National initiatives driven by the American Nurses Association have determined nursing-quality outcome indicators that are intended to focus plans and programs to increase quality and safety in patient care. The following outcomes are commonly used nursing-quality indicators:
• complications such as urinary tract infections, pressure ulcers, hospital-acquired pneumonia, and DVT
• patient falls
• surgical patient complications, including infection, pulmonary failure, and metabolic derangement
• length of patient hospital stay
• restraint prevalence
• incidence of failure to rescue, which could potentially result in increased morbidity or mortality
• patient satisfaction
• nurse satisfaction and staffing
Mr. J is a 72-year-old retired rabbi with a diagnosis of mild
dementia. He was admitted for treatment of a fractured right hip
after falling in his home. He has received pain medication and is
drowsy, but he answers simple questions appropriately.
A week after Mr. J was admitted to the hospital, his daughter,
who lives eight hours away, came to visit. She found him restrained
in bed. While Mr. J was slightly sleepy, he recognized his daughter
and was able to ask her to remove the restraints so he could be
helped to the bathroom. His daughter went to get a certified
nursing assistant (CNA) to remove the restraints and help her
father to the bathroom. When the CNA was in the process of helping
Mr. J sit up in bed, his daughter noticed a red, depressed area
over Mr. J’s lower spine, similar to a severe sunburn. She reported
the incident to the CNA who replied, “Oh, that is not anything to
worry about. It will go away as soon as he gets up.” The CNA helped
Mr. J to the bathroom and then returned him to bed where she had
him lie on his back so she could reapply the restraints.
The diet order for Mr. J was “regular, kosher, chopped meat.”
The day after his daughter arrived, Mr. J was alone in his room
when his meal tray was delivered. The nurse entered the room 30
minutes later and observed that Mr. J had eaten approximately 75%
of the meal. The meal served was labeled, “regular, chopped meat.”
The tray contained the remains of a chopped pork cutlet.
The nurse notified the supervisor, who said, “Just keep it
quiet. It will be okay.” The nursing supervisor then notified the
kitchen supervisor of the error. The kitchen supervisor told the
staff on duty what had happened.
When the patient’s daughter visited later that night, she was
not told of the incident.
The next night, the daughter was present at suppertime when the
tray was delivered by a dietary worker. The worker said to the
patient’s daughter, “I’m so sorry about the pork cutlet last
night.” The daughter asked what had happened and was told that
there had been “a mix up in the order.” The daughter then asked the
nurse about the incident. The nurse, while confirming the incident,
told the daughter, “Half a pork cutlet never killed anyone.”
The daughter then called the physician, who called the hospital
administrator. The physician, who is also Jewish, told the
administrator that he has had several complaints over the past six
months from his hospitalized Jewish patients who felt that their
dietary requests 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.
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. Use the
Turnitin Originality Report available in Taskstream as a guide for
this measure of originality.
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.
E. Demonstrate professional communication in the content and presentation of your submission
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