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Informatics and Nursing-Sensitive Quality Indicators: Transcript

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Informatics and Nursing-Sensitive Quality Indicators: Transcript

Hello and welcome to the Capella Hospital. My name is Brandee Forster, and today I’m honored to introduce you to the Nursing-Sensitive Quality Indicators (NSQIs) and the National Database of Nursing Quality Indicators. These are the measures that play a fundamental role in the enhancement of quality of care, the development of training programs, and the establishment of best practices and patient satisfaction levels. Monitoring NSQIs gives us vital information that not only informs the management but also leads to quality initiatives and finally results in the patients getting the best of care: Informatics and Nursing-Sensitive Quality Indicators: Transcript.

NDNQI does not just mean a list of key performance indicators and metrics. It is the real basis of our unswerving quality of healthcare provision. Using practice-based evidence and thoughtful data collection, we, as nurses, do more than improve the quality of care we deliver; we build a culture of constant learning and improvement that can help us inspire and retain the best of us. Welcome aboard!

So, what is the National Database of Nursing-Sensitive Quality Indicators?

Put in simple terms, the National Database of Nursing-Sensitive Quality Indicators, or NDNQI in short, is an extensive and broad platform established by the American Nurses Association (ANA), and which is focused on questioning and monitoring the work of nurses and their connection to patient outcomes, as noted by Oner et al. (2020). Initiated in 1998, NDNQI is an instrument healthcare organizations in the US use to monitor clinical performance and compare nursing measures on the local, regional, and even national level.

The major nursing-sensitive indicators are addressed by the scope of NDNQI; they are the quality indicators of the nursing care structure, process, and outcome. These factors are stringently attained after a thorough survey of research literature, including validation steps to make sure of their relevance and validity in nursing. Through NDNQI, healthcare organizations can pinpoint areas to improve and implement interventions based on evidence proven to lead to higher quality of care.

Besides that, NDNQI acts as a cornerstone, facilitating the development of evidence-based practice guidelines, supporting quality improvement strategies, and creating a culture of lifelong learning and development for healthcare organizations. NDNQI, by way of accurate data collection, analysis, and reporting, empowers nurses to operate in driving the change and improving the patient’s outcome.

On the same foundation, we can now define and discuss the nursing-sensitive quality indicators.

These indicators are categorized into three measures: structure, process, and outcome indicators. Structure indicators describe the attributes of the care environment, such as nurse-to-patient ratio or nursing education level. Second, process indicators will consist of the manner in which the care was carried out—a routine skin check or a timely pain assessment, in this case—as Afaneh et al. (2021) note. Lastly, outcome indicators indicate the outcomes of care and overall efficiency of nursing interventions, including the percentage of development of pressure ulcers.

The existence of nursing-sensitive indicators is necessary since it shows the important role that nursing plays in the larger healthcare process. Besides, they reveal the relationship between patient safety, organizational performance, and the everyday activities of the nursing personnel. To newer nurses, these indicators clarify the significance of regular activities that maintain precision, constancy, and responsibility in patient care.

To elaborate, let’s look into a particular quality indicator, that is, pressure ulcer rate.

Healthcare organizations can monitor many indicators, but the pressure ulcer rate is one of the indicators that present specific significance and is thus the subject of today’s tutorial. This measure monitors both existing pressure ulcers that are present upon the admission of a patient and the new ulcers that occur during a patient’s stay in the hospital. It is categorized as both a process and outcome indicator, reflecting preventative interventions’ quality and clinical results.

Notably, pressure ulcers develop when the skin is under pressure, particularly over bony areas such as the heels, sacrum, and hips. Immobile, critically ill, or malnourished patients are especially vulnerable. Monitoring this rate is crucial because pressure ulcers are largely preventable with proper nursing care. Moreover, Zaidi and Sharma (2024) note that the presence of pressure ulcers is often seen as a failure of the healthcare system to maintain basic safety and prevention standards.

Moving on, let us now explore the broader impact of this indicator on care quality and patient safety.

