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This article explores the impact of physical restraints and pressure ulcers on patient outcomes, and the importance of quality improvement in nursing practice. It also discusses the QSEN competencies and the need for nursing education to focus on quality improvement.
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Quality Indicators & Safety Initiative: Group 4, Part 3 Kristin DeJonge Ferris Stat University MSN Program
Nursing Sensitive Indicators • Quality must become the center of healthcare(6) • Improved outcomes = Improved nursing care (1) • Data collection helps build relationship and understanding to nursing measures • Ultimate goal of improving organizational processes and outcomes(16)
Restraints • What’s the problem with physical restraints? • Physical harm: pressure ulcers, joint/nerve injury, death or strangulation • Physiological harm (16) • “But we have to use them to prevent our patients from falling” -NO! (4) • Restraints show increased harm to patients • Restraint removal does not correlate with increased falls
Restraints • Psychiatric unit Pilot Study (13) • Restraint use decreased from 36 to 0 incidents • Nurses were key to developing new care models • Interventions: • focused staff training; • ward projects for change and hope; • staff support through coaching; • and enhanced staff and patient communication projects • Limitations: Small sample • Support the strong impact of nursing
Pressure Ulcer • 1 in 10 patients • 10,000 to 20,000 dollars in increased health care expenses (10) • The Agency for Health Care Policy and research published guidelines for the prevention and early treatment • Braden & Norton Scales • Research of 723 patients on 33 different units • Relationship between skin integrity and number of beds on unit and daily census on the unit • Relationship between skin integrity and nursing assessments (10)
Pressure Ulcer • Reliability of Assessment tools? (8) • “Do risk assessment tools accurately predict risk?” • “Does risk assessment using risk assessment tools prevent pressure ulcer development?” • “Do escalation strategies prevent pressure damage?” • Score may be more reflective of nursing judgment rather than actual patient status (2) • Questions point to the significance of developing nurses who have the necessary knowledge, skills, and attitudes to identify areas of quality improvement (8)
QSEN: Why Quality Improvement? • Safety and Quality are key issues (6) • Organization cost: (14) • Financial • Patient Satisfaction • Staff morale • HCAPS (5,9) • Nursing plays a key role • Must be prepared!
QSEN Competencies: Quality Improvement • Improve Nursing’s quality & safety (3,14) • Practice of inquiry • Evidence-based standards • Systematic approach to adverse events/incidents
Support for Quality Improvement Initiative • Nursing is the largest division of the healthcare workforce (7) • The Good (11) • Students showed increased self-efficacy & self-confidence related to quality & safety in nursing practice • The Not-So Good (15) • Quality Improvement in nursing education continues to lag in comparison to other QSEN initiatives • Need to continue to research and develop new teaching strategies and curriculums that produce nurses with the necessary knowledge, skills, and attitudes to face quality improvement in healthcare.
Conclusion • Nursing sensitive indicators • Recognition is vital to improving the quality of care provided • Nursing plays a key role • Nurses must be prepared with adequate knowledge, skills, and attitudes associated with quality improvement • QSEN provides a reliable foundation to the educational preparation of professional nurses
