Nurse leaders often have to face challenging situations and resolve ethical problems in their practice. The American Nursing Association (ANA) identified nonmaleficence as its fourth principle of ethics, according to which nurses must practice without causing harm to the patients and their communities (Gaines, 2020). In the case study scenario, the hospital personnel breached this ethics principle since the Jewish patient was restrained without a necessity and was served non-kosher meat. This paper will analyze the nursing quality indicators, resources, and hospital data to improve the quality of care at this facility.
Nursing-quality indicators are a range of metrics that evaluate patient outcomes considering the care practices administered by nurses. These benchmarks can assist in identifying the issues that obstruct patient care because, for example, a nurse leader can review the number of patient falls and compare them to the data about restraints use and pressure ulcer incidents. If the number of pressure ulcer cases and restraints use are high, the hospital may need to review its policy and use fewer restraints. According to Oner et al. (2020), pressure ulcers are among the most frequently used nursing-sensitive indicators of care quality, together with mortality, errors, and others, in the scholarly literature. This suggests that pressure ulcers are a severe healthcare concern, and the medical personnel has to pay special attention to ensuring that care interventions, such as restraints, are administered considering the risks. This approach is also consistent with ANA’s code of ethics (Gaines, 2020). Thus, nursing quality indicators allow one to determine the problematic patient outcomes caused by nursing interventions and address them appropriately.
Hospital data on specific quality indicators can assist in improving the quality of patient care across the hospital since this information accumulates records of the patient issues, interventions, and outcomes systematically. For example, the use of restraints and the incidents of pressure ulcers can provide insight into the number of pressure ulcer cases that can be avoided. In the scenario, it appears that the patient is well-oriented and does not need restraints to prevent falls, which points out the possibility of nurses overusing restraints. If, after the review of hospital data, a nurse leader determines that there is a correlation between a high number of pressure ulcers and restraints use, they can conclude that this is a systematic problem in this hospital. Moreover, they can compare the collected data to the national averages and benchmarks set by professional organizations. Therefore, hospital data can help nurses make informed and evidence-based decisions and implement interventions that will improve the quality of services.
The system resources, referrals, and colleagues that a nursing shift supervisor can use to resolve the ethical issue in this scenario are data on the Jewish patients’ referrals, use of restraints and other resources, CAN’s opinion on the red marks on Mr. J’s back, and feedback from the dietary workers. Based on the hospital admission and religious profile of the patients in this hospital data from the case study, the Jewish community avoids this facility, which may be linked to the mistreatment and lack of cultural competency from the personnel. Hence, to resolve the issue, it is best to acknowledge that these errors have happened, apologize to the patients who were mistreated, and establish a cultural competency training for the personnel that is specifically designed to discuss the specifics of the Jewish religion and associated care.
The feedback from the CNA can help understand why the patient’s pressure ulcer was not noticed by them, which may point out to a broader problem, such as lack of personnel or resources that requires nurses to overwork and leads to errors. For example, Kim et al. (2019) report that understaffing correlates with a high number of pressure ulcer cases. Alternatively, this information and the feedback of the dietary professionals may show negligence or improper cultural education of the staff, which is why they overlook their Jewish patients’ nutritional preferences.
By using the information collected from the hospital data and additional resources. A nurse leader can determine whether this instance with Mr. J. is a single case of negligence or a systematic problem. In the latter case, this means that the quality of care in this hospital is compromised, and the nurse leader has a duty to advocate for their patient’s wellbeing by contacting the management and discussing the intervention measures. Moreover, the supervisor’s decision to hide the fact that the patient was served non-kosher meat is a serious breach of ethics that the management has to address also.
In summary, this case study shows some critical errors that the staff and leaders of the hospital have left unnoticed, which lead to a disregard for the traditions respected by the Jewish community. Hospital data that can assist one in identifying the root cause and consequences of the problem includes data on the number of patients falls, pressure ulcer incidents, and complaints about the catering. This data, combined with additional resources a nurse leader can use, will provide insight into the problem and find evidence-based solutions.
Gaines, K. (2020). What is the Nursing Code of Ethics? Nurse. Web.
Kim, J., Lee, J., & Lee, E. (2020). Risk factors for newly acquired pressure ulcer and the impact of nurse staffing on pressure ulcer incidence. Journal of Nursing Management. Web.
Oner, B., Zengul, F., Oner, N., Ivankova, N., Karadag, A., & Patrician, P. (2020). Nursing‐sensitive indicators for nursing care: A systematic review (1997–2017). Nursing Open. Web.