NURS-FPX4040 Assessment 4: Informatics and Nursing Sensitive Quality Indicators

Informatics and Nursing Sensitive Quality Indicators

Nurses should always be skilled and prepared to provide quality care. However, many issues, including knowledge and situations, hamper nurses’ ability to provide quality care. When new nurses join health care organizations, awareness of the issues hampering care quality should be a priority. They should understand the connection between nursing practice and patient outcomes and their role in delivering the desired health outcomes. Accordingly, awareness of nursing-sensitive indicators is crucial for all nurses. The purpose of this tutorial is to describe the importance of nursing-sensitive indicators and the nurses’ role in accurate reporting and high-quality results.

National Database of Nursing-Sensitive Quality Indicators

Before examining nursing-sensitive indicators, it is crucial to examine the National Database of Nursing-Sensitive Quality Indicators (NDNQI), mainly focusing on its roles. According to Harding et al. (2019), the American Nursing Association established the NDNQI as a national database for providing timely and detailed reports on the unit-level effects of nursing. NDNQI provides quarterly and annual reports. Its mandate implies that NDNQI’s primary goal is to build a growing body of knowledge that describes the issues impacting the quality of nursing care. Such a database is vital since nursing must continuously assess and improve practice.

Nursing-Sensitive Quality Indicators

At every level, nurses impact their patients significantly. However, the impacts cannot be accurately determined without accurate indicators. At the basic level, nursing-sensitive quality indicators reflect patient care elements that the nursing practice affects directly. According to Oner et al. (2021), nursing-sensitive quality indicators reflect three nursing care aspects: structure, process, and outcomes. In nursing practice, structural indicators have much to do with the supply of nursing staff and their skills. Education and certification levels of nurses are other structural indicators. Process indicators include methods that assess patients and nursing interventions. Outcome indicators reflect outcomes related to quality and quantity of care. Suitable examples include patient falls and pressure ulcers.

Nurse Turnover as a Nursing-Sensitive Quality Indicator

Nurse turnover is a staffing measure since it varies depending on the supply of nursing staff and job satisfaction levels. I have selected nurse turnover as the focus of this tutorial since all nurses can be victims of nurse turnover. Besides, new nurses are associated with high nurse turnover due to challenging work environments, workplace incivility, and the inability to cope with their job’s emotional and mental demands. Whether new or old in practice, the decision that a nurse makes has a profound impact on patient care. As a result, nurse turnover must be a priority area.

Before examining why it is crucial to monitor nurse turnover, it is vital to evaluate what nurse turnover entails and the underlying causes. It represents nurses leaving the job at any point, mainly when it is unexpected. Dewanto and Wardhani (2018) categorized the reasons for nurse turnover into three main groups: personal reasons, job offers from other organizations, and leaving due to working conditions. Personal reasons include issues such as age or joining other professions. The problem cannot be overlooked since the current nurse turnover in the United States ranges from 8.8% to 37% (Haddad et al., 2020). The rates vary depending on an organization’s location and nurses’ specialty.

Why it is Important to Monitor Nurse Turnover

At all times, nurses must be in the proper physical and mental state to provide patient care. Nurse turnover impedes nurses’ ability to work optimally since it increases the workload on nurses before they get a suitable replacement. Daouda et al. (2021) further mentioned that replacements do not always match the skills and experiences of the nurses that leave their job at a given time. Such challenges imply that patient care is affected adversely, an issue that nurses must always avoid. Worse, the increased workload may cause burnout, leading cause of burnout in nursing. Monitoring turnover is essential to facilitate replacement plans and ensure nurses are empowered to continue serving as expected.

The other reason for monitoring nurse turnover is its effects on health care costs. Currently, healthcare costs are high, and health care organizations should invent new ways of making health care affordable. However, it is challenging to achieve this objective when health care organizations spend substantial time and financial resources to deal with nurse turnover. Dewanto and Wardhani (2018) found that health care organizations spend massively recruiting and training nurses due to nurse turnover. Such resources could have been used in other programs such as nurse empowerment and purchasing health care technologies. Monitoring nurse turnover can help health care organizations to understand its dynamics and respond promptly.