Transitioning from definition to impact, it is vital to understand why pressure ulcer prevention is significant for healthcare institutions and nursing teams. Pressure ulcers can lead to pain, infection, sepsis, and extended hospital stays. They are also associated with increased mortality rates in high-risk patients, as noted by Zaidi and Sharma (2024). From a financial standpoint, treating pressure ulcers can cost hospitals millions in unreimbursed expenses.

Also, pressure ulcers are categorized as never events by regulatory agencies, signifying that they should not happen in a well-run care facility. Their presence may provoke fines, litigation, or de-accreditation. Therefore, the rate of pressure ulcers is a noticeable indicator of patient safety and nursing performance. To mitigate this risk, preventive measures, including regular repositioning, support surface use, and proper skin care, should be consistently applied and documented, as explained by Headlam and Illsley (2020).

In this regard, new nurses need to familiarize themselves with this quality indicator when providing patient care.

Essentially, nurses are at the heart of prevention, so this quality indicator needs to be thoroughly acquainted with by new nurses on the first day. As nurses, our responsibilities will include conducting thorough skin assessments, calculating Braden Scale scores, identifying risk factors, and implementing evidence-based interventions. Prevention of pressure ulcers is highly linked with the vigilance and responsiveness of the nursing staff.

It is also vital that documentation of these actions be done. The record of repositioning times, any changes in skin condition and status, and escalating concerns to wound care experts are all valuable pieces of patient care and institutional reporting. Nursing-sensitive indicators, as Oner et al. (2020) state, are not a tool that measures the quality of care solely but facilitate the perpetual education, feedback, and refinements of clinical practices.

Let us now delve into data collection and how organizations track pressure ulcer rates.

Like most facilities, Capella Hospital relies on electronic health record (EHR) systems to record skin assessments and preventive actions. Nurses input data during routine care, using tools embedded within the EHR to guide consistency, such as Braden Scale checklists or skin condition templates.

In a recent conversation with a nurse manager from a mid-sized regional hospital, it was emphasized that documentation begins with bedside nurses. However, additional layers of quality control are often applied. For example, Gould et al. (2023) note that monthly prevalence audits are conducted in which wound care specialists verify documentation by physically assessing patients’ skin and comparing findings to what is entered in the record. This ensures that both care and reporting meet clinical standards.

How information is disseminated or shared across the system?

Once collected, this data does not remain siloed. The hospital uses aggregate reporting systems to distribute findings across departments. Nursing leadership, quality improvement committees, and frontline staff review monthly and quarterly pressure ulcer reports. These reports compare current pressure ulcer incidence to institutional goals and national benchmarks from the NDNQI.

In addition, the facility posts unit-specific dashboards in staff areas or includes performance metrics in shift huddles to keep everyone informed. According to the nurse manager I interviewed earlier, these visual summaries help maintain transparency and drive staff engagement in performance improvement. The pressure ulcer rate becomes a statistic and a shared goal across the care team.

In this respect, what is our role as nurses in ensuring data accuracy and integrity?

The role of nurses in this process extends far beyond documentation. Nurses serve as the primary data stewards in pressure ulcer prevention. When interventions such as repositioning, moisture control, or device padding are not accurately recorded, they may as well not have occurred from a quality monitoring standpoint. Inaccurate or incomplete documentation may distort the organization’s quality metrics and put the patient and facility at risk.

By contrast, when nurses consistently document skin assessments and care interventions, it validates the clinical work and informs future strategies. Afaneh et al. (2021) emphasize that the reliability of quality data hinges on accurate and real-time input from frontline care providers. In short, our careful attention to detail translates into measurable improvements in patient outcomes.

In conclusion, the pressure ulcer rate is more than a data point; it reflects the quality, safety, and compassion embedded in everyday nursing care. As a newly hired nurse, your ability to prevent, assess, and document pressure ulcers will have a direct impact on patient health, institutional performance, and professional growth. Besides, we are not only caregivers but also guardians of quality and key players in healthcare transformation.

Nursing informatics enables us to track and evaluate outcomes efficiently, but the heart of success lies in the frontline, our practice, our documentation, and our judgment. By embracing this responsibility, you contribute to patient safety and continuous improvement. Thank you for listening, and welcome to a community of nursing professionals committed to excellence in care.

