Running head: QUALITY IMPROVEMENT IN HEALTH 1

Quality Improvement in Health

Name

School
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The quality of care provided to patients is a critical indicator for nurses, quality measures

enable nurses to identify gaps in patient care and to devise interventions to enhance quality care.

In most patient settings, nurses fail to utilize the quality measures in care due to challenges such

as staffing shortages, limited availability of protocols on patient care modalities and staff

disregard of the interventions.

Nursing quality indicators such as patient fall, decubitus ulcers, the use of physical

restraints and poor patient satisfaction of care are prevalent in J's case scenario. The nurses in the

case scenario ought to have utilized quality measures such as J's risk for bed sores due to his

advanced age and immobility (due to restraints) to alter the care and ensure regular turning to

enhance the patient's outcome of care. The use of restraints has been an emotive issue with

restraints in the elderly being a concern for both the patient's safety and a violation of the

patient's rights(Kalula & Petros, 2016). The nursing teams ought to have utilized available

resources to minimize the use of physical restraints in the patient based on the evidence-based

information on the high risks of harm to the patient as well as the risk of poor patient experience

of care due to restraint use. The nursing team ought to have ensured and individualized care

planning for J to ensure culturally sensitive care regarding his dietary needs. Utilizing

individualized patient care also would have enhanced the prevention of poor patient outcomes

such as decubitus ulcer development by enhancing regular patient turning.

To enhance the quality of patient care within the health care settings, data plays a critical role in

ensuring effective nursing care is provided to patients. Availability of data such as data n patients

developing decubitus ulcers on admission is an important indicator that can be utilized to identify

quality improvement interventions. Such data would inform in making decisions on the nursing

staffing and the staff ratios to allocate to ensure among others, effective patient turning, and
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other care interventions such as patient massage, changing of linen among others to prevent

decubitus ulcers(Zolot, 2016).

Quality improvement data is also imperative in informing on identifying the gaps in staff

skills and knowledge and in informing evidence-based practice. In the scenario, the disregard of

patient's dietary needs indicates gaps in culturally sensitive care and hence such information can

guide in identifying the need for staff training in transcultural care. Lack of utilization of

evidence-based practice in restraints for the elderly also indicates a need for staff training in

evidence-based practice to enhance quality care interventions. Data on quality is also imperative

in developing standard operating procedures in practice; data on the use of physical restraints can

be utilized to develop policies and standard operating procedures that can be utilized to ensure

patient safety and prevent adverse patient outcomes of care.

Nursing care is guided by ethical principles which identify the various principles that are

essential to ensuring patient safety and respect for patient needs in care. One of the outstanding

ethical concern in the care of the J in the case scenario is the lack of staff to adhere to the

principle of beneficence. Beneficence refers to the nurse's obligation to do good for the patient to

enhance their recovery and outcomes. In the case scenario, patient beneficence is violated when

the nurse recognizing increased risk for pressure sores, fails to reposition the patient. The nursing

staff also use physical restraint on the elderly patient limiting his movement and increasing his

discomfort. There is a significant disregard for his requests as well as withholding information

from the patient's family on his care.

As a shift supervisor I would utilize the available nurse assistants in the shift to resolve

the issue by providing an allocation for the nurse assistant to closely monitor J. I would educate

the staff on the risks of using restraints on the patient as well as the importance of ensuring
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regular turning and patient massage to ensure effective circulation in preventing pressure ulcers.

The nurse assistants would then conduct patient turning every 2-hourly and utilize a ripple

mattress to further minimize the risk of pressure sure development(Sharp, Schulz Moore &

McLaws, 2019). I would collaborate with the kitchen supervisor as well as the dietician to ensure

that all meals served to J are Kosher as per his request as well as ensuring that all other meal

requests are respected. I would provide continuous education to both the kitchen supervisor and

staff on the importance of cultural sensitivity in patient care which is underlined in the American

Nurses Association practice standard 8 (Marion, Douglas, Lavin, Gazaway & Thoma, 2017). I

will also involve the patient's relatives in the care of the patient by providing regular updates on

their care and progress as well as educating the patient and his daughter/relatives on the patient

care needs for J to enhance patient satisfaction with the care provided as well as enhance better

patient outcomes.

In conclusion, the quality of care indicators is important in guiding nursing practice and

ensuring better outcomes of care. Nurses also ought to incorporate the patient in their care to

enhance post-discharge care as well as prevent patient readmissions and enhance the patient's

satisfaction with care. Utilizing quality improvement data to enhance skills, staffing and practice

policies is critical to better patient outcomes.

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References

Kalula, S., & Petros, S. (2016). Use of physical restraint in hospital patients: A descriptive study

in a tertiary hospital in South Africa. Curationis, 39(1). doi:

10.4102/curationis.v39i1.1605

Marion, L., Douglas, M., Lavin, M., Gazaway, S., & Thoma, E. (2017). Implementing the New

ANA Standard 8: Culturally Congruent Practice. The Online Journal of Issues in

Nursing, 22(1). doi: DOI: 10.3912/OJIN.Vol22No01PPT20

Sharp, C., Schulz Moore, J., & McLaws, M. (2019). Two-Hourly Repositioning for Prevention

of Pressure Ulcers in the Elderly: Patient Safety or Elder Abuse? Journal of Bioethical

Inquiry, 16(1), 17-34. doi: 10.1007/s11673-018-9892-3

Zolot, J. (2016). Physical Restraint Use Associated with RN Staffing. AJN, American Journal of

Nursing, 116(12), 16. doi: 10.1097/01.naj.0000508649.33070.e1