Nursing is a profession that encompasses empowering people in need and helping them to achieve social, physical, or psychological independence. The vast knowledge of the nurse practitioners provides them with proficiency in making diagnosis tests as well as administering treatment in the area of expertise. However, nurse practitioners cannot attain much if they do not incorporate their expertise with the correct understanding of the fundamental nursing legal and ethical principles, as they aid the nurses in examining the major style and approach that should be taken in managing patients’ care. This paper will review a case study of Mr. J, a 72-year-old patient suffering from mild dementia.
Nursing Sensitive Indicators
The scenario has provided us with nursing-sensitive indicators, which could assist the nurses in identifying issues that may interfere with patient care. To start with, the hospital has a good structure that accommodates staff members, who have the required qualifications as required by the American Nurses’ Association. This is demonstrated by the fact that the hospital has certified clinical nurses as well as an assistant, who is also certified. Nursing certification is one indicator that helps to ensure effective patient care (Fulmer, Foreman, & Walker, 2001).
The other indicator that could assist the nurses in identifying issues that may interfere with the level of patients’ care includes the job process. This translates that the nurse practitioners should demonstrate proficiency in carrying out patients’ assessments as well as interventions. In this scenario, the nurse practitioners do not seem to understand the reason why Mr. J should be restrained as well as how he should be restrained. This is demonstrated by the fact that Mr. J demonstrated calmness and understanding of questions while requesting her daughter to remove the restraints so that he could walk to the bathroom.
According to the rules of restrains, Mr. J should have been restrained only if he portrayed agitation and the aggressive behavior that is characterized by the cognitively impaired patients (Fulmer, Foreman, & Walker, 2001). However, the use of restrains in this scenario could be attributed to achieving the hospital’s goals that serve to enable the nurse practitioners to complete their work within a specified timeframe. This demonstrates poor intervention since the main goal of any clinical setting is patients’ satisfaction, and therefore restrains should only be used when the objective best serves the patients’ needs rather than the managements’ needs.
More so, the nurse practitioners should demonstrate proficient knowledge on how the patient should be restrained as well as the material that should be used in the restraining process. In this scenario, the correct and recommended restraint device should have been used in accordance with the manufacturers’ specifications to avoid additional injuries resulting from the restrain material, such as the depressed area over Mr. J’s lower spine.
More so, proper education should have been dispensed to the clinical nurse assistant, as this would have helped her to carry out a safe restrain practice. In this scenario, careful observation of Mr. J’s outcome could have served as a nursing-sensitive indicator in assisting the nurse to identify issues that may interfere with the care of patients infected with dementia. A careful observation of pressure ulcers, patients’ falls, and infection from restrains is of paramount importance since a patient’s diagnosis tests could also multiply due to the hospital’s environment and working conditions (Fulmer, Foreman, & Walker, 2001). As such, the clinical nurse leader could have closely monitored Mr. J during the period of restrain.
Additionally, when the clinical nurse assistant became aware of Mr. J’s additional injuries resulting from the restrain, he was not in a position of making a clinical judgment that is based on a sound knowledge base, which carries out an evaluation that clearly reviews the effectiveness of the care that has been given. Hence, this calls for providing the clinical nurse assistance with knowledge on potential diagnoses tests, as it could assist the nurses in identifying issues that may interfere with patient care (Fulmer, Foreman, & Walker, 2001).
Quality Patient Care
From the evidence-based nursing practice, it is apparent that a number of people who have fallen victims of restrains have verified that physical restrains are characterized by physical injuries, which include pressure ulcers, infections, patient falls, and physical impairment (Qizilbash, 2002). Qizilbash (2002) affirms that restraining a cognitively impaired patient does not prevent falls that happen to the patients, and there lacks enough evidence that suggests that restrains play a vital role in a clinical setting.
Thus, the hospital’s data is critical in evaluating the validity of this hypothesis since it gathers information on diseases’ epidemiologic data, which, in this case, includes the mortality and the morbidity rate relative to pressure ulcers, infections, as well as physical impairment resulting from restrains of cognitively impaired patients. This data keeps the staff workers informed about the current affairs pertaining to these diseases as well as their devastating future if adequate measures were not applied in preventing their reoccurrence. This, in turn, could advance quality patient care since the data will quicken the spirit of the hospital workers towards taking preventive measures on poor and unnecessary restraints.
Additionally, hospital’s data on specific nursing indicators, including the presence physical impairment emanating from patients’ falls could stand out to be imperative since it can be used for a cross-comparison between the restrained patients and the unrestrained patients at the hospital in a bid to evaluate the effectiveness of restraining a cognitive impaired patient. This should also go along with a cross-comparison of the type of diet that is more appropriate for a patient suffering from dementia. This data, in turn, will help to reduce the morbidity and mortality rate relative to restraining cognitively impaired patients.
System Resources, Referral, or Colleagues
This scenario has provided us with a background of the relationship between the nurses and the kitchen staff, which helps us to assess the attitudes of the nurses and kitchen staff concerning Jewish patients, including Mr. J. Thus, the scenario provides us with enough evidence in verifying that the legal relationship that is required between the two departments is questionable. This is portrayed by the fact that Mr. J received “regular, chopped meat” instead of “regular, kosher, chopped meat.” The management of this dilemma is also lacking since the responsibilities are marked with a lack of a proper collaboration between the nursing department and the kitchen department, and the Jewish are not taking it kindly.
However, there are a number of resources, which a nursing shift supervisor can employ in managing this ethical issue. According to Kerridge, Low, & McPhee (2005), ethics are the values that ought to guide clinical staff as well as other health care personnel in their profession and resolution making. As such, the nursing shift supervisor should use manuals that educate on the relevance of ethical concepts to the management of the entire hospital. One of the ethical principles that should be emphasized on is justice principle, which endeavors to provide satisfaction to all patients regardless of their ethnic groups. This can only be achieved through a collaboration process with the kitchen supervisor in enacting a policy that necessitates the kitchen staff to identify the cognitive impaired patients’ requirements through their relatives or guardians before offering them their daily meals.
References
Fulmer, T. T., Foreman, M. D., & Walker, M. K. (2001). Critical care nursing of the elderly. New York: Springer Pub. Co.
Kerridge, I., Lowe, M., & McPhee, J. (2005). Ethics and Law for the Health Professions. Annandale, N.S.W: Federation Press.
Qizilbash, N. (2002). Evidence-based dementia practice. Osney Mead, Oxford, UK: Blackwell Science.