References

Afaneh, T., Abu-Moghli, F., & Ahmad, M. (2021). Nursing-sensitive indicators: A concept analysis. Nursing Management, 28(3), 28–33. https://doi.org/10.7748/nm.2021.e1982

Gould, L. J., Alderden, J., Aslam, R., Barbul, A., Bogie, K. M., Masry, M. E., Graves, L. Y., White‐Chu, E. F., Ahmed, A., Boanca, K., Brash, J., Brooks, K. R., Cockron, W., Kennerly, S. M., Livingston, A. K., Page, J., Stephens, C., West, V., & Yap, T. L. (2023). WHS guidelines for the treatment of pressure ulcers—2023 update. Wound Repair and Regeneration, 32(1), 6–33. https://doi.org/10.1111/wrr.13130

Headlam, J., & Illsley, A. (2020). Pressure ulcers: An overview. British Journal of Hospital Medicine, 81(12), 1–9. https://doi.org/10.12968/hmed.2020.0074

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

Zaidi, S. R. H., & Sharma, S. (2024). Pressure ulcer. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK553107/

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Question 

Assessment 4 Informatics and Nursing-Sensitive Quality Indicators

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

Introduction:

The focus is on how informatics supports monitoring of nursing-sensitive quality indicator data. You will develop a training module to orient new nurses in a workplace to a single nursing-sensitive quality indicator critical to the organization. You will address how data are collected and disseminated across the organization along with the nurses’ role in supporting accurate reporting and high-quality results.

Professional Context
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.

NDNQI® was established as a standardized approach to evaluating nursing performance in relation to patient outcomes. It provides a database and quality measurement program to track clinical performance and to compare nursing quality measures against other hospital data at the national, regional, and state levels. Nursing-sensitive quality indicators help establish evidence-based practice guidelines in the inpatient and outpatient settings to enhance quality care outcomes and initiate quality improvement educational programs, outreach, and protocol development.

The quality indicators the NDNQI® monitors are organized into three categories: structure, process, and outcome. Theorist Avedis Donabedian first identified these categories. Donabedian’s theory of quality health care focused on the links between quality outcomes and the structures and processes of care (Grove et al., 2018).

Nurses must be knowledgeable about the indicators their workplaces monitor. Some nurses deliver direct patient care that leads to a monitored outcome. Other nurses may be involved in data collection and analysis.

In addition, monitoring organizations, including managed care entities, exist to gather data from individual organizations to analyze overall industry quality. All of these roles are important to advance quality and safety outcomes.

Reference

Preparation
As you begin to prepare this assessment you are encouraged to complete the Conabedian Quality Assessment Framework activity. Quality health care 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.

This assessment requires you to prepare an 8–10 minute audio training tutorial (with optional video) for new nurses on the importance of nursing-sensitive quality indicators. To successfully prepare for your assessment, you will need to complete the following preparatory activities:

Instructions
For this assessment, first review the nursing-sensitive quality indicators presented in the Assessment 04 Supplement: Informatics and Nursing Sensitive quality Indicators [PDF] (ATTACHED) resource and select one nursing-sensitive quality indicator to use as the focus for this assessment.

Next, imagine you are a member of a Quality Improvement Council at any type of health care system, whether acute, ambulatory, home health, managed care, et cetera. Your Council has identified that newly hired nurses would benefit from comprehensive training on the importance of nursing-sensitive quality indicators. The Council would like the training to address how this information is collected and disseminated across the organization. It would also like the training to describe the role nurses have in accurate reporting and high-quality results.

The Council indicates a recording is preferable to a written fact sheet due to the popularity of audio blogs. In this way, new hires can listen to the tutorial on their own time using their phone or other device.

As a result of this need, you offer to create an audio tutorial orienting new hires to these topics. You know that you will need a script to guide your audio recording. You also plan to incorporate into your script the insights you learned from conducting an interview with an authority on quality monitoring and the use of technology to collect and report quality indicator data.

You determine that you will cover the following topics in your audio tutorial script:

Additional Requirements

Competencies
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

Scoring Guide

Notes

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