How to write an original essay on Nursing Quality Indicators (Solved): Mr. J’s Case study

How to write an original essay on Nursing Quality Indicators (Solved): Mr. J’s Case study

Case study: Mr. J is a 72-year-old retired rabbi with a diagnosis of mild dementia. He was admitted for treatment of a fractured right hip after falling in his home.
He has received pain medication and is drowsy, but he answers simple questions appropriately.
A week after Mr. J was admitted to the hospital, his daughter, who lives eight hours away, came to visit. She found him restrained in bed. While Mr. J was slightly sleepy, he recognized his daughter and was able to ask her to remove the restraints so he could be helped to the bathroom.

His daughter went to get a certified nursing assistant (CNA) to remove the restraints and help her father to the bathroom. When the CNA was in the process of helping Mr. J sit up in bed, his daughter noticed a red, depressed area over Mr. J’s lower spine, similar to a severe sunburn. She reported the incident
to the CNA who replied, “Oh, that is not anything to worry about. It will go away as soon as he gets up.” The CNA helped Mr. J to the bathroom and then returned him to bed where she had him lie on his back so she could reapply the restraints.
The diet order for Mr. J was “regular, kosher, chopped meat.” The day after his daughter arrived, Mr. J was alone in his room when his meal tray was delivered. The nurse entered the room 30 minutes later and observed that Mr. J had eaten approximately 75% of the meal. The meal served was
labeled, “regular, chopped meat.” The tray contained the remains of a chopped pork cutlet.
The nurse notified the supervisor, who said, “Just keep it quiet. It will be okay.” The nursing supervisor then notified the kitchen supervisor of the error. The kitchen supervisor told the staff on duty what had happened.
When the patient’s daughter visited later that night, she was not told of the incident.
The next night, the daughter was present at suppertime when the tray was delivered by a dietary worker. The worker said to the patient’s daughter,
“I’m so sorry about the pork cutlet last night.” The daughter asked what had happened and was told that there had been “a mix up in the order.” The
daughter then asked the nurse about the incident. The nurse, while confirming the incident, told the daughter, “Half a pork cutlet never killed
The daughter then called the physician, who called the hospital administrator. The physician, who is also Jewish, told the administrator that he has had several complaints over the past six months from his hospitalized Jewish patients who felt that their dietary requests were not taken seriously by the hospital employees.
The hospital is a 65-bed rural hospital in a town of few Jewish residents. The town’s few Jewish members usually receive care from a Jewish hospital 20 miles away in a larger city.

Mr. J’s Case solved: Application of Nursing Quality Indicators

Nursing quality indicators are indicators used to assess the quality of care given to the patients, improve quality of care, and strategies that can be used to achieve goals (Ferrell et al., 2018). For this case scenario, a complications indicator, i.e., pressure ulcers, could have been implemented, and it would have prevented Mr. J from bedsores. The nurses could have evaluated the risk factors for pressure ulcers and put appropriate measures in place. This includes repositioning Mr. J two hourly, offloading body pressure on the mattress using a pillow or other pressure materials, emphasizing good nutritional status, and taking adequate fluids to improve wound healing (Ferrell et al., 2018). They could ensure Mr. J’s skin is conditioned and not exposed to urine, stool, or moist surface.

Patient satisfaction has an impact on clinical outcomes. It affects the delivery of patient-centered quality health care. For this case, Mr. J was served with “chopped pork cutlet” instead of “regular, chopped meat,” which he ordered. The confusion about not serving the ordered meal was not communicated effectively to Mr. J or her daughter. Implementation of Patient satisfaction as a nursing health indicator would allow gathering feedback from patients, patient check-ins to confirm orders, and effective communication to satisfy Mr. J and her daughter. All this will impact the delivery of care and patient outcomes positively.

Nurse satisfaction and staffing are considered indicator because the quality of care and patient outcomes depends on the quantity and quality of nursing care provided. For instance, nurses attending to Mr. J were unable to put enough measures to prevent bedsores and were insensitive to Jewish culture and beliefs of not consuming pork. Considering this nursing quality indicator, they could have second thoughts and self-insight; hence this could have been avoided and generally improved the quality of care and patient outcome.

Hospital data on the incidence of pressure ulcers

Data on the incidence of pressure ulcers will serve as a reference point when preventing pressure ulcers and the associated complications. The data on the incidence of pressure ulcers includes the age groups of individuals who are most likely to suffer from pressure ulcers, the duration of hospital stay that is associated with individuals suffering from pressure ulcers, the conditions that are mostly associated with pressure ulcers, the shearing and friction forces that results to pressure ulcers and the surfaces that is most likely to cause pressure ulcers (Ferrell et al., 2018). When health care providers consider immobility associated with old age or conditions that result in the problem of sensory perception, they will be able to frequently turn patients and apply pressure-reducing devices to immobile patients and the elderly. The health care providers will be aware of the surfaces and the forces involved in the development of pressure ulcers and take note of incidences of pressure ulcers and their relationship to the duration of hospital stay. Through this, the health care providers taking care of Mr. J would be aware of risk factors for pressure ulcers and how they can be avoided. This would have a positive impact on delivering quality care.

Hospital data on patient satisfaction

Patient satisfaction is the degree of happiness expressed by the patient due to the quality of care provided both inside or outside health institutions. Records on patient satisfaction will give health care providers insights into numerous fields of medicine; this includes the effectiveness of providing health care services and expressing empathy to patients seeking care. The nurse demonstrated a low level of empathy when she told Mr. J’s daughter, “Half a pork cutlet never killed anyone,” which was against Jewish culture. This event would negatively impact the delivery of quality care. With data on patient satisfaction, the health care providers and staff will identify areas for modification and what they should avoid while providing quality care.

Resolving the ethical issue

One of the resources that the nursing shift supervisor could have used is unit-based ethics mentors, who help in addressing routine ethical concerns that arise. These mentors help tackle conflicts from a preventive perspective and contribute to avoiding further conflicts. In this case, a reminder of the patient’s culture could have prevented the mix-up in meal orders. Additionally, the supervisor can cultivate an education-friendly environment where they regularly discuss common ethical issues. Open dialogues on ethical issues promote learning from other people’s mistakes and new approaches to certain ethical issues. Also, the supervisor could utilize electronic health record alerts where sensitive ethical issues such as Mr. J’s diet could be put on alert. This way, it would constantly remind the care providers of what meals to avoid when attending to him. These resources and systems go a long way in preventing ethical mistakes and enhancing patient satisfaction, which is the primary goal of healthcare.



Ferrell, B. R., Twaddle, M. L., Melnick, A., & Meier, D. E. (2018). National consensus project clinical practice guidelines for quality palliative care guidelines. Journal of palliative medicine, 21(12), 1684-1689.


Related Posts:

Translate »