What we do/our interventions has an impact on our patients. How do we demonstrate that to others?

Task 1

My notes from the video for task 1:

What are Clinical Nursing Sensitive Indicators?

Nursing-Sensitive Indicators (NSIs) are measures and indicators that reflect the structure, processes and outcomes of nursing care (American Nurses Association, 2004). These measures reflect the impact of nursing care. Three types of NSIs were presented in our Magnet evidence: Clinical Quality, Patient Satisfaction and Nurse Satisfaction.

• Nursing has an impact on risk factors, taking appropriate steps to prevent issues/illness, incr satisfaction scores.
• What we do/our interventions has an impact on our patients. How do we demonstrate that to others?
• What we do contributes to the success of other disciplines so how do we differentiate our interventions from other disciplines? > Nursing Sensitive Indicators..
• NSI are broadly grouped: Structures, Processes, Outcomes

STRUCTURE: Staffing Levels, Staffing Mix, Education level, Experience level

• Structural indicators include the supply of nursing staff, the skill level of nursing staff, and the education and certification levels of nursing staff.
  • Magnet hospitals pushing for BSN. Structure aspects of NSIs show pt outcomes improved when nurses were prepared at BSN level.
  • How many years of work experience does a unit have. Greater wealth of knowledge.
  • Looking at the organizational pieces of nursing care: As staffing levels fall, quality of care goes
    down; and so do pt outcomes. Vice versa.
  • Staffing mix: the more RNs, the better outcomes. It may be expensive, but there are better

PROCESSES: Methods of assessments, methods of care, types of interventions

• Process indicators measure methods of patient assessment and nursing interventions. Nursing job satisfaction is also considered a process indicator.
• P/Ps can have a significant impact on outcomes. Evidenced base is best.
• Staff satisfaction is considered a process. If staff is satisfied w the work that they do and the care that they are provided and the support that the organization provides, they will provide better care. If im not happy, I don’t do a good job, I wont get good outcomes

OUTCOMES: Related to the quality or quantity of nsg care provided

• Outcome indicators reflect patient outcomes that are determined to be nursing-sensitive because they depend on the quantity or quality of nursing care. These include things like pressure ulcers and falls. Other types of patient outcomes are related to other elements of medical care and are not considered to be nursing-sensitive – these include things like hospital readmission rates and cardiac failure
• Pressure ulcers, infection rates, patient satisfaction (ie: pain management)
• So what is NOT a nsg outcome?

Things related to medical decisions:  C-sections, readmission rates

IMPORTANCE:

• Provide evidence for staffing, evidence for additional educational needs/staff development/what needs to be taught and who needs to be taught (not necessarily higher degrees)
• Evidence of nursing impact and reflect the quality of care
• Accrediting Agencies: measure quality

PERSONAL PROFESSIONAL PRACTICE

• In your professional practice how do you use NSI. If you are more aware of nursing influenced factors, you can pay more attention to s/sx, risk factors, satisfaction, take action to prevent or correct problems.

INSTITUTIONAL LEVEL

• Educational needs
• Guides decision making: QA dept collects data; foundation for decision making. Nurse managers, Administrators can recognize the contribution that Nsg provides and to make valid decisions to support nursing.
• Shares data: NDNQI (Nursing Sensitive Indicators Data Base) collects data allows you to compare against other organizations.

Recruitment & retention, education, public perception, meets accrediting requirements.

The ten original indicators that apply to hospital-based nursing are:

• Patient satisfaction with pain management
• Patient satisfaction with nursing care
• Patient satisfaction with overall care
• Patient satisfaction with medical information provided
• Pressure ulcers
• Patient falls
• Nurse job satisfaction
• Rates of nosocomial infections
• Total hours of nursing care per patient, per day
• Staffing mix (ratios of RNs, LPNs, and unlicensed staff

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