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Nursing: Deviation

Good Performance and Areas of Opportunity

Clinical and administrative indicators serve to highlight areas where organisations are doing well and areas that require some form of improvement (Brown, Aydin, & Donaldson, 2008). They also serve to show specific areas where high-quality healthcare services are being provided when it comes to clinical or healthcare settings. A positive deviation indicates a step in the right direction, while a negative deviation indicates an area that requires some form of improvement (Brown, Aydin, & Donaldson, 2008). There are several different indicators that show good performance in the inpatient rehabilitation unit. The registered nurses’ care hours were beyond the target meaning that more hours were spent to provide care to patients (Smolowitz et al., 2015). The positive deviation has been stable throughout different periods meaning that good performance has been noted in the abovementioned area. The registered nurses’ courtesy also has a positive deviation throughout different periods. The increase in courtesy creates a good environment for patients. The patients’ length of stay has also increased over time and means that better healthcare services have been performed (Hibbard & Greene, 2013). It may also mean that more professional help is provided to patients. Other areas that the setting has performed well include functional independence measures involved in determining the patients’ bowel levels and the nursing care hours per patient day.


Although there are various areas where the healthcare unit has performed especially well, there are certain spheres that still require improvement. Some of these areas include the total number of falls recorded in the healthcare setting. Negative deviations in the number of falls indicate that the management probably is not doing what is required in taking care of the patients. Other aspects that require more concern include reducing the number of patients who suffer from pressure ulcers and those with acquired pressure ulcers. The unit also needs to increase the number of individuals who are assessed for pressure ulcers in the first twenty-four hours after their arrival in the healthcare settings. Other areas of opportunity that could be improved involve taking such measures as reducing the number of people who are at risk of falling, as well as increasing promptness and response to pain and care coordination. One major opportunity that could be improved is aimed at a significant decrease in the number of falls witnessed in the healthcare or clinical settings.

The number of falls in any healthcare setting has long been a source of concern due to the adverse effects it has on the patients’ well-being. Falls from hospital beds aggravate already present injuries the patients suffer from (Spoelstra, Given, & Given, 2012). They do not help in the recovery process but make the condition worse. Patient fall is attributed to some unfavorable factors in clinical settings, though the situation can be effectively controlled by the clinical management resulting in better nursing outcomes.

Action Based Nursing Plan

An action based nursing plan provides mechanisms or methods that could deal with any issue of concern in a clinical setting, namely the problem of patient falls. First, patient falls within the hospital can be reduced by increasing the nurse-to-patient staffing ratio. Nurses are supposed to take care of all the patients within the clinical setting and monitor changes in their physical and emotional state. When the number of nurses in a clinical setting is low, nurses do not watch over the patients to check their sleeping positions and sometimes do not conduct the hourly rounds to check patients’ state, as they have to do other chores (Haas et al., 2012). This increases the chances of patients falling off from beds. When there is a higher nurse-to-patient ratio, the close monitoring of the patients’ sleeping positions can be done, and as a result, fewer incidents associated with patient falls are likely to occur. Assistant nurses can be hired to monitor the condition of one group of patients, while other nurses will deal with other patients. Moreover, such roles could be delegated to undergraduate nursing students in cases where hospitals have staff shortages. The long-term plan is to increase the number of nurses in clinical settings so that patients’ care is improved. Patient falls also occur on the hospital premises where patients have been admitted. In some cases patient falls occur in the bathrooms, toilets and even across the hallway. Such falls could easily be avoided when there were higher nurse-to-patient ratio, which would improve the patients’ care.


There are some other strategies that could be implemented to reduce the number of patient falls. The first one is the setting of bed alarms that will indicate whether the patient is still in bed or not (Garrard, Boyle, Simon, Dunton, & Gajewski, 2016). Patients could either trigger the bed alarm if they feel that their sleeping position is not good or in case they fall off beds (Leone & Adams, 2016). The presence of bed alarms ensures that nurses react with immediate effect to the needs of different patients. It serves as an indicator to the hospital management if improvements are being made in specific areas within the clinical setting. Hourly safety rounds reduce the number of bed falls within clinical settings. In essence, nurses should check the patients’ state after certain intervals to monitor their sleeping position and their emotional well-being, which makes them more comfortable. Other strategies that have been utilised and were successful in the past include providing a nursing companion to the patient, who will help prevent bed falls, or having one of the family members within the specific room in which they are present (Guglielmi et al., 2014). Family members will keep the patients busy and serve as the link to the nurses in case of any changes in the body position of the patient. The last strategy involves the identification of patients who are at high risk of falling from their beds and providing them with requisite care.

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