Informatics and Nursing Sensitive Quality Indicators

Informatics and Nursing Sensitive Quality Indicators

Hello and welcome to Preston County Diabetic Health Care System. My name is Simone Williams, and I am a member of the hospital’s quality improvement council. We, as the nursing department of Preston County Healthcare, are so delighted to have you join us and look forward to working with you. Today we focus on nursing-sensitive quality indicators and how they are utilized in this care system and beyond in the enhancement of quality of healthcare provision. These quality indicators are domiciled within the National Database of National Quality Indicators (NDNQI).

To begin with, NDNQI is a creation of the American Nursing Association, currently located at the nursing school of Kansas Medical Center. The basis of its creation was the increasing need for the assessment of the nexus between nursing practice and staffing to the level of healthcare quality that patient receives. This database, therefore, aims to aid nurse practitioners in improving the general quality of healthcare provision by providing evidence-based data on nursing practice and how it affects patient outcomes. Since its creation in 1998, NDNQI has been able to adopt a specific set of sensitive quality indicators that guide nursing practice toward the attainment of improved quality care.

According to Stalpers, Kieft, van der Linden, Kaljouw & Schuurmans in 2016, nursing-sensitive quality indicators provide great efficacy in the determination of nursing practices and projects that improve quality. These quality indicators are targeted at establishing the impact nursing practice has on clinical outcomes. These indicators are stratified into stratiforms that help to understand how nursing practice concerns affect patient care. This entails emphasizing the context of the delivery of nursing care with specific considerations on equipment, staff as well as finances. Additionally, interactions between the nurses and patients during the healthcare delivery processes are highlighted. These indicators also define the elements to which outcomes can be measured, such as patient satisfaction and health status, among others.

Nursing-sensitive quality indicators are reflective of the three aspects of nursing practice. These include structural, process, and outcome indicators. Structural indicators are those based on nurse staffing and knowledge. The supply of nursing staff, their level of nursing practice skills, and their certification and education levels are considered in this indicator. Process indicators are based on the nurses’ skill in inpatient assessment as well as their interventions in the care processes. Outcome indicators, on the other hand, are based on the clinical outcomes that are said to be sensitive to nursing. Nurse-sensitive patient outcomes include patient falls, patient satisfaction with pain management, and pressure ulcers, among others. In this discussion, we will focus on process indicators as determinants of quality care provision.

Process indicators touch on every aspect of nursing practice. As a newly recruited nurse in this hospital, every clinical decision you make will not only define your competency but will also be used to judge your skills as far as nursing is concerned. Oner et al., 2020 describe process indicators as methods of measurement that are utilizable in the quantification of a nurse’s competency in patient assessment as well as in nursing intervention. This is one special area that each one of you can always perfect by maintaining your knowledge base in the aspects of nursing practice that were imparted to you in nursing schools.

Process indicators maintain great significance as a determinant of improved patient outcomes. They will determine how well a nurse addresses the presenting clinical problems. The success of nursing will be based on fast and accurate clinical decision-making as well as on their skills in navigating through the routine complexities that clinical cases often present. Poor nursing interventions have been implicated in devastating clinical outcomes and are thus discouraged. In your future nursing practice and as part of the nursing staff in this hospital, you will be required to exhibit exemplary skills in patient assessment as well as a sound nursing intervention that can improve the quality of care in this facility.

As new nurses, you are required to be familiar with the process indicators as determinants of better patient outcomes. This will enable you to assume full responsibility for the patient care process and in this regard, prevent care-related errors that may affect the overall clinical outcome. Additionally, this will increase your desire to sharpen your skills and have better patient assessment skills as patient outcomes depend on them.

In quality monitoring, various nursing-sensitive indicators are utilized. An assessment of these indicators, as well as the patient outcomes that are linkable to them, often indicates the quality of the care process. In illustrating how quality care improvement is affected in this hospital, I interviewed the chairperson of the quality improvement council of this hospital. The interview interrogated the collection of data on the process indicators of quality as well as how the data aggregate is disseminated. The role of nurses in supporting accurate reporting was also discussed.

