Nursing-Sensitive Indicators - Report Example

Introduction

Nursing-sensitive indicators (NSI) are statistical outcomes that facilitate the quantification of nursing care efficiency, cost effectiveness and company performance. NSIs have been widely applied to observe and account for the quality of nursing care. There are three basic elements of NSIs which include Nurse Satisfaction, Patient Satisfaction and Clinical Quality. These indicators are significant components of the equation used to establish evidence-based practice principles. However, determination of these indicators is basically not good science – it is imperatively ethical. Existing Nursing’s foundational guidelines and values state nursing, as a profession, has an authority to calculate, assess, and enhance the quality of nursing practice.

The history and evolution of NSI

There has been an evolution in quality estimation in health care over the years. The studies by the American Nurses Association (ANA) in the 1970s, the extensive distribution of the Quality Assurance (QA) model (Rantz, 1995), and the ushering in of Donabedian's constitution, development, and results model (Donabedian, 1988, 1992) have presented a all-inclusive process for assessing quality of health care.

The early 1990s redesigning and restructure of the workforce illustrated the necessity for the ANA in evaluating nurse staffing and identifying relationships between patient outcomes and nurse staffing. ANA instigated the Patient Safety and Quality Initiative in the year 1994, which initially identified numerous quality indicators. Proof of the efficiency of such indicators was utilized in the implementation the last 10 sets of nursing-sensitive indicators to used in assessing the quality of patient care (Gallagher & Rowell, 2003). The guidelines to the implementation were published afterwards (ANA, 1999). ANA also launched the National Database of Nursing Quality Indicators in 1998. While they differ from medical indicators of quality care, nursing-sensitive indicators are different and explicit to nursing, thus becoming somewhat of an exhortation in health care currently.

Definitions and classifications

Nursing-sensitive performance measure are activities and outcomes, and structural substitutes for these activities and outcomes (such as nurse staffing hours and skill mix), that are influenced, provided and affected by nursing workforce but for which nursing is not exclusively responsible (The American Nurses Association and the National Quality Forum, 2004). The three aspects of nursing care reflected upon by NSI include outcomes, process and structure.

Structural terms

The structural aspects classified comprised of subcategory factors linked to setting, nursing, patients. Patient characteristic is an example of patient-related structural terms identified. An expression ‘patient characteristic’ commonly means demo-graphics features which include the patients’ age, gender and other factors such as type of method used, length of hospitalization and the type of ward. Registered Nurses (RNs)’ amount of experience and his/her education level make up the nursing-related structural aspects.

Finally, the setting-related structural aspects are composed of percentage of hours supplied by RNs, workload intensity, patient turnover, patient acuity, nurse staffing, hours of patient’s nursing care per day and managerial features of the nurse practice setting for instance sufficient facilities or budget for quality of care, associations with other practitioners, nursing education’ support and nurse supervisors’ capability associated to management and support.

Process terms

The two sub-classes identified were nursing and setting. Processes related to nursing were symbolized as nursing practice or nursing intervention. Any treatment, influenced by the nurse’s clinical decision and understanding, that is used to improve patient outcomes is described as nursing intervention (McCloskey &Bulechek 2000). On the other hand, a setting-related practice term called nursing care plan or nursing documentation.

Outcome terms

Three elements of patient outcomes were focused on. Jennings et al. (1999) and Doran (2011) presented the list of the most frequent elements of patient-related outcomes include clinical management, functional status, use of health care, perception and safety. Safety, in relation to a patient, was commonly considered unfavorable processes which comprised shock, gastrointestinal bleeding, sepsis, restraint, failure to rescue, vein system complication, pneumonia, medication error, nosocomial urinary tract infection, nosocomial selective infection, falls and falls with injury and prevalence of pressure ulcer. On the other hand, perception in regard to patients included family/patient satisfaction with pain management and family/patient satisfaction with nursing care. While the use of health care by patient included post discharge unexpected hospital visits, waiting time for nursing care and duration of stay. Self-care ability and vital sign status are the patient-related functional status. Patient’s clinical care was aimed at symptoms reduction as nursing-related outcomes were considered to comprise safety of nursing job and nursing satisfaction with job. Finally, setting-related outcomes were nurse turnover and mortality. Psychiatric and pediatric indicators have recently been included following the requests by participating hospitals for indicators for these terms.

Explanation of factors

• Nursing Hours per Patient Day

Nursing Hours per Patient Day (NHPPD) is the workload monitoring system. This workload include the amount of nursing hours in a unit in a duration of 24-hour. Habasevich (2012) argued that there is no criterion for determining NHPPD. It is used to ensure that the variable demands of equity and patient care in duty among staff is met.

