Efforts to define the quality of nursing practice began with Florence Nightingale, as she worked to improve hospital conditions and measure patient outcomes. More recently, research linking hospital nurse staffing issues and adverse patient outcomes has caught the attention of those both inside and outside of health care. Numerous studies were done on the correlation between the two during the ’90s and the early 2000s, an era when news about the nursing shortage was bleak and nurses were reporting under-staffed units, burnout, and job dissatisfaction. When it was reported that under-staffing was associated with increased mortality, the media and the public became interested in the conclusions of these studies. The resulting attention has helped to pave the way for measuring other indicators that relate to the quality of care.
It was in 1996 that a team of researches coined the phrase “nursing-sensitive indicators” to reflect elements of patient care that are directly affected by nursing practice – and it’s become a bit of a buzzword in health care today. These indicators are said to reflect three aspects of nursing care: structure, process, and outcomes.
- Structural indicators include the supply of nursing staff, the skill level of nursing staff, and the education and certification levels of nursing staff.
- Process indicators measure methods of patient assessment and nursing interventions. Nursing job satisfaction is also considered a process indicator.
- Outcome indicators reflect patient outcomes that are determined to be nursing-sensitive because they depend on the quantity or quality of nursing care. These include things like pressure ulcers and falls. Other types of patient outcomes are related to other elements of medical care and are not considered to be nursing-sensitive – these include things like hospital readmission rates and cardiac failure.
Taking it a step further…
[programpush poi=”MSNINF”]In 1999, the American Nurses Association (ANA) identified 10 critical nursing sensitive indicators for acute care settings. In 2002 the ANA added 10 others that are applicable to community-based, non-acute care settings. Since then, the lists have been refined and expanded many times, with new indicators being added annually. The ten original indicators that apply to hospital-based nursing are:
- Patient satisfaction with pain management
- Patient satisfaction with nursing care
- Patient satisfaction with overall care
- Patient satisfaction with medical information provided
- Pressure ulcers
- Patient falls
- Nurse job satisfaction
- Rates of nosocomial infections
- Total hours of nursing care per patient, per day
- Staffing mix (ratios of RNs, LPNs, and unlicensed staff)
By identifying this first group of indicators, the ANA became a pioneer, of sorts, in evidence based practice. The next step was a literature search to identify other indicators that were potentially nurse-sensitive. Those were then reviewed and either validated as being truly nurse-sensitive, or discarded.
In 1998, the ANA established the National Database of Nursing Quality Indicators™ (NDNQI®), in order to continue to build on data gained from earlier studies. There was already an established link between nurse staffing and patient outcomes, but more data and reporting was needed to evaluate other indicators of nursing quality at the unit level. The NDNQI became the very first database to gather such unit-level information. It now supplies hospitals with performance reports that allow administrators to compare their data with national averages, percentile rankings, and other important information.
Nursing sensitive quality indicators are an important part of the equation when it comes to establishing evidence-based practice guidelines. But measuring these indicators is not simply good science – it’s an ethical imperative. Nursing’s foundational principles and guidelines state that, as a profession, nursing has a responsibility to measure, evaluate, and improve the quality of nursing practice.
Next week, more on the databases that are measuring and improving nursing practice!
Tagged as BSN, case management, evidence based practice, infection control, MSN, RN to MSN
Engaging in evidence-based nursing practice is just one sign that a nurse is a leader. Learn how to empower yourself with knowledge, through an online RN to BSN or RN to MSN degree. American Sentinel University is an innovative, accredited provider of online nursing degrees, including programs that prepare nurses for a specialty in case management and infection control.
Values and Study Practices of Nursing Students : an Indicators of Their Performance in the Nurses Licensure Examination
...Chapter I The Problem and Its Background Introduction Nursing involves specialized skills and application of knowledge based on education that has both theoretical and clinical components. Nursing upholds standards set forth by professional organizations and follows an established code of ethics. The concerns of nursing focus on human responses to actual or potential health problems and are increasingly focus on wellness, an area of caring that encompasses nursing’s unique knowledge and abilities. Nursing is rich in tradition, which is used to develop and redefine both the art and science of nursing. Furthermore, nursing is increasingly being recognized as scholarly with academic qualifications, research, and publication specific to nursing is increasingly becoming more widely accepted and respected. Background of the Study One of the major issues in nursing currently involves nursing education. Nursing profession provides a single route for the educational preparation of its practitioners. However, the development of nursing as a profession has resulted in three major educational routes that prepare graduates to write the National Council Licensure Examination (NCLEX) for registered nursing. The three traditional educational avenues that prepare men and women for registered nursing are hospital-based diploma programs, 2-year associate degree programs (primarily found at junior and community colleges), and baccalaureate programs (offered at 4-year......