Nurse turnover hampers the quality of care and patient safety. Overworked nurses cannot concentrate as naturally expected. Their productivity also declines as they lose concentration and interest on the job. Besides this adverse outcome, nurses are usually assigned specific patients depending on patients’ conditions, the intensity of care required, and special needs. Over time, nurses and patients form personal bonds that break when nurses leave an organization (Senek et al., 2020). The care process lacks continuity, and patients cannot receive patient-centered care. Such outcomes show the severity of nurse turnover and why it needs close monitoring.

Familiarity with Nurse Turnover

Knowledge is vital for new nurses to ensure that they are prepared and adequately skilled to cope with practice challenges. Accordingly, new nurses should understand nurse turnover and its implications on patient care. They should avoid issues fueling turnover as they help their colleagues cope with situations and adjust accordingly. Furthermore, new nurses should identify circumstances leading to turnover and ask for support to ensure that patient care is not adversely affected.

Collection and Distribution of Quality Indicator Data

Data is an integral part of today’s health practice. It is challenging to monitor trends and make accurate decisions without using data. When collecting data, nurses should consider technologies to enhance accuracy and promptness. However, new nurses cannot understand data collection and their role without interacting with experienced colleagues. From my interview with a colleague in the quality control department, my organization collects data on nurse turnover through a monthly analysis of staffing conditions. As the progressive reports also demonstrate, the monthly analysis compares the number of nurses who left the organization with those still working to quantify the turnover rate. In this analysis, unit managers provide the number of nurses who left and the causes. Next, the qualitative and quantitative summaries are handed over to the quality control department and the management to compose progressive reports. Such reports are detailed about the trends in nurse turnover, among other crucial data that guides the management and human resource department in decision-making regarding staff recruitment, training, and retention.

Data dissemination plays an instrumental role in creating an informed workforce. As an administrative practice, data dissemination helps nurses and other staff to understand the organizational performance on critical aspects of care (Shi, 2020). The organization disseminates aggregate data in two main ways. The first strategy is by sharing progressive performance reports. Here, departmental leaders and the management analyze how the units perform in terms of employee retention and whether any interventions are necessary based on the turnover rates. The other strategy includes briefs on the organization’s education page. Here, the staff is updated on the current developments, including nurse turnover and expected changes in the work schedules.

Regardless of their length of service, nurses play a crucial role in supporting accurate reporting and high-quality results. It is also a role that new nurses must embrace and be conversant with as they start actual practice. Firstly, nurses must provide timely updates on issues that affect the quality of care. Besides timely reporting, nurses must give an accurate report of any update as professionally required. In this case, nurses must enter the correct data in data collection systems and use technologies as necessary.

Conclusion

New nurses need to be ready to execute their mandate besides being adequately skilled. One way to achieve this goal is by being aware of nursing-sensitive quality indicators and their role in reporting and supporting high-quality results. As a concluding note, it is crucial to remember that nurse turnover can occur at any point in a nurse’s service. New nurses are also vulnerable to nurse turnover as they try coping with practice challenges and adapting to new environments. As a critical nursing-sensitive quality indicator, nurse turnover adversely affects patient safety and care quality. Besides being conversant with nurse turnover, nurses should help with accurate and timely data reporting to ensure high-quality results.

 

 

References

Daouda, O. S., Hocine, M. N., &Temime, L. (2021). Determinants of healthcare worker turnover in intensive care units: A micro-macro multilevel analysis. PloS One16(5), e0251779. https://doi.org/10.1371/journal.pone.0251779

Dewanto, A., &Wardhani, V. (2018). Nurse turnover and perceived causes and consequences: a preliminary study at private hospitals in Indonesia. BMC Nursing17(2), 1-7. https://doi.org/10.1186/s12912-018-0317-8

Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2020).Nursing shortage. StatPearls [Internet].https://www.ncbi.nlm.nih.gov/books/NBK493175/

Harding, M. M., Kwong, J., Roberts, D., Hagler, D., &Reinisch, C. (2019). Lewis’s medical-surgical nursing e-book: Assessment and management of clinical problems, single volume. Elsevier Health Sciences.

