this patient to avoid further harm and achieve quality patient care. Mild dementia can create problems in some patients with their ability to reason, make sound judgment, and respond appropriately to requests and interventions. The simple fact that he fell, has mild dementia, and is drowsy does not, according to ANA standards and the Joint Commission, make him a candidate for use of restraints. Falls risk indicators should be assessed on admission and at least every 24 hours post admission. Optimally, the falls risk should be addressed each shift, as in some patients with dementia there can be marked differences in cognitive levels of function at different times of day, making them more susceptible to falls at night. Unless a patient is in immediate danger of harming self or others, such as pulling out IV lines, trying to remove breathing or feeding tubes, or striking out at staff without being able to be redirected, there is no indication that restraints should be used. There are many restraint alternatives that can be employed in the care of patients who are at risk for falls, have cognitive issues, or are combative. Use of bed alarms, personal alarms, active listening, direct observation, one-to-one sitters, family visits, and redirection should all be attempted prior to obtaining a physician order for restraints. Restraints should never be applied without the knowledge of the attending physician, and there are very strict guidelines in place for frequent skin checks, restraint-removal trials, and frequent vitals and welfare checks. All staff, whether licensed care professionals or unlicensed assistive personnel should be aware of the institutional policies regarding use of restraints.
Likewise, the development of pressure ulcers while hospitalized is greatly increased by immobility. It takes only two hours of lying in one position for skin to begin breakdown, especially over bony prominences such as the buttock/coccyx area. This can also be exacerbated by incontinence, whether the incontinence is due to lack of control or simply lack of staff to assist in toileting needs. Quality patient care in the case of Mr. J would have to include restraint alternatives, falls prevention care plans, frequent skin checks, and frequent...
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