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...quality nursing services by providing leadership to the nursing profession in self-regulation. OuR vISIOn is excellence in nursing practice everywhere in Ontario. Infection Prevention and Control ISBN 1-897074-32-8 Pub. No. 41002 Copyright © College of Nurses of Ontario, 2009. Commercial or for-profit redistribution of this document in part or in whole is prohibited except with the written consent of CNO. This document may be reproduced in part or in whole for personal or educational use without permission, provided that: • Due diligence is exercised in ensuring the accuracy of the materials reproduced; • CNO is identified as the source; and • The reproduction is not represented as an official version of the materials reproduced, nor as having been made in affiliation with, or with the endorsement of, CNO. First published February 1996 as Infection Control Guidelines (ISBN 1-894557-33-6) Reprinted January 2000, October 2000, revised for Web June 2003, reprinted January 2004 as Infection Control (ISBN 1-894557-44-1) Revised June 2004, December 2005. Reprinted May 2008 (ISBN 1-897074-32-8). Updated in June 2009. Additional copies of this document may be obtained by contacting CNO’s Customer Service Centre at 416 928-0900 or toll-free in Ontario at 1 800 387-5526. College of Nurses of Ontario 101 Davenport Rd. Toronto, ON M5R 3P1 www.cno.org Ce fascicule existe en français sous le titre : La prévention des infections, n° 51002 PR ACTICE STAndARd 3 Nursing......
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...Quality indicators are defined as parameters along which a healthcare organization’s performance is measured (The Healthcare Management Council, 2009). These indicators may be determined by the organization based on its unique needs, or they may be dictated by regulatory agencies. The measures of the indicators allow an organization to gauge its performance against itself over time or against other similar organizations statewide or nationwide. Regardless, the quality indicators must be congruent with the organization’s mission, vision, and values. This paper will provide a description of the Community Health Center of Franklin County, Inc. (CHCFC), describe the mission, vision, and values of CHCFC, explain some quality indicators and measures currently in place at CHCFC, and discuss who is responsible for CHCFC’s quality improvement plan. CHCFC Description CHCFC is a nonprofit federally funded community health center located in rural Alabama. It operates 10 clinics in eight different counties. TCMC is fully accredited by The Joint Commission. Services vary slightly from clinic to clinic. Each clinic offers general primary healthcare, in-house laboratory testing, patient medication assistance programs, and four of the clinics offer in-house X-ray services. According to CHCFC’s 2008 Uniform Data System Report, providers within......
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... Nursing leadership and management Leadership refers to setting a new direction or a way forward for a group of people, so that can they follow. Management on the other hand is controlling or directing people or resources in a group regarding the values that have already been established. Leadership and being an outstanding leader depends on ones qualities and behaviors that they exhibit in different circumstances or situations (Hader, 2008). Leadership has to go hand in hand with management because; without management, the direction that is set does not reflect on how the new direction is going to be achieved. Others will have to work hard in the shadows that have been left behind by the others. Effective nurse leaders are those who involve others to work together in pursuit of a common goal (Sullivan & Decker, 2005). For this reason, I choose to shadow with my manager for couple of hours to see how a tipical day goes for him. In this essay, I will discuss how my manager manages our unit, his communication style and it effectiveness, his type of leadership style or styles and it effectiveness, and what my thoughts and reactions are about this experience. Our unit is a mixed unit consisting of respiratory and geriatric patients. We also care for stroke patients on the unit. In managing the unit, our manager uses more democratic, or participative leadership style though he also exhibits transactional and transformational styles.......