Oner, B., Zengul, F. D., Oner, N., Ivankova, N. V., Karadag, A., & Patrician, P. A. (2021). Nursing‐sensitive indicators for nursing care: A systematic review (1997–2017). Nursing Open8(3), 1005-1022. https://doi.org/10.1002/nop2.654

Senek, M., Robertson, S., Ryan, T., King, R., Wood, E., Taylor, B., &Tod, A. (2020). Determinants of nurse job dissatisfaction-findings from a cross-sectional survey analysis in the UK. BMC Nursing19(1), 1-10. https://doi.org/10.1186/s12912-020-00481-3

Shi, L. (2020). Novick& morrow’s public health administration.Jones & Bartlett Learning.

Prepare an 8-10 minute audio training tutorial (video is optional) for new nurses on the importance of nursing-sensitive quality indicators.

Introduction

As you begin to prepare this assessment you are encouraged to complete the Conabedian Quality Assessment Framework activity. Quality health care delivery requires systematic action. Completion of this will help you succeed with the assessment as you consider how the triad of structure (such as the hospital, clinic, provider qualifications/organizational characteristics) and process (such as the delivery/coordination/education/protocols/practice style or standard of care) may be modified to achieve quality outcomes.

The American Nursing Association (ANA) established the National Database of Nursing Quality Indicators (NDNQI®) in 1998 to track and report on quality indicators heavily influenced by nursing action.

NDNQI® was established as a standardized approach to evaluating nursing performance in relation to patient outcomes. It provides a database and quality measurement program to track clinical performance and to compare nursing quality measures against other hospital data at the national, regional, and state levels. Nursing-sensitive quality indicators help establish evidence-based practice guidelines in the inpatient and outpatient settings to enhance quality care outcomes and initiate quality improvement educational programs, outreach, and protocol development.

The quality indicators the NDNQI® monitors are organized into three categories: structure, process, and outcome. Theorist Avedis Donabedian first identified these categories. Donabedian’s theory of quality health care focused on the links between quality outcomes and the structures and processes of care (Grove et al., 2018).

Nurses must be knowledgeable about the indicators their workplaces monitor. Some nurses deliver direct patient care that leads to a monitored outcome. Other nurses may be involved in data collection and analysis. In addition, monitoring organizations, including managed care entities, exist to gather data from individual organizations to analyze overall industry quality. All of these roles are important to advance quality and safety outcomes.

The focus of Assessment 4 is on how informatics support monitoring of nursing-sensitive quality indicator data. You will develop an 8–10 minute audio (or video) training module to orient new nurses in a workplace to a single nursing-sensitive quality indicator critical to the organization. Your recording will address how data are collected and disseminated across the organization along with the nurses’ role in supporting accurate reporting and high quality results.

Reference

Grove, S. K., Gray, J. R., Jay, G. W., Jay, H. M., & Burns, N. (2018). Understanding nursing research: Building an evidence-based practice (7th ed.). Elsevier.

Preparation

This assessment requires you to prepare an 8–10 minute audio training tutorial (with optional video) for new nurses on the importance of nursing-sensitive quality indicators. To successfully prepare for your assessment, you will need to complete the following preparatory activities:

  • Select a single nursing-sensitive quality indicator that you see as important to a selected type of health care system. Choose from the following list:
    • Staffing measures.
      • Nursing hours per patient day.
      • RN education/certification.
      • Skill mix.
      • Nurse turnover.
      • Nursing care hours in emergency departments, perioperative units, and perinatal units.
      • Skill mix in emergency departments, perioperative units, and perinatal units.
    • Quality measures.
      • Patient falls.
      • Patient falls with injury.
      • Pressure ulcer prevalence.
      • Health care-associated infections.
        • Catheter-associated urinary tract infection.
        • Central line catheter associated blood stream infection.
        • Ventilator-associated pneumonia.
        • Ventilator- associated events.
      • Psychiatric physical/sexual assault rate.
      • Restraint prevalence.
      • Pediatric peripheral intravenous infiltration rate.
      • Pediatric pain assessment, intervention, reassessment (air) cycle.
      • Falls in ambulatory settings.
      • Pressure ulcer incidence rates from electronic health records.
      • Hospital readmission rates.
      • RN satisfaction survey options.
        • Job satisfaction scales.
        • Job satisfaction scales – short form.
        • Practice environment scale.
  • Conduct independent research on the most current information about the selected nursing-sensitive quality indicator.
  • Interview a professional colleague or contact who is familiar with quality monitoring and how technology can help to collect and report quality indicator data. You do not need to submit the transcript of your conversation, but do integrate what you learned from the interview into the audio tutorial. Consider these questions for your interview:
    • What is your experience with collecting data and entering it into a database?
    • What challenges have you experienced?
    • How does your organization share with the nursing staff and other members of the health care system the quality improvement monitoring results?
    • What role do bedside nurses and other frontline staff have in entering the data? For example, do staff members enter the information into an electronic medical record for extraction? Or do they enter it into another system? How effective is this process?
  • Watch the Informatics and Nursing-Sensitive Quality Indicators Video Exemplar.
Recording Your Presentation

