Leadership
A. Nursing Sensitive Indicators
A nurse that has knowledge of nursing-sensitive indicators (NSIs) can greatly improve patient care. “Nursing sensitive indicators identify structures of care and care processes, both of which in turn influence care outcomes” (Montalvo, 2007). Having a knowledge of which structures and processes have evidence to be beneficial can compel nurses to provide care that produces these positive outcomes.
The NSIs of skill mix and nursing hours per patient day refer to staffing levels. According to Twigg, Duffield, Bremner, Rapley, and Finn (2012), “Findings from previous studies indicate that higher nurse staffing levels and a richer skill mix are associated with improved patient outcomes”. In the given example, the patient was assisted to the bathroom by a certified nursing assistant (CNA). The daughter spoke with the CNA about her concerns about the red area on the patient’s lower back, and the CNA did not realize that the patient might be developing a serious complication. A nurse with an understanding of NSIs might analyze the situation and determine that a different skill mix could lead to a better outcome for the patient. For example, a nurse who understands NSIs could assist the patient to the bathroom. The nurse could then note the red area and implement pressure ulcer treatment/prevention, education the daughter, and pursue discontinuing the restraints. Therefore, this change in skill mix/nursing hours per patient day could lead to better outcomes for the patient.
C. System Resources, Referrals, or Colleagues
As the nursing supervisor, I would realize that the ethical issue is that Jewish dietary restrictions are not being followed and respected. The first immediate action would be to apologize to the daughter, and validate her concerns. Next I would attempt to resolve the ethical issue by changing the culture of the hospital regarding Jewish dietary restrictions. First, I...