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...Catalog | * Reuse process assets like business objects and services across processes | Oracle ADF Mobile | * Develop UI for mobile devices | Packaged Application Adapters | * Integrate with legacy systems and extend your applications for greater functionality and flexibility | Best Practices with Process Accelerators Feature | Benefit | Predefined Process Models and Business Rules | * Reach process excellence faster and with lower risk | Easy-to-Customize Process Definitions | * Reuse and extend the pre-built solution for your unique requirements | Embedded Best Practices | * Leverage embedded design patterns for creating best-in-class, process-based applications | Pre-Defined Metrics and Key Performance Indicators | * Get started with your process monitoring and improvement | Caso de una empresa que haya utilizado ese producto BPMS Corporación GEO soporta sus operaciones financieras en Oracle BPM y Oracle SOA Con las soluciones, la organización tendrá la facultad de generar indicadores comerciales diarios prácticamente en tiempo real Vista de uno de los complejos inmobiliarios Por Redacción BPM-Spain.com Actualizado el 10 de abril, 2012 - 00.06hs. Disminuir tamaño de letraAumentar tamaño de letra Corporación GEO (www.casasgeo.com), desarrolladora de vivienda en México y Latinoamérica, planea integrar todas sus operaciones comerciales al cierre de 2012 con la oferta de soluciones de Oracle. Con las soluciones Oracle BPM y......
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Nurse Sensitive Indicators
...Nurse Sensitive Indicators Samantha Hardley Western Governors University Nurse Sensitive Indicators Nurse sensitive indicators are intended to measure patient and family satisfaction of care. Whether it be perception of care, quality of care, care management or patient outcome. Nursing care is a critical determination in the quality of care in hospitals and in patient outcomes. They are a critical component of the healthcare delivery system. According to the American Nurses Association (“Nurse Quality Indicators”, 2011) the definition of nurse sensitive indicators is as follows: “Nurse sensitive indicators reflect the structure, process, and outcomes of nursing care. The structure of nursing care is indicated by the supply of nursing staff, the skill level of the nursing staff, and the education/certification of nursing staff. Process indicators measure aspects of nursing care such as assessment, intervention, and RN job satisfaction. Patient outcomes that are determined to be nursing sensitive are those that improve if there is a greater quantity or quality of nursing care (e.g., pressure ulcers, falls, and intravenous infiltrations)” An understanding of nurse sensitive indicators by anyone on the nursing staff or anyone involved in patient care would help identify issues that could interfere with patient care in the future. These are measured in healthcare by monitoring, surveying, and tracking of pressure ulcers, patient falls, restraint use, skill mix, and......
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Nursing Sensitive Indicators
...TASK 1 RTT1 TASK 1 A. Discuss how an understanding of nursing-sensitive indicators could assist the nurses in this case in identifying issues that may interfere with patient care. Nursing-sensitive indicators are determinations used to delineate the excellence of nursing interventions and positive patient outcomes. This is not a new concept. In the 1800’s, Florence Nightingale, a promoter of outcomes, revealed such indicators when she revealed her statistical findings of soldier’s mortality rate associated to environmental conditions during the Crimean War (Fee & Garofalo, 2010). Over the past decades, various studies world-wide have been conducted on the connection of nursing quality indicators and their outcomes. The American Nurses Association (ANA) recognized these studies were an important focus in evidenced-based practice among the nursing profession; and in 1998, they established a program for implementing, developing and storing these nursing-sensitive indicators, known as the National Database of Nursing Quality Indicators (NDNQI) (ANA, 2014). The NDNQI serves as a valuable resource for hospitals nationwide at the acute level for administrators and nurses alike to compare various indicators and outcomes with that of other facilities to determine best practices for patients and staff. In the case of Mr. J, it is clear the nurse caring for this patient had little or no knowledge of indicators of restraint prevalence. However, my initial concern......
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...Babies constantly need someone to look after them. However, care does not mean meeting only physical needs of a child; they need sensitive care. I have always thought that there is no substitute of a mother for a baby because no one else can care for baby like mother herself. Though, researches and studies have given me a broader picture of the concept of sensitive mothering, mother and child bonding and their impacts on the social and emotional development of a child. In this essay we will discuss sensitive mothering in relation to attachment theory of John Bowlby together with Ainsworth patterns of attachment. Also, link the concept with Erik Erikson psychodynamic theory and will look into researches on the impact of early attachments on social and emotional development over a life span. Sensitive mothering as explained (Ainsworth et al. (1971) in Meins et al. 2001) is mother’s sensitivity and her positive attitude towards a child. Sensitive mother is able to understand a child’s specific behaviour and respond to his/her needs on time in a proper manner. She is able to establish mother- child communication and can arouse child senses without obstructing child’s own interest and always puts her child first. Sensitive mothering allows emotional attachment, and enables mothers to read child’s emotions and respond to them accordingly. In contrast, in sensitive mother is the one who gives priority to her own schedule and her care is based on her own wish. Thus, she ignores the......
