Importance of Nurse-Sensitive Indicators in Relationship to Patient Outcomes
Selection of a Condition or Disease
The condition chosen is pressure ulcers. The condition arises among patients when they experience injuries to the skin and its underlying tissue because of prolonged pressure. The condition is also referred to as bedsores. Pressure ulcers often affects skin that covers bony areas of the patient (Peterson et al., 2015). The body parts often affected include hips, tailbones, ankles, and heels. Bedsores is most prevalent in patients that have other underlying medical conditions that make them spend most of their time in the chair or in bed. They often develop in patients within hours or days. Most sores heal with treatment, however some never heal fully. Nursing practitioners can initiate a number of steps to prevent and help patients with pressure ulcers heal.
Identification of Nurse-Sensitive Indicators
The indicators often reflect three aspects in relation to quality of nursing care. Structural indicators relate to the availability of nursing practitioners, their skill level, and the professional accreditations. Process indicators concerns with measuring patient assessments and interventions, while outcome indicators reflect the outcomes among patients that depends on quality and quantity of nursing care.
Nursing-sensitive indicators is an increasing area of concern in the acute care setting leading to considerable development in research. The development arises from collaboration between nursing executives and nursing academics. The indicators continue to produce valid and reliable means of improving quality and performance in caring for patients with pressure ulcers within the acute care setting. The indicators are among the variables which practitioners have used to enhance strategies for improving patient outcomes. The nursing practice environment exhibits complexities and variations highlighting importance of the measures, theories, and models. The various reforms and policies within the health sector continues to advocate for development of nursing-sensitive indicators to support implementation of evidence-based practice.
One process indicator in preventing pressure ulcers among vulnerable elderly patients is risk assessment. The assessment should be done on admission to predict the likelihood of formation of pressure ulcers and form a basis for intervention. If the assessment risk score is high, then a preventive intervention measure is addressing their repositioning needs and management of tissue loads within the first twelve hours to prevent formation of pressure ulcers.
Another process indicator is nutrition. For example, if a vulnerable elderly patient is judged to be at risk of developing pressure ulcers and has malnutrition, then it is vital to institute a dietary intervention. Poor dietary habit is an independent indicator of developing pressure ulcers among patients requiring acute care. Studies link risk for malnutrition including low caloric intake, involuntary weight loss, low albumin level, anorexia among others and formation of pressure ulcers (Cullen, 2015). They further link the severity of malnutrition and the severity of the ulcers.
Pressure ulcer evaluation is another process nursing-sensitive quality indicator. For example, if a patient has a pressure ulcer, they should be assessed for location, depth, size, stage, and presence of necrotic tissue. The assessment provides data for later comparison of the healing process and also in predicting healing time. A structural indicator is the management of full-thickness ulcers. If the ulcer does not show no improvement with 4 weeks of administering treatment, then the plan should be assessed for appropriateness and presence of cellulitis.
Another structural indicator of care is the pressure ulcer debridement. If the patient presents full-thickness trochanteric or sacral ulcer, then the practitioner should perform debridement using an enzymatic, mechanical, or autolytic procedures within three days to remove any dead tissue. Cleaning is another structural indicator that determines patient outcomes. If the patient that requires acute care exhibits a stage 2 or greater sore, then is necessary not to use a topical antiseptic to clean the wound.
If a patient that requires acute care has full-thickness pressure ulcer and exhibits signs and symptoms of infection and they do not have another identified cause, then it essential to debride the necrotic tissue within twelve hours (Peterson et al., 2015). The measure will reduce dead tissue which are a medium for bacterial invasion. Finally, the last indicator is topical dressing. In instances where patients needing acute care have a clean partial or full-thickness pressure ulcer, then a moist environment should be available around the wound together with a topical dressing. The reason is to facilitate better healing, because moist environments are the most ideal.
Plan of Care using Nurse-Sensitive Indicators
Using the indicators in practice will help care for patients holistically to deliver evidence-based and patient-centered care. The indicators of quality care in managing and treating pressure ulcers will facilitate creating a comprehensive care plan. The indicators such as risk assessment and nutrition will help in making early and accurate nursing diagnoses of pressure ulcers. The indicators will also help in achieving the desired outcomes among patients in the acute care setting. For example, it is important to debride the necrotic tissue within the require time frames, not cleaning a stage 2 or greater ulcer with a topical antiseptic, and undertaking comprehensive evaluations to improve patient outcomes. The indicators will also help in improving nursing interventions in managing and treating pressure ulcers. For example, it important to provide a moist wound-healing environment and cleaning with topical antiseptic in instances where patient have a clean full-thickness or partial-thickness pressure ulcer. Finally, the indicators will help in evaluation of the quality of care. Keeping data helps in comparing the healing process and also in predicting outcomes.
References
Cullen, G. E. (2015). Reducing Hospital Acquired Pressure Ulcers in Intensive Care. BMJ Open Quality. Retrieved from doi: 10.1136/bmjquality.u205599.w3015
Peterson, J., Adlard, K., Walti, B., Hayakawa, J., McClean, E., & Feidner, S. C. (2015). Clinical Nurse Specialist Collaboration to Recognize, Prevent, and Treat Pediatric Pressure Ulcers. Clinical Nurse Specialist, 29(5), p. 276-282. Retrieved from doi: 10.1097/NUR.0000000000000135
