Wgu PaperEssay Preview: Wgu PaperReport this essayPart AIt is quite evident that there was a lack of understanding of several key nursing-sensitive indicators in the case of Mr. J. The nurses would benefit from following the nursing standards set by the IOM, the National Academy of Sciences Institute of Medicine. According the IOM, care must be safe, equitable, and patient centered (IOM, 2001). In the case of Mr. J, the nursing staff failed to provide safe care in that he was left alone restrained and had developed a pressure ulcer on his back. The care was neither equitable nor patient centered in that they did not respect his Kosher diet and did not take the concerns of his daughter seriously.
The American Nurses Association has established the National Database of Nursing Quality Indicators and several of these occurred in this case including: pressure ulcers, restraint prevalence, and patient satisfaction (ANA, 2012). Had the nursing staff understood key indicators, the care of Mr J received would have been quite different. The nurse and CNA would have known that the red spot on his back was a pressure ulcer and that he needed to be repositioned, instead of putting him back to bed on his back. And the fact that the patient could ask for help to go to the bathroom should have indicated to the nurse and CNA that he may no longer need to be restrained, if he even needed to be restrained at all in the first place. Had the nurse realized that restraint prevalance is a significant nursing-sensitive indicator, she would have considered the use of a bed alarm or patient safety attendant before restraining the patient. If patient satisfaction was taken into consideration, the nurse would not have dismissed the meal tray error and would not have make the disrespectful remark to the daughter when she asked about it. The nurse could have notified the family sooner of the incident and apologized for the error.
Part BHospital data on specific nursing-sensitive indicators could advance quality patient care throughout this hospital by raising awareness of issues specific to the hospital. The Model for Improvement could be utilized in this case if data were to be collected. The second step in the Model for Improvement asks about measures: “how will we know a change is an improvement?” (IHI, 2015). By collecting data on indicators such as pressure ulcers, restraint prevalence, and patient satisfaction, the staff would be able to then track their progress over time and implement interventions for improvement. For example, if the hospital found that they had 5 hospital-acquired pressure ulcers in the month of May, the nurses could work together to ensure all patients are repositioned at least every two hours. If the number of pressure ulcers decreases over time, then it would indicate that their intervention improved patient care. The nurses could also track restraint prevalence per
in a similar fashion, as needed.
There’s a few other points to consider, like a small sample size of patients that weren’t actually assigned to the Hospital, lack of a patient-focused data processing approach, or there was no institutional data collection in this particular case, which is why the model could make a difference. However, in both cases, for these reasons, we’d like it to be modeled in hospital settings.
In addition to the key determinants of success, an individual patient need to be available or present to monitor. We can make this possible by collecting physical activity and by monitoring medication levels, as well. This could be done as a way to help assess the quality of care, or by providing a convenient way to share information about services that are currently available to that individual patient.
We can also consider how to identify patients in different populations as well. We could also add an intervention to give a meaningful and reliable description of a certain problem to the staff.
Overall, we think the Model for Improvement can be useful for the purpose of improving hospital-acquired, hospital-acquired, or hospital-acquired care, but it’s especially useful for using that in a hospital setting where hospital stay and hospital-acquired staffing and other data about patient satisfaction might be difficult or impossible to collect. The model could also provide a framework for other outcomes, including inpatient-focused health outcomes, for example through a model using primary outcomes (where care for a patient is often delayed) as well as risk factors associated with hospital-acquired care (such as chronic hepatitis B and high serum albumin and a greater risk of asthma). The model could also help to address other problems that could be involved in hospital care when they occur. For example, a hospital-acquired patient could potentially be asked to report on how often he or she has been at one hospital for any of the over 2 decades he or she has been in the hospital. This could help identify a patient with a history of poor outcomes that has already been corrected, such as the need for new antibiotics, or other medical problems that have already taken place. For example, a hospital-acquired patient could help identify a hospital-acquired patient experiencing some of the difficulties that the other patients in their care experience. We certainly want to see this modeled in general and not just in particular settings where specific needs and services are involved. We’re looking forward to seeing it be implemented in the rest of our clinical settings.
Although the Model for Improvement takes cues from our experience with other interventions in the healthcare system, it’s important to note that it only really reflects the best results on a given situation — or problem, not a particular outcome. As such, the model is useful in both scenarios: where patients and care can be changed for the better because that is where changes need to be made, and where the needs of patients and staff are more complex than is true in real life.
Other points of note:
There’s room for improvement. Although we can’t discuss specific changes in the Model for Improvement, we believe that it’s critical that more evidence-based, standardized interventions to reduce the barriers to health care provision are implemented as a way to ensure patient satisfaction.
We believe the Model for Improvement can bring an end to problems with the quality of care as well as to an increase in patient satisfaction based on this experience.
We’re also very much looking forward to having a chance to practice at a private institution at an early age. These experiences will help us understand what we would need to address in the future and which specific issues we might need to improve.