• Patient Falls& falls with injury

This is the total number of patient falls that took place an appropriate reporting unit in a calendar month.

The Collection Question

What was this unit’s amount of patient falls in the calendar month? Injury level classified as Death, Major, Moderate, Minor or None.

• Pediatric Pain Assessment, Intervention, Reassessment (AIR) Cycle

The pain assessment-intervention-reassessment (AIR) cycle is a three-step process used for managing pain. These steps included evaluating the levels of pain; giving pain medicine when needed and reexamining the situation ensure the medicine is functioning well.

• Pressure Ulcer Prevalence:

Nurses play a big role, even though the deterrence of pressure ulcers is a multidisciplinary duty. Pressure Ulcer is divided into Community Acquired, Hospital Acquired and Unit Acquired sub indicators. Only the observable pressure ulcer that complies with hospital-acquired (nosocomial) is documented. The ulcers that are diagnosed or documented a day after inpatient admission are Hospital-acquired (Joint Commission, 2009)

• Psychiatric Sexual/Physical Assault Rate

Violence in place of work is a big concern to psychiatric-mental health nurses and a grave problem in health care. The outcomes of workplace violence have significant implications to the physical conditions of the labor force and the entire organization because of its impacts on staff income, non-attendance, patient outcomes, staff morale and treatment for the injured persons (American Psychiatric Nurse Association, 2012).

Restraint prevalence

This caused by Manual processes, mechanical equipment material or device (such as side rails, vest, roll belt, waist or limb) that stops or diminishes the capability of a patient to move his or her head, body, legs or arms freely.

Collection Question

Was there any physical restraint for this patient when the prevalence was studied?

• RN Certification/Education

This is the clinical advancement opportunity of education/career development, Active development of staff or progressing with educational courses for nurses while working (JCI, 2009).

• RN Satisfaction: the fundamental factors
• Countless teamwork between nurses
• Adequate staff to get the work done and practical workload
• Patient care tasks foster quality of care
• Continuing education programs and active staff development
• Collaboration between physicians and nurses
• A chief nursing officer is very accessible and visible to staff
• Skill Mix

The amount of helpful hours worked by Licensed Vocational Nurses and Licensed Practical Nurses employed into the organization with direct patient care duties.

• Voluntary Nurse Turnover

The number of work separations from qualified Registered Nurse staff in a calendar month.

Collection question

From Joint commission (2009), what was the number of employment separations for qualified Advance Practice Nurses in a calendar month?

• Nurse Vacancy Rate

Calculating vacancy rate is to solve nursing scarcity, to increase the number of nursing personnel. To present Statistical information about the demand and supply for nurses.

• Nosocomial Infections
• Ventilator-associated pneumonia (VAP)
• Central line catheter associated blood stream infection (CABSI)
• Urinary catheter-associated urinary tract infection (UTI)

Nosocomial infections can be found anywhere around the world, in both developed and developing countries. Increased morbidity and death among hospitalized patients are majorly caused by infections acquired in health care settings. These infections are a big trouble to both the patient and public health (WHO, 2010).

Responsibilities of the nursing staff

The role of the nursing staff is to implement patient care practices for infection management. Nurses should be familiar with practices to prevent the occurrence and spread of infection, and maintain appropriate practices for all patients throughout the duration of their hospital stay. (WHO, 2010).

Purposes

Nursing sensitive indicators enhance patient care outcomes and improve patient care. They also enable information to be identified and collected concerning methods and outcomes influenced by nursing care, up to a Unit level (Heslop & Lu, 2014). Additionally, they provide knowledge and awareness into more evidence based practices.

These indicators are used in setting up significant quality monitoring process to motivate health experts to modify practice and enhance an excellent and safe of clinical care. (Ryan 2009, Jha et al. 2012). They also light up the nursing works and sustain nurses' engagement through quality monitoring and reporting system. Through nursing sensitive indicators, information systems are able to disclose position of the healthcare facility and the present condition of quality care.

Conclusion


Nursing sensitive indicators present a gateway into evidence based information and facilities that can enhance the care of every patient. The significance of nursing sensitive indicators, the awareness about the available resources and nurse leaders and nurses is highlighted in the American Nurses Association’s statement of belief that we should support those whom we care for and effort to constantly enhance the nursing practice. NSIs make nursing practice not only more holistic but also substantial field of science and study.