INTRODUCTION
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
SCENARIO
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 employees.
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.
REQUIREMENTS
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. An originality report is provided when you submit your task that can be used as a guide.
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. ***From the scenerio think about roles outside of nursing, such as hospital chaplain, risk manager, the local rabbi, and the Ethics Consult Team.
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.
Additional Breakdown:
Prepare to write:
Be sure you are writing to the Task Requirements and then verify with the Task Rubric.
• Recommended length 2-3 pages as you analyze the provided scenario
Task Helpful Tips
A. Understanding of Nursing
Quality Indicators
1. Define NQI
2. Identify at least 2 NQIs in the scenario
3. Choose one of those indicators and discuss how knowledge of the
NQI (risk factors, signs and symptoms) can guide the nurse’s
practice in identifying issues that may interfere with patient care
4. Use the resources listed above: NQIs Video, NQIs articles
B. Advancing Quality Patient
Care
1. Focus on one NQI from the scenario
2. What is done with data (provide examples of data collected) on
that NQI to make it meaningful
3. Directly discuss the role of data in quality care
4. Don’t forget to address quality patient care throughout the facility
5. Not looking for numbers, but what role can the data play in the QI
process. The video & NDNQI article discuss this concept.
C. Resolution of Ethical Issues
1. Identify the ethical/cultural issue
2. Focus on collaboration with others
3. Review the scenario and think about who could be used as a
resource for education related to the ethical/cultural issue
4. Identify a minimum of two resources, including one internal and
one external resource (outside of the facility) and what their roles
are to help resolve the issue
5. Be sure not to fix the situation as the Nursing Supervisor – you
must collaborate here!
D. Sources Visit the Writing Center (found under Success Centers at top of Degree
Plan) for resources.
The submission includes in-text citations for sources
that are properly quoted, paraphrased, or summarized and a reference list
that accurately identifies the author, date, title, and source location as
available. See Working with IHI Website for how to cite IHI.
Professional Communication Mechanics, usage, and grammar promote accurate interpretation and
understanding. Visit the Writing Center (found under Success Centers at
top of Degree Plan) for resources to support Professional Communication.

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