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The National Database of Nursing Quality Indicators (NDNQI) is a system that allows healthcare organizations to measure and analyze the performance of nurses and compare the results to the national average. This database is the only existing national initiative that develops quarterly reports and shows changes in nurses’ quality of care in different units (Montalvo, 2007). The NDNQI can assist nurses in creating plans for the future because its data represents areas with opportunities and possible pitfalls.
Thus, its review is vital for designing nursing plans for the advancement of care. This analysis considers nurse-sensitive quality indicators such as patient satisfaction and recommends improvements to the nursing plan based on the NDNQI data and best practices focused on communication and attention to specific needs.
To choose a path for the future, one should review the gathered data and locate areas that need improvement. However, positive indicators should also be assessed to reinforce their level and determine the correct steps of the plan. The discussed Dashboard shows that the presented Inpatient Rehabilitation Unit has both positive and negative changes in each quarter. For instance, the amount of RN care hours exceeds the target level, thus denoting that nurses provide sufficient time to care for patients and address their needs. The unit also has an adequate rate of highly-skilled and educated professionals – the level of nurses with certificates and Bachelor’s degrees is above the norm.
Nevertheless, some NDNQI data reveal areas for improvement for the facility. The percentage of patients with pressure ulcers is much higher than the set target number. Moreover, the rate of acquired pressure ulcers is high as well.
These measurements mean that the facility’s staff does not adequately prevent the development of ulcers during patients’ stay at the unit. Furthermore, the most significant difference between the national average and the unit’s indicator is the rate of patients assessed for pressure ulcers before data collection. This variance of -39,13 suggests that only approximately 60 percent of all patients were evaluated for their pressure ulcers – a number that falls lower than the expected 100 percent rate. Another negative measurement is the rate of patient falls in the unit – it is below the target number for 6,05 points. This is one of the opportunity areas that should be considered by the facility’s nurses.
Nurse-sensitive indicators should also be analyzed because they present a view of the staff’s relationship with patients. The fluctuations in quarterly results determine that the functional independence of patients has improved throughout the year. Similarly, the length of stay has also seen positive changes, as the unit’s measurement is below the target number, meaning that patients are treated well enough to leave the hospital earlier than possible. Moreover, patient satisfaction surveys show that nurses’ courtesy is at a high level.
Nonetheless, other indicators in this survey do not reveal positive developments. In a contrast, their results fluctuate, falling below the expected target number in the last quarter of the discussed year. For instance, the promptness of nurses’ responses, as well as their attentiveness to patients’ specific needs and pain, are low. Their numbers have fallen below the target line after surpassing it in the previous quarter. At the same time, patients point out a lack of education upon being discharged and sent home from the facility. Finally, the level of care coordination also seems to be inadequate. These negative indicators should be considered and reviewed to design a new nursing plan.
The Area for Improvement
Such nurse-sensitive factors as patient satisfaction present an area of opportunity for future improvement. The dashboard shows that almost all answers from individuals deem the quality of care not satisfactory enough. These results may significantly affect the hospital’s image because they reveal a lack of trust and understanding between patients and nurses. According to Buhlman (2016), a nurse-patient relationship is an integral part of care because it has a positive impact on a patient’s adherence to treatment, view of the services, openness about problems and medications, and overall health-related outcomes. By developing a meaningful and reliable relationship with clients, nurses can promote better self-help practices.
Such factors as pain responsiveness and special needs management should be addressed in this specific situation because an inpatient rehabilitation unit is focused on helping patients recover both mentally and physically. These factors should be improved to lower the inherent suffering of rehab patients. It should also be noted that discharge instructions have to be updated as well to increase patients’ confidence in their treatment plan and future outcomes. Thus, the area of patient satisfaction is essential in forming the view of the facility and its relationship with patients.
Suggested Nursing Plan
Focusing on the patient survey and nurses’ attention to the clients’ specific needs, one can introduce several changes to the nursing plan. The plan should interview nurses and formulate their understanding of current issues and possible interventions. Then, one can review the findings and determine which details of the program need more attention than others. For example, training and evidence explanation may help nurses to understand why change is necessary how it will affect their performance. After the preparations are completed, one should start the implementation process.
First of all, nurse engagement strategies should be upgraded to increase nurses’ interest in their duties. Dempsey, Reilly, and Buhlman (2014) find that purposeful hourly rounding is a strategy that encourages patient-nurse communication and enhances the experiences for both sides. Montalvo (2007) supports this idea, showing that staff responsiveness rises as a result of these rounding interactions. Nurses can utilize regular rounding to ask patients whether they need a position change or toileting assistance. It should be noted that this initiative can also lower the rate of pressure ulcers.
The second proposed suggestion is the bedside shift report – an activity during which patients can assess the nurses’ view of their health. Bedside handovers involve patients in the care process and engage them as observers and participants in nurses’ exchanges. Dempsey et al. (2014) argue that this initiative improves the continuity of care and discharge transition. Thus, such indicators as nurses’ attention to special needs and coordination of care may change as a result.
Finally, a teach-back system for discharge instructions should be improved to ensure that the patients understand their treatment. Griffey et al. (2015) note that patients’ levels of comprehension may become a barrier to their communication with nurses. Limited health literacy should be overcome with the development of intuitive and straightforward instructions that have visual aids. Therefore, nurses should be trained not only to ask patients to repeat the information back but to explain why certain activities should be performed.
The NDNQI data allows hospitals and medical professionals to review their performance and variances in activities. This information can be used as a foundation for future nursing plans. In the discussed dashboard, the inpatient rehabilitation unit employs skilled and polite professionals. However, their interactions with patients do not lead to reliable and strong relationships. Thus, such changes as purposeful hourly rounding, bedside shift reports, and an improved teach-back system can be introduced in the new nursing plan.
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Buhlman, N. (2016). Nurse staffing and patient experience outcomes: A close connection. American Nurse Today, 11(1), 49-52.
Dempsey, C., Reilly, B., & Buhlman, N. (2014). Improving the patient experience: Real-world strategies for engaging nurses. Journal of Nursing Administration, 44(3), 142-151.
Griffey, R. T., Shin, N., Jones, S., Aginam, N., Gross, M., Kinsella, Y.,… Kaphingst, K. A. (2015). The impact of teach-back on comprehension of discharge instructions and satisfaction among emergency patients with limited health literacy: A randomized, controlled study. Journal of Communication in Healthcare, 8(1), 10-21.
Montalvo, I. (2007). The National Database of Nursing Quality Indicators® (NDNQI®). OJIN: The Online Journal of Issues in Nursing, 12(3), 112-214.