To prepare to record the audio for your presentation, complete the following:

  • Set up and test your microphone or headset using the installation instructions provided by the manufacturer. You only need to use the headset if your audio is not clear and high quality when captured by the microphone.
  • Practice using the equipment to ensure the audio quality is sufficient.
  • Review the for Kaltura to record your presentation.
  • View Creating a Presentation: A Guide to Writing and Speaking. This video addresses the primary areas involved in creating effective audiovisual presentations. You can return to this resource throughout the process of creating your presentation to view the tutorial appropriate for you at each stage.

Notes:

  • You may use other tools to record your tutorial. You will, however, need to consult Using Kaltura for instructions on how to upload your audio-recorded tutorial into the courseroom, or you must provide a working link your instructor can easily access.
  • You may also choose to create a video of your tutorial, but this is not required.
  • If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact DisabilityServices@Capella.edu to request accommodations.

Instructions

For this assessment, imagine you are a member of a Quality Improvement Council at any type of health care system, whether acute, ambulatory, home health, managed care, et cetera. Your Council has identified that newly hired nurses would benefit from comprehensive training on the importance of nursing-sensitive quality indicators. The Council would like the training to address how this information is collected and disseminated across the organization. It would also like the training to describe the role nurses have in accurate reporting and high-quality results.

The Council indicates a recording is preferable to a written fact sheet due to the popularity of audio blogs. In this way, new hires can listen to the tutorial on their own time using their phone or other device.

As a result of this need, you offer to create an audio tutorial orienting new hires to these topics. You know that you will need a script to guide your audio recording. You also plan to incorporate into your script the insights you learned from conducting an interview with an authority on quality monitoring and the use of technology to collect and report quality indicator data.

You determine that you will cover the following topics in your audio tutorial script:

Introduction: Nursing-Sensitive Quality Indicator
  • What is the National Database of Nursing-Sensitive Quality Indicators?
  • What are nursing-sensitive quality indicators?
  • Which particular quality indicator did you select to address in your tutorial?
  • Why is this quality indicator important to monitor?
    • Be sure to address the impact of this indicator on the quality of care and patient safety.
  • Why do new nurses need to be familiar with this particular quality indicator when providing patient care?
Collection and Distribution of Quality Indicator Data
  • According to your interview and other resources, how does your organization collect data on this quality indicator?
  • How does the organization disseminate aggregate data?
  • What role do nurses play in supporting accurate reporting and high-quality results?
    • As an example, consider the importance of accurately entering data regarding nursing interventions.

After completing your script, practice delivering your tutorial several times before recording it.

Additional Requirements
  • Audio communication: Deliver a professional, effective audio tutorial on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion.
  • Length: 8–10 minute audio recording. Use Kaltura to upload your recording to the courseroom, or provide a working link your instructor can access.
  • Script: A separate document with the script or speaker’s notes is required. Important: Submissions that do not include the script or speaker’s notes will be returned as a non-performance.
  • References: Cite a minimum of three scholarly and/or authoritative sources.
  • APA: Submit, along with the recording, a separate reference page that follows APA style and formatting guidelines. For an APA refresher, consult the Evidence and APA page on Campus.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

