Nursing quality indicators are commonly unit-specific measurable indicators which reflect correlation of certain elements of staffing, direct patient care, and quality outcomes. Nursing quality indicators ultimately exist to ensure data is tracked and evaluated in an appropriate manner, usually in comparison to other organizations nationally. The nursing quality indicators were established by the American Nurses Association to determine nursing impact on healthcare, as it is part of the professional responsibility to monitor and promote quality outcomes (Lockhart, 2018). Quality indicators can be objective such as instances of restraints and pressure injuries as seen in this case to more subjective ones such as patient satisfaction. Applying the quality indicators allows to identify where the staff fell short. Obviously, pressure injuries should be avoided; therefore, since the patient has to be restrained, nursing staff should do more to reposition the patient to avoid injuries. Similarly, if quality indicators suggest patient dissatisfaction with dietary services, staff should take measures on cultural competency and screening foods going out.
Data regarding specific Qis is beneficial for hospital and management. It essentially measures performance in the past to the present, which in turn, helps guide future improvement efforts. One of the first steps in the improvement of performance measures, is to select, define, and apply the specific indicators. By focusing on specific QIs as a manner of performance measurement, it becomes considerably more important. By evaluating data, potential correlations can be made such as use of restraints, staff shortage, and as a consequence, pressure injuries as was seen in this case study. Once data is analyzed, procedural or systemic changes are made with the available resources to improve the specific quality indicator which does not meet the set hospital standards. Nurses, which are integral frontline members of the healthcare team, often have the ability to first detect quality of care issues and provide avenues for change (Hughes, 2008).
There are a few ethical issues to consider in this case study. First, the violation of Mr. J’s religious norms by providing him with a meal that he assumed to be kosher. Second, the actions on behalf of the supervisor with the intent to keep the incident “quiet” and hidden from the patient’s daughter. Once the issue was resolved and the correct meal brought the next day, but the incident still became known, the religious beliefs of the family were further disrespected by the staff, dismissing the incident as minor. As a nursing shift supervisor, once it became known that the patient was served an incorrect meal, it would have been prudent to address the matter to the hospital administrator directly, highlighting the necessity for employees to be more attentive to patient requests. The patient and his daughter should have been notified with appropriate apologies on behalf of the hospital and assurances that the matter was being investigated and fixed, as it was. This would have been the ethical approach.
The nursing supervisor can use the systemic resources to resolve the issue, by being a leader and attempting to work with colleagues to ascertain the cause of the problem. The supervisor can meet with the dietary manager and the hospital administrator to develop a system where patient requests are followed through and there is an element of verifying foods that go out. Foodservice is an important issue in hospital settings, influencing patient’s satisfaction as well as their ability to recover through healthy and nutritious that are tailored to the patient’s condition and individual needs (Aminuddin et al., 2018). There is a possibility of involving a social worker or other counsel (clergy if available) that can provide guidelines and education regarding religious limitations and impact of health conditions. The key would be to develop a methodological approach to improving quality indicators in terms of patient satisfaction and respect for their requests, particularly if such resources are available through the use of external and internal knowledge.
References
Aminuddin, N. F., Kumari Vijayakumaran, R., & Abdul Razak, S. (2018). Patient satisfaction with hospital food service and its impact on plate waste in public hospitals in East Malaysia. Hospital Practices and Research, 3(3), 90–97. Web.
Hughes, R.L (ed.). (2008). Patient safety and quality: An evidence-based handbook for nurses. Agency for Healthcare Research and Quality. Web.
Lockhart, L. (2018). Measuring nursingʼs impact. Nursing Made Incredibly Easy!, 16(2), 55. Web.