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Nursing Sensitive Indicators
...Running head: NURSING-SENSITIVE INDICATORS 1 Nursing-Sensitive Indicators Christen Steele Western Governors University NURSING-SENSITIVE INDICATORS Nursing-Sensitive Indicators The ANA has formulated a list of aspects of patient care that are impacted by nurses. These are called nursing-sensitive indicators (Sauls, 2013). . A knowledge of nursing-sensitive indicators is a way for nursing staff to impact the care that they give to patients and also a way that nursing can impact policy and procedure at the facilities that employ them. Identifying Issues With Nursing-Sensitive Indicators In the case of Mr. J, an understanding of nursing-sensitive indicators by the nursing staff is important in assisting those caregivers to identify issues that are interfering with Mr. J’s care. In this case, the nurses having knowledge that Mr. J’s decreased mental status due to receiving pain meds and being restrained to the bed increase his risk of acquiring a pressure ulcer on his bony prominences. With this knowledge, changes in Mr. J’s care, including regular position changes and perhaps changes in pain medications to decrease lethargy would be key in decreasing his risk of developing a hospital acquired pressure ulcer. Advancing Quality Patient Care With Nursing-Sensitive Indicators In the hospital setting, collecting data on specific nursing-sensitive indicators and reporting those results to the staff, can empower the staff to improve patient outcomes. Committees can be formed......
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...Nursing-Sensitive Indicators Frances Westlake WGU Nursing-Sensitive Indicators Having knowledge and understanding of nursing-sensitive indicators assist the nurse with providing quality, ethical and safe care to the patient. In Mr, J’s case, the plan of care was not evidence based; otherwise they would not have applied restraints. The restraints only impeded his care by restricting movement which resulted in him having a pressure ulcer. By Mr.J being drowsy and having some dementia he was a high fall risk. The nurses could have used a bed alarm or staffed a sitter at his bedside. The nurse providing care to Mr. J should have immediately provided him the correct diet according to his religious beliefs. Family involvement also increases better outcomes for the patient; however, the Mr. J’s daughter was not included in the plan of care or notified of the use of restraints or the change in his diet. The nursing-sensitive indicators analyze the quality and patient outcomes of nursing care provided to patients. The information can be used to look at the nursing practice and processes, as well as how changes have influenced patient care and outcomes throughout the hospital. The measures are used for quality improvement in areas that have scored high or that could become potential issues. For example, if the pressure ulcer rate was high throughout the hospital, a pressure ulcer prevention program would be implemented. Staff would be educated on the program, and then nurse......
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Nursing Sensitive Indicators
... Nursing Sensitive Indicators The American Nurses Association established national initiatives called nursing-sensitive outcome indicators that focus plans/programs to increase quality and safety in patient care. They gauge aspects of direct patient care related to quality of nursing care by reflecting on structure, process and outcomes of nursing care. Structure in regard to staffing and the skill, education and certification of staff; process in regards to measuring aspects of nursing care related to assessment, intervention and RN job satisfaction, and outcomes by improving the rates of specifics in relation to patient outcomes such as in this particular case preventing hospital acquired pressure ulcers, improving patient satisfaction and restraint prevalence. Nursing Sensitive indicators are only specific to nursing and in 1998, ANA developed a National Data base of nursing quality indicators (NDNQI) so they could continue to collect and build on data from studies to expand nursing knowledge related to factors that influence the quality of nursing care. Why is this important? The nursing profession has the responsibility to measure, evaluate and continually improve practice. NDNQI identify where and how the staff is needed and show the need to increase staff in particular areas of nursing care that need improvement. The NDNQI mission is to help the RN in patient safety and quality improvements by providing research based national and comparative data on nursing......
