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Florence Nightingale Persuasive

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In the 1800’s an effort to redefine nursing, by improving upon patient care, Florence Nightingale stands as the patron leader. She went onto grapple with the task of improving upon deplorable hospital conditions; while, measuring patient’s outcomes in a statistical method. Over a hundred years later, more recent compiled research related to a link between hospital staffing issues and adverse patient outcomes grabs the attention of internal and external healthcare populations. In the 90’s and early 2000’s new studies surface regarding the understaffed units, job dissatisfaction, and nursing burnouts; and, the correlation with the patients’ unforeseen negative outcomes. The general population fueled by the media (that followed the story closely) became fascinated with finding out the conclusion of the studies. As a result of the heightened attention the new practice of measuring indicators is born.

In 1996 Maas Johnson and Moorhead went on to coin the phrase “nursing-sensitive-indicators.” This was a phrase that was meant to depict the elements that were important to derive positive patient outcomes. Needleman went on to point out that nursing sensitive indicators are a comprehensive term. He went on to add that research in this given area focuses on the interrelationship of inadequate nursing care and the in meshed relationship with negative outcomes. Examples of negative patient outcomes included: patient falls, nosocomial infections, and medication errors (to name a few). In contrast patient outcomes can be greatly improved if the quantity and quality of nursing care is provided (Nursing World, 2013). In this particular case the patient’s outcome could have been much better; given, the CNA and RN would have provided nursing care intertwined with the knowledge base of nursing sensitive indicators.

In this case there were many measures that could have been taken to prevent harm to the patient; such as, repositioning the patient q2-3hrs with adequate pillow support and providing the patient with an ulcer reducing mattress. Another fall out was the improper positioning (by the CNA) of the patient flat on his back without elevating the head of bed. This improper way of laying down a confused patient succumbs them to risk for aspiration. The ineffective review of policy and procedures (or lack of) pertaining to
restraints should be visited by the nursing staff. The review of proper restraints policy can guide the nursing staff to choose the correct management plan for patients that require physical/chemical restraints; more so, it can serve as a checklist to determine the need for the drastic measure. The nursing sensitive indicator that pertained to patient satisfaction was obviously missed; when, the patient’s daughter’s concerns were shunned with disregard. Inappropriate comments were definitely perceived to be a lack of compassion for the patient and family member’s emotional as well as spiritual wellbeing.

In this case (as well as other like cases) the hospital/s have a duty to the affected patients in question and the prospective future patients. Their emphasis should be placed on not just remedying the wrongs ; more so, preventing issues and empowering everyone that is affiliated with patient care with the knowledge to discern a pending issue. A way that this can be implemented is by having multispecialty teams composed of (not limited to) wound care nurses, case management , dietary , and Nurse Practitioners .A team like this one can focus on separate issues based on their specialty and meet together to share the solution/s with the unit leaders and governing bodies of each corresponding unit. The unit leaders can initiate daily huddles and or weekly meetings with nursing staff and share the problem/ solution in an open forum. With the problems highlighted, preventions being taken, and initiatives in place; thus, unit RN’s can delegate for their patient’s wellbeing by keeping tabs through rounding. The higher chain of command can do their part to keep the best practices in place by keeping the descending staff accountable for their actions; yet, promote compliance by honoring those that make a difference through special acknowledgement.

Within the hospital there are many resources that are within reach to assist with issues that have a tendency to arise. The patient in this case came in with comorbidities caused by an in home fall. Case management is a behind the scenes resource that can assist with needed medical equipment such as a walker or assist the client with a rehab facility post discharge. Another excellent resource is the dietary department. The RN or unit leader can advocate for the patient in efforts to assure that the special dietary needs of the patient is granted. As for getting the special mattress /bed that offers ulcer reducing properties, each hospital has a specialty medical supply department that is available to assist the patient meet his/her need.

All hospitals don’t all function the same ; yet, in order to understand what they stand for most (if not all )are guided by a mission statement. All employees and their employers have a mission to uphold; for which, the patient and family should be the centered goal. Lastly, I would like to proudly share with you the mission statement of the trauma hospital I am blessed to work for –it goes on to state : To deliver quality, compassionate and cost effective healthcare services, in a safe environment, through operational excellence recognizing the cultural diversity of our employees and communities we serve (HCA,2013).

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