  • Competency 1: Describe nurses’ and the interdisciplinary team’s role in informatics with a focus on electronic health information and patient care technology to support decision making.
    • Describe the interdisciplinary team’s role in collecting and reporting quality indicator data to enhance patient safety, patient care outcomes, and organizational performance reports.
  • Competency 3: Evaluate the impact of patient care technologies on desired outcomes.
    • Explain how a health care organization uses nursing-sensitive quality indicators to enhance patient safety, patient care outcomes, and organizational performance reports.
  • Competency 4: Recommend the use of a technology to enhance quality and safety standards for patients.
    • Justify how a nursing-sensitive quality indicator establishes evidence-based practice guidelines for nurses to follow when using patient care technologies to enhance patient safety, satisfaction, and outcomes.
  • Competency 5: Apply professional, scholarly communication to facilitate use of health information and patient care technologies.
    • Deliver a professional, effective audio tutorial on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion.
    • Follow APA style and formatting guidelines for citations and references.

Informatics and Nursing-Sensitive Quality Indicators Scoring Guide

Criteria Non-performance Basic Proficient Distinguished
Describe the interdisciplinary team’s role in collecting and reporting quality indicator data to enhance patient safety, patient care outcomes, and organizational performance reports. Does not describe the interdisciplinary team’s role in collecting and reporting quality indicator data to enhance patient safety, patient care outcomes, and organizational performance reports. Begins to identify but does not describe the interdisciplinary team’s role in collecting and reporting quality indicator data. Describes the interdisciplinary team’s role in collecting and reporting quality indicator data to enhance patient safety, patient care outcomes, and organizational performance reports. Describes in a professional manner the interdisciplinary team’s role in collecting and reporting quality indicator data to enhance patient safety, patient care outcomes, and organizational performance reports. Offers valuable insight into the impact of the interdisciplinary team on data collection.
Explain how a health care organization uses nursing-sensitive quality indicators to enhance patient safety, patient care outcomes, and organizational performance reports. Does not explain how a health care organization uses nursing-sensitive quality indicators to enhance patient safety, patient care outcomes, and organizational performance reports. Attempts to explain how a health care organization uses nursing-sensitive quality indicators to enhance patient safety, patient care outcomes, and organizational performance reports. Explains how a health care organization uses nursing-sensitive quality indicators to enhance patient safety, patient care outcomes, and organizational performance reports. Provides a comprehensive, professional, and academic explanation for how a health care organization uses nursing-sensitive quality indicators to enhance patient safety, patient care outcomes, and organizational performance reports.
Justify how a nursing-sensitive quality indicator establishes evidence-based practice guidelines for nurses to follow when using patient care technologies to enhance patient safety, satisfaction, and outcomes. Does not justify how a nursing-sensitive quality indicator establishes evidence-based practice guidelines for nurses to follow when using patient care technologies to enhance patient safety, satisfaction, and outcomes. Describes but does not justify how a nursing-sensitive quality indicator establishes evidence-based practice guidelines for nurses to follow when using patient care technologies to enhance patient safety, satisfaction, and outcomes. Justifies how a nursing-sensitive quality indicator establishes evidence-based practice guidelines for nurses to follow when using patient care technologies to enhance patient safety, satisfaction, and outcomes. Provides a comprehensive and scholarly justification for how a nursing-sensitive quality indicator establishes evidence-based practice guidelines for nurses to follow when using patient care technologies to enhance patient safety, satisfaction, and outcomes.
Deliver a professional, effective audio tutorial on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion. Does not deliver an audio or a video tutorial with a script or speaker’s notes on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion. Provides a script or speaker’s notes of a tutorial without audio or video on a selected quality indicator, or the tutorial lacks purpose, coherence, or focus or has technical issues that distract from the presentation. Delivers a professional and effective audio or video tutorial along with speaker notes on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion. Submission includes a reference list with at least three scholarly references. Delivers a polished, professional, and effective audio or video tutorial along with speaker notes on a selected quality indicator that engages new nurses and motivates them to accurately report quality data in a timely fashion. Audio or video presentation is appropriate for the audience. Submission includes a reference list with at least three scholarly references.
Follow APA style and formatting guidelines for citations and references. Does not follow APA style and formatting guidelines for citations and references. Partially follows APA style and formatting guidelines for citations and references. Follows APA style and formatting guidelines for citations and references. Academic citations and references are largely error-free. Follows APA style and formatting guidelines for citations and references with flawless precision and accuracy.