Nursing and culturally Sensitive Care Essay

RTT Task One: Nursing Sensitive Indicators
Angela Kroemer
Western Governors University

RTT Task One: Nursing Sensitive Indicators
An important aspect of nursing care, nursing-sensitive indicators provide measurements of how a health care facility as a whole provides quality care to its customers: the patients, their families, and the community it serves. An understanding of what these indicators are and how they are used allows nurses and the entire health care team to monitor patients for early recognition of potential adverse events, complications and errors. In the scenario of Mr. J., who was admitted to the hospital after sustaining a mechanical fall at home which resulted in a fractured hip, several potential and actual issues for harm were noted which are indicative for closer examination. The following indicators all relate to the given scenario with Mr. J:
Patient satisfaction with pain management, nursing care, overall care, medical information provided.
Pressure ulcers
Patient falls
Nursing job satisfaction
Rates of hospital acquired infections
Total hours of nursing care per patient per day
Staffing mix (ratios of RNs, LPNs, unlicensed staff

Problems with Mr. J’s skin breakdown and risk for falls, along with his dietary concerns could have been avoided or reduced if the staff had provided better patient-centered care and using evidence based practices while working together as a whose primary focus would be to provide the safest and best care possible for Mr. J. Obvious risks for injury include Mr. J’s history of dementia, which may have contributed to his fall at home. Now being medicated for pain, his cognitive function has the potential to further decline and contribute to his risk of falling in the hospital due to confusion and inability to ambulate on his own or ask for help. By placing restraints on Mr. J, the staff increased his risk of injury by increasing the potential for pressure ulcer development due to immobility. The potential for lying on moist skin for extended periods of time due to possible incontinence further puts him at risk for skin breakdown. The possibility of loosening a restraint and getting tangled up in the bedrails is a very real risk for injury and can contribute to falls, slips, and even airway problems including suffocation. His risk for infection is increased due to possible urinary catheter placement, or fecal incontinence. The surgical incision site and probable implanted metal devices in Mr. J’s hip are also potential sites of infection and Mr. J’s vital signs and mental status should be closely monitored for any possible signs of sepsis and or blood loss. He is also at risk for hospital acquired pneumonia and DVT since he is bedbound and unable to ambulate without assistance. An understanding of nursing-sensitive indicators such as falls, pressure ulcers, patient satisfaction as well as staffing deficiencies and level of education could have greatly reduced Mr. J’s potential for the problems he experienced during his hospitalization. The risks for these problems would have significantly decreased by having both the nurses and aides make more frequent rounds on the patients. Physical therapy could also be involved in making observations while ambulating the patient and reporting back to the nurse and charge nurse any potential skin issues. Frequent skin checks, toileting and repositioning as well as padding of bony prominences should be performed and documented on a routine basis and verbal reports of skin integrity maintained at hand off. All staff members, including unlicensed personnel need to be educated on how to be vigilant in observing for potential skin and tissue injury. Photo documentation of existing skin wounds should be performed on admission to assist nursing staff and physicians in preventing further injury to existing skin problems. Restraint protocols should be strictly followed and the least restrictive methods should be

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