The chairperson noted that the rise in clinical incidences of hospital-acquired infections within the hospital as well as a report of a nurse’s satisfaction with the care process, prompted the collection of data on process indicators of quality. Nurse satisfaction data was obtained from the routine quarterly staff feedback carried out by the hospital’s administration. As noted by Li, Z. et al. in 2016, the effectiveness of nursing interventions is dependent on their level of acceptance and satisfaction with their work environment. Environmental satisfaction and acceptance enable a better understanding of the work environment and consequently raise their work effectiveness. As nurses set to start practicing in this hospital, you should all know that your environmental satisfaction is necessary for enhancing your work processes.

The rise in nosocomial infections within the hospital coincided with the nursing satisfaction report, with the peak rise being noted when the nurses’ feedback reports were at their lowest. A committee of experts tasked to investigate this situation concluded that the rise in infection was attributable to poor nurse handling with adequate evidence of poor hygienic observance. The nurses’ dissatisfaction was, however, attributable to burnout that resulted from the staff shortage that the hospital had at the time of the investigation. Resolution of the staff issue adequately returned the situation to normalcy. Currently, nurses within this hospital can carry out their roles adequately well, and your inclusion in our workforce is expected to further this course.

Upon conclusion of their investigations, the investigational body presented their findings to the quality improvement council. At the council, all members agreed in one accord that the report would be disseminated to the entire hospital staff via an internal memo. Additionally, various resolutive measures were suggested, with staff recruitment at the top of the list. The nurses were also encouraged to observe hygienic considerations in their intervention to prevent the recurrence of the same.

As newly recruited nurses, your input inaccurate reporting maintains great significance to the hospital. In the earlier case presented by the director, it was an extrapolation of nurses’ feedback and nosocomial incidence report that prompted investigations that finally led to the resolution of the problem. You should, therefore, be ready to be agents of accurate reporting and never shy from being bold for whatever you see as not right. Your interventions in nursing care are also important but may be the source of the hospital’s problems. Assuming full responsibility for your interventions and patient assessment process is thus important.

In conclusion, I want to congratulate you for joining the nursing workforce in this hospital. You are, however, reminded to utilize the knowledge you have acquired from this tutorial to improve your level of practice. Understanding the various nursing-sensitive quality indicators and their utility in the determination of quality patient outcomes is key. Process indicators, as mentioned above, are dependent on your patient assessment skills, nursing intervention capabilities as well as your general satisfaction with the work environment.

References

Li, Z., Cheng, S., Lv, L., She, X. Y., & Liu, X. H. (2016). The application of nursing-sensitive quality indicators in evaluating nursing efficacy. La Clinica terapeutica, 165(5), e342–e345. https://doi.org/10.7417/CT.2014.1760

Oner, B., Zengul, F., Oner, N., Ivanova, N., Karadag, A., & Patrician, P. (2020). Nursing‐sensitive indicators for nursing care: A systematic review (1997–2017). Nursing Open, 8(3), 1005-1022. DOI: 10.1002/nop2.654

Stalpers, D., Kieft, R., van der Linden, D., Kaljouw, M., & Schuurmans, M. (2016). Concordance between the nurse-reported quality of care and quality of care as publicly reported by nurse-sensitive indicators. BMC Health Services Research, 16(1). DOI: 10.1186/s12913-016-1372-z

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Prepare an 8-10 minute audio training tutorial (video is optional) on the importance of nursing-sensitive quality indicators for new nurses.

Informatics and Nursing Sensitive Quality Indicators

As you begin to prepare this assessment, you are encouraged to complete the Canadian Quality Assessment Framework activity. Quality healthcare delivery requires systematic action. Completion of this will help you succeed with the assessment as you consider how the triad of structure (such as the hospital, clinic, provider qualifications/organizational characteristics) and process (such as the delivery/coordination/education/protocols/practice style or standard of care) may be modified to achieve quality outcomes.

The American Nursing Association (ANA) established the National Database of Nursing Quality Indicators (NDNQI®) in 1998 to track and report on quality indicators heavily influenced by nursing action.