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Questions on Nursing

Question 1
Hospital-acquired nursing-sensitive outcomes are defined by American Nurses Association (ANA) as those most affected by nursing care (ANA, 1996). These comprise measures of changes in patients’ health status directly influenced by hospital nursing care, such as patient-related complications (pressure ulcers, urinary tract infections, central-line associated bloodstream infections) or surgical complications (surgery site infection, heart or pulmonary failure, sepsis). Patients’ failure to rescue or to keep from falls (fall rate or pulmonary embolism rate) is another important nurse-sensitive indicator. Patients’ length of stay due to unplanned readmissions or emergency department referrals is also nurse-sensitive. The last group of nurse-sensitive indicators measures overall patient’s satisfaction from the quality of hospital stay (physical, mental and emotional): patient’s satisfaction with pain management, educational information, and nursing care. The main finding of ANA Nursing's Safety & Quality Initiative (ANA, 1996) is a close connection between specific nursing activities and outcomes of the patients. Another ANA finding resulted in striving to ensure reporting of core 10 nursing-sensitive quality indicators by hospitals across the US. For this purpose, ANA created a Nursing Report Card (ANA, 1997) and funded the development of a national nursing-sensitive quality indicators database, to enhance the patients’ safety and nursing care quality. 

Question 2

Though the question of alarm fatigue is highly debated, the patients’ safety can be seriously compromised if the alarm is turned off. E.g. the patient with myocardial infarction in acute care unit experiencing critical decrease of blood oxygen levels can die from heart failure in case of turning off the alarm signalling about life-threatening conditions. Legally, this can result in a malpractice suit, and ethically it represents the violation of non-maleficence principle, as turning off the alarm definitely deprives the patient of possibility to report the changes in his state in timely manner and imposes a threat to the patient’s life. Still, a recent comprehensive metaanalysis of clinical trials demonstrates that the alarms are not as effective as they were designed to be and that the alarm fatigue affects nurses’ work quality (Chan et al., 2010). Meanwhile, the Joint Commission’s (JC) Sentinel Event database reports about 98 alarm-related events which in majority resulted in patients’ death (82%) or permanent loss of function (13%) for such a short period as 3,5 years ( January 2009 - June 2012) (JC,2013). The problem of alarm fatigue is evidently is a highly controversial issue, which however can be resolved. The measures aimed at making the alarms threshhold lower but still safe and appropriate for patients’ life can be helpful (Chan et al., 2010). The staff should be adequately trained on safe alarms’ techniques, and an interdisciplinary team which can focus on the optimization of alarm procedures, should be created in every hospital (JC, 2013). Together with investment in modern systems to monitor alarm surveillance, these measures can provide effective alarm management and reduce the number of unnecessary or false alarms thus solving the problem of alarms fatigue and still not affecting the patients’care.

References

1. American Nurses Association (ANA) (1997). Implementing Nursing's Report Card. Washington, DC: ANA. Retrieved from: http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/PatientSafetyQuality/Research-Measurement/The-National-Database/Nursing-Sensitive-Indicators_1/ANA-Indicator-History
2. American Nurses Association (ANA) (1996). Nursing Quality Indicators: Definitions and Implications. Washington, DC: ANA. Retrieved from: http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/PatientSafetyQuality/Research-Measurement/The-National-Database/Nursing-Sensitive-Indicators_1/ANA-Indicator-History
3. Chan, P.S., Jain, R., Nallmothu, B.K., Berg, R.A, & Sasson, C. (2010). Rapid response teams: A systematic review and meta-analysis. Arch Intern Med ,170:18-26.
4. The Joint Comission Sentinel Event Alert (2013). A complimentary publication of Joint Comission, # 50. Retrieved from: www.jointcommission.org