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Ways to assess the care of loved ones

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According to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the growing shortage of nurses in America’s hospitals is putting patient lives in danger and requires immediate attention. “The current nursing shortage threatens to heavily impact our citizens’ health and our nations’ security preparedness”. (Person, 2003) The nursing shortage that is sweeping across the United States has been upgraded from a health crisis to a national security concern. A recent study in Pennsylvania found that surgical patients in hospitals with high patient-to-nurse ratios experience higher rates of mortality and deaths following complications. Nurses working in these establishments tend to experience greater burnouts, job dissatisfaction, which in turn leads to poor patient care. “A recent national survey found that an astounding 75 percent of RNs feel that the quality of nursing care at their facility has declined during the past two years, with 68 percent of RNs citing staffing levels as a major contributing factor to this problem.” (AFSCME, 2003)

Nurses are often pressured into taking short cuts to save hospitals money. Most of the time, this results in inadequate care provided to patients. Hospitals have found that with lower nurse to patient ratios will enhance the ability to recruit new nurses at lower costs. “Research shows there are concrete costs of inadequate RN staffing. Nurses report that they are assigned too many patients to be able to deliver optimal nursing care and adequately supervise support staff. With too many patients to care for, a hospital RN might not have time to clean a urinary catheter frequently enough to prevent a urinary tract infection. The nurse may not have enough time to ensure that a bedridden patient is turned, allowing secretions to build up in the patient’s lungs resulting in pneumonia. These are among the hospital incurred infections that are preventable with appropriate RN staffing” (Myers, 2003)

In the profession of nursing, nurses can be leaders and managers. In this role, nurses are responsible for the quality of client care through a process, which is known as quality assurance. “Quality assurance consists of the quality control activities that evaluate, monitor, or regulate the standard of services provided to the consumer” (Lemone & Burke, 7).

Obviously, a higher nurse-to-patient ratio in acute-care hospitals significantly improves patient care and safety. Beyond that general principle, one may ask what clues can help patients and their loved ones judge the quality of a facilities nursing care. Nursing facility standards adopted by all states must include requirements to ensure that residents of nursing facilities receive appropriate care, including medical, nutritional, social and pharmaceutical care. (ASCP, 1998) These standards must also ensure residents’ rights and quality of their care.

There are many ways to assess the quality of care for each organization. By asking questions and receiving complete answers can be an indicator of a proper and safe nursing facility. By observing the staffing levels and nurse to patient ratio allows the prospective family to view the interaction of the nurse with his/her patients. In order to see how many patients a nurse sees in one shift, ask the nursing supervisor or a nurse manager.

Through talking to staff and observing their verbal and nonverbal actions can be an indicator of care. This way you are not just viewing hospital statistics you can hear real opinions. On a general medical surgical level, a nurse should be caring for no more than six patients, and in an intensive care unit no more than two patients. (Needleman, 2002) Recent studies have shown that more nursing experience leads to better patient outcomes.

Nurses have different work schedules than most professionals. Nurses usually work twelve-hour shifts to have better patient coverage. Working more than a twelve-hour shift, especially double shifts, causes a visible decline in performance. Ask about the average length of the nursing shift on a hospital floor, and how often nurses work long or double shifts. It is also helpful to find out if the hospital has an on-call pool of nurses, or another way to bring in new nurses when a shortage arises.

Workplace stress, poor lighting, and lack of communication among nurses and other staff at the hospital can lead to poorer patient care. Information about those conditions may be hard to find, but by “seeing for yourself,” you can be the judge. If a hospital is hesitant about providing information about nursing conditions, this presents a problem. One can’t expect a busy nursing supervisor to provide information on the spot, but if someone doesn’t get back to you relatively soon and doesn’t fully answer questions, it’s a sign the hospital isn’t taking such concerns seriously.

Besides proper medical care, there are other therapeutic ways that nurses can ensure a proper care standard. The Nursing Practice Act (NPA) defines the practice of nursing as those functions including “basic health care, that help people cope with difficulties in daily living that are associated with their actual or potential health or illness problems or the treatment thereof, and that require a substantial amount of scientific knowledge or technical skill including all of the following: direct and indirect patient care services…” (NPA, Section 2725, 2003). These direct and indirect patient benefits include the capability of registered nurses to provide information concerning alternative therapies, and to perform these alternative measures in accordance with the Standards of Competent Performance.

Nursing is directly involved in any quality assurance activity that evaluates nursing care. The art of nursing is an interactive and problem-solving process used by the nurse to give organized and personalized care. The objective of nursing care is to maximize a person’s level of well being and positive interactions with the environment through the nursing process.

Nurses are legally liable and morally responsible for the quality of the care they provide to patients; yet the meaning of ‘high quality nursing care’ remains unclear. This is mainly because models used to define it are taken from other exercises. Patient outcomes are the result of the service nurses give. This rating of quality of care give is most effective when evaluated from the patient’s perspective. Defining quality from the nursing profession focuses on evaluating the services provided, such as nursing actions and behaviors. High quality nursing is interconnected with competence in the cognitive, affective, and psychomotor areas.

Work Cited

American Federation of State, County, and Municipal Employees (AFSCME). (2003) Is There Really a Nursing Shortage? The Critical Need to Bring Nurses Back to the Hospital Industry Retrieved: November 11, 2003 From: http://www.afscme.org/una/sns02.htm

ASCP Board of Directors (1996, March) ASCP Principles for Achieving Quality Care in Nursing Facilities. ASCP Online. Retrieved November 5,2003 from: http://www.ascp.com/public/pr/other/principles.shtml

Brent, Nancy. (1997). Nurses and The Law, A Guide to Principles and Applications. W.B.Saunders Company.Lamone, P. & Burke, K. (2000) 2nd ed. Clinical Handbook for Medical Surgical Nursing. Upper Saddle, NJ: Prentice Hall.

Medi-Smart. (2003) Nurse Practice Acts Retrieved November 8, 2003 from: http://www.state.de.us/research/profreg/Frame.htm

Meehan, T. (2003, October) Careful nursing: a contemporary nursing practice. Journal of Advance Nursing. Vol. 44 Issue 1, pp. 99-108.

Myers, G. (2003, February) Executive Budget Relating to Health Issues. Retrieved: November 9, 2003 from: http://www.nysna.org/programs/NPS/testimonies/budgetII.htm

Needleman, J. (2002, May). Nurse-Staffing Levels and the Quality of Care in Hospitals. The New England Journal of Medicine Online. Retrieved November 3, 2003. from: http://content.nejm.org/cgi/content/abstract/346/22/1715

Person, M. (2003) Retrieved November 6,2003 from: http://www.aacn.nche.edu/Media/shortageresource.htm

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