Nurse Sensitive Indicators

Quality improvement issues in healthcare focus on the care that patients receive and the outcomes that patients experience. Nurses play a major advocacy role for ensuring safe and quality care to all patients. Also, nurses share the responsibility in leading the efforts in improving patient care in all settings (Berwick, 2002). One of the ongoing problems plaguing hospitals and nursing homes is the development of new pressure ulcers in patients after admission. A pressure ulcer can be defined as a localized area of necrotic tissue that is likely to occur after soft tissue is compressed between a bony prominence and a surface for prolonged periods of time (Andrychuk, 1998). According to the Centers for Medicare and Medicaid,

Although the situation was quite challenging, it provided me with some useful experiences for the future practice. I understand that all institutions should have a policy for documenting the assessment of patients, including pressure ulcers (Morison 2001). I have come to be familiar with the homes assessment policy using the Sterling Pressure Sore Severity Scale and most importantly I have learned that by using a universal assessment tool it supports a systemic and consistent approach to pressure ulcer evaluation. This therefore supporting continuity of care.

According to the Agency for Healthcare Research and Quality (AHRQ), 2.5 million patients are affected by pressure ulcers and incur costs anywhere from $9.1 billion to $11.6 billion per year in the United States (AHRQ, 2014). As of October 1, 2008, the Centers for Medicare and Medicaid Services (CMS) will not reimburse hospitals for cases in which the pressure ulcer was acquired after admission (CMS, 2008). Because of this high cost, the number of patients affected each year, and insurances no longer reimbursing hospital acquired pressure ulcers (HAPU), an accurate skin assessment upon admission is critical to reduce costs, ease pain in patients, and lower incidences of pressure ulcers. This paper will address what leadership and management skills and functions are required of a wound care nurse who identifies a problem with the accuracy of skin assessments on newly admitted patients.

Hospital data on specific nursing-sensitive indicators can help a facility advance quality patient care and prevent any new adverse events through education, increased staff, acknowledgement, and accountability. The healthcare facility can post these indicators and the data associated with them including location in the facility and staffing numbers. This helps to bring these indicators to a more individual level whether it be per unit or per person. This along with acuities helps to justify the need for larger numbers in staffing. Although facilities would sometimes rather work with minimum staffing allowed, it is necessary to show that with more staff patients are receiving a higher level of quality care. These numbers might reflect this. This data might also compare the number of hospital acquired pressure ulcers with the use of restraints. This might show staff another reason for promoting a restraint free environment. It must be stressed to nursing staff that they have a direct impact on these nursing-sensitive indicators. Nursing staff could be educated on prevention and early detection of any indicators.

Nursing sensitive indicators are identified as steps towards standardized measurements of nursing care, which provides details about the relationship between qualities of healthcare given to patients (ANA, 2011). Today healthcare strives to provide great quality service to the patrons of the community. Everyone knows that providing quality healthcare care plays a dramatic role in encouraging helpful patient outcomes. It also important to remember the way nursing sensitive indicators are delivered has a major influence on the patient. It has been known that nursing care standards were identified through the nurse sensitive indicators.

Nurses are integral key players in multidisciplinary teams caring for patients in complex healthcare systems. Hospitals, a primary care delivery portal within the health system, are inundated with patients requiring higher acuity care. Nurses must be prepared to recognize patients’ health care needs and provide quality patient care outcomes. The knowledge of nursing sensitive indicators can be helpful in providing the care which meets quality standards. Nursing sensitive indicators rely on evidence-based practice. The American Nurses Association created a repository for implementing, developing, and

The demands of nursing profession leave a significant impact on not only the registered nurses themselves, but the patients and hospital organizations as well. Nurses have a duty to provide safe quality care to all patients, however they must have an appropriate level of nurse-patient ratios to do so. Inadequate ratios are associated with increased levels of falls, hospital acquired infections, and pressure ulcers. Infections such as pneumonia that can lead to death, and hospital acquired pressure ulcers are preventable, and when they occur they can be costly for the hospital. Hospital acquired

This is an analysis of the nurse-sensitive indicators in a case study regarding an elderly, Jewish male patient with dementia in a hospital setting. Nurse-sensitive indicators presented in the scenario such as patient falls, using restraints, development of pressure ulcers, and patient satisfaction will be discussed. When nurses are aware of these nurse-sensitive issues they can provide better care for their patients. There are multiple resources available to nursing staff to help resolve ethical issues.