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Nursing Sensitive Indicators
...Nursing Sensitive Indicators: Organizational Systems Gleidis Angeles Western Governors University Nursing Sensitive Indicators: Organizational Systems The knowledge of nursing sensitive indicator can be helpful in providing the patient care which meets the quality and ethical standards. Nursing sensitive indicators rely on evidence to take patient care decisions (Patrician, 2010). According to Patrician (2010), Evidence Based Nursing is the use of personal expertise and research to take decisions on patient care. In case of Mr. J, there is a clear lack of evidence based nursing. Mr. J was kept in restraint without considering that Mr. J was not trying to get out of bed by himself. When the pressure ulcer was identified, the nurse neglected evidence which should have been a basis of removing restraint. Even if the risk of falling was high, a sound alarm could have been placed at the bedside, which Mr. J could have used when he wanted to use the bathroom. The body of Mr. J was in unnecessary discomfort due to restraint and constant pressure was causing ulcer in the back. Mr. J was diagnosed with mild dementia and was drowsy, so the nursing staff had put him in restraint. Although, there are very flexible guidelines for the use of restraint in the National Quality Forum (2004), but, in case of Mr. J, the nurse is rigidly focused on keeping the patient in restraint to reduce risk of falling. The restraint makes the patient’s body immobile and can also make the patient......
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...Introduction: An economic indicator is simply any economic statistic, such as the unemployment rate, GDP, or the inflation rate, which indicate how well the economy is doing and how well the economy is going to do in the future. If a set of economic indicators suggest that the economy is going to do better or worse in the future than they had previously expected, they may decide to change their investing strategy. Economic indicators include various indices, earnings reports, and economic summaries. Examples: unemployment rate, quits rate, housing starts, Consumer Price Index (a measure for inflation), Consumer Leverage Ratio, industrial production, bankruptcies, Gross Domestic Product, broadband internet penetration, retail sales, stock market prices, money supply changes. Three Attributes of Economic Indicators 1. Relation to the Business Cycle / Economy Economic Indicators can have one of three different relationships to the economy: 1. Procyclic: A procyclic (or procyclical) economic indicator is one that moves in the same direction as the economy. So if the economy is doing well, this number is usually increasing, whereas if we're in a recession this indicator is decreasing. The Gross Domestic Product (GDP) is an example of a procyclic economic indicator. 2. Countercyclic: A countercyclic (or countercyclical) economic indicator is one that moves in the opposite direction as the economy. The unemployment rate gets larger as the economy gets worse so...
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...1.A) Sensitive periods are specific, limited time when the child shows a strong attraction to a particular activity. The activity child is drawn to aid the child in his/her physical, mental and emotional development. Sensitive periods can be long, short, some overlap or run parallel. When a child is gaining new skills or knowledge during a sensitive period, he/she does so with great ease and with deep concentration. * The first one is the period of Sensory awareness. It originates at birth and continues until the young one reaches the age of 4. During this time the child needs to fully implement all the senses in order to expand them as much as possible. * The second sensitive period which focuses on Language development does not start until the age of three months. The child is in this phase until he/she reaches almost 6 years of age. In this time the little one distinguishes the sound of a human voice and is able to identify the person’s mouth moving. During this stage the child imitates certain sounds, especially the ones that people make. This shows the ability that the small being has to be able to discriminate and mimic the noise that other individuals make. * The third sensitive period focuses on Order. It appears from the age of one and subsides at the age of three. In this time the child expresses the need for stability as this is the organizational phase. The little one is concentrating on forming patterns and foundations for understanding the world......
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...quality patient care within the healthcare team. The Grade 2 Year 1 Registered Nurse will Page 1 October 2010 Position Description Division One, Grade 2 Year 1 Registered Nurse be responsible for ensuring his / her own professional development in order to maintain clinical skills and knowledge. KEY RESPONSIBILITIES RESPONSIBILITY AREA 1: Continuum of Care The Grade 2 Year 1 Registered Nurse will ensure that the nursing care delivered is at the highest possible standard and in accordance with legislation affecting nursing practice. The Grade 2 Year 1 Registered Nurse is responsible for his/her own professional development. Performance Indicators: Ensures delivery of high quality care incorporating the values and Health Care Philosophy of St Vincent’s Health Australia. Accurately documents patient care in accordance with hospital guidelines. Adheres to all aspects of confidentiality in regard to patients, staff and personnel. Responds to clinical changes in patients conditions and initiates consultation with relevant medical/nursing and multidisciplinary team as required. Seeks guidance from senior nurse when limited by own level of expertise. Develops discharge planning skills involving patients and/or family. Is responsible for own professional development, including achievement of 100% annual clinical competencies within designated timeframes. Attendance and participation in four study days and unit based education. Application of......
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