Pressure ulcer prevention has been the nursing worry for many years. Florence Nightingale in 1859 wrote, “If he has a bedsore, it’s generally not the fault of the disease, but of the nursing” (Nightingale, F). People may think pressure ulcers associated with poor nursing care. Prevention of pressure ulcers is a multidisciplinary responsibility; however, nurses have a primary role. Patient participation in prevention of pressure ulcers (pup) care has been shown to result in improved patient safety and satisfaction with care ((Weingart, S.N., Zhu, J., Chiappetta, L., Stuver, S.O., Schneider, E.C., Epstein, A.M. 2011). Purpose of the study includes the nurses and patients partnering together with prevention of pressure ulcers (pup) may be an effective strategy for reducing pressure ulcers (PU) among at-risk individuals. So the research team developed a pressure ulcer prevention care bundle (PUPCB) targeted at both patients and nurses, encouraging patient participation in PUP care with three simple evidence-based messages: 1) Keep moving; 2) Look after your skin; and 3) Eat a healthy diet. Messages were provided to patients with a poster, brochure and DVD. Nurses had training regarding how to be companion with patients in pressure ulcer prevention (Roberts et al. 2016).

Nursing sensitive indicators (NSI) were developed by the American Nurses Society (ANA )in the 1990’s as a way to link patient outcomes to nurse staffing (Montalvo, 2007). NSI established parameters to focus on and to provide a means to evaluate the care given by nursing (Nursing sensitive indicators, 2013). The scenario might have ended differently if the NSI had been adhered to and utilized. NSI’s have shown if a certain process are followed then a certain outcome would be achieved. The value of use of an already identified process are that evidence has shown that these processes are effective (NSI, 2013). The pressure ulcer and restraint use are under the NSI. The outcome for the patient are shorter hospital stays, respectful treatment, and cost-effective care.

This study evaluates the decision making of nurses in relation the prevention and management of pressure ulcers. There are many assessment tools create to help nurses assess the level of risk a patient have, and from there, they can create a plan of care in pressure ulcer prevention.

Great post! I must tell you that I was very impressed with your work place and the implementation of staff nurses that are responsible for assessing those patients who are at risk for pressure ulcers. How so? At my place of employment, every nurse assigned to a patient is totally responsible for following the Braden scale to the max. This is done on every shift; it would be nice if we have nurses from the wound and colostomy care team that work at nights. This would prevent a backlog of patients waiting for skin consultation. I believe that the longer a client waits to have his or her skin assess for pressure ulcer, the greater the chance for having the skin compromised. It is great that at your work place there are nurses that work

As nurses, it is our obligation to protect the health and safety of patients as well as advocate for them. To do this the nurse must understand their role, analyze concerns, and improve patient care. Nurses rely on evidence based factors specific to nursing, which impact patients through the care provided, known as nursing-sensitive indicators. These indicators are then used to identify, evaluate, and improve patient care as well as prevent future occurrences (ANA, 2014).

I am doing my evidence-based paper on why it is important to prevention of pressure ulcers in intensive unit. It’s important in nursing care because you see it everywhere not just intensive care, but hospitals, nursing homes, and people at their own homes. Patients in the intensive care units are usually end up with the most

It was during my first week clinical placement in the ward when I came across with the Waterlow risk assessment tool. My mentor made sure that I got all the risk assessment tools commonly used in the ward as these will play a key part in my duty as a qualified staff nurse. True enough, this risk assessment tool became visible in every patient’s charts and serial risk assessment was done on a weekly basis.