Being senior adults, the patients are at the risk of developing heart attacks and heart failure and thus require close monitoring. This safety concern is exacerbated by other complexities at Senior Care Center, including understaffing, comorbid disorders, lack of adequate knowledge and evidence-based practice in the management of hypertensive patients, and inadequate medication and facilities. According to Yoon et al. (2015), blood pressure increases the risk of developing a heart attack due to atherosclerosis. Atherosclerosis is a slow process whose fatalities increase with age and, thus, increases the susceptibility of senior hypertensive patients to heart attack. Damage of the blood vessels over time also predisposes an individual to heart failure. Heart attack and heart failure have high morbidity and mortality rates among adult populations with high blood pressure.
The burgeoning number of patients at Senior Care Center results in a high patient-nurse ratio. In this regard, understaffing is a major complexity at the facility, resulting in the straining of the workforce. It is difficult for the nurses to effectively monitor and attend to the needs of all patients, thus increasing the risks of heart attack cases going unnoticed. Heart attacks and heart failure results in death in a short time if not attended to promptly. Besides understaffing, the existing workforce does not have adequate knowledge on the management of high blood pressure, in line with the current EBP requirements. This may sometimes result in inaccurate diagnosis and resolution of patient situations ( Alexander, 2016). There is also inadequacy of medication and equipment such as ECG machines to facilitate patient monitoring. This problem is caused by a large number of patients at the facility. Comorbid conditions such as age-related diseases, diabetes, and terminal illnesses make it difficult for the NPs to administer hypertensive drugs without the risk of adverse drug reactions ( Hughes & Lapane, 2015).
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Nursing Sensitive Outcomes
Nursing sensitive outcomes are markers of quality used to assess the effectiveness of nursing interventions. According to the American Nursing Association, these outcomes reflect the quality of service (Pearce et al., 2018). In Senior Care Center, a reduced morbidity and mortality rate resulting from a heart attack and heart failure is an important nursing-sensitive outcome. Curtailing the fatalities implies that the patients are receiving appropriate and effective care and monitoring. Increased knowledge of their medications among patients is also a nurse-sensitive outcome of the interventions. Patients should also indicate fewer signs of adverse drug interaction when nurses are more careful when administering drugs ( Hughes & Lapane, 2015). Patient satisfaction is a nursing outcome that depicts the patients’ response to the quality of care they receive. Improved care and close patient monitoring will result in positive health benefits, thus patient satisfaction.
Intervention Related to the Safety Concern
Increasing the nurse staffing ratio is an important safety intervention that will result in the desired clinical outcomes and effectively address the safety concern. The recommended nurse-patient ratio at a critical care nursing senior nursing facility is 1:4 (Alexander, 2016). Care for senior hypertensive patients is categorized as critical care, and thus, there is need to increase the number of caregivers at the facility to meet the recommended ratio. Patient safety is jeopardized by the strained workforce which makes it difficult to monitor the development of heart attack among all the residents. A higher nurse-patient ration would enable each caregiver to attend to a certain manageable number of patients and, therefore, make it possible to attend to their needs promptly. Averting complications requires that the caregiver understand and effectively respond to the needs of all patients (Alexander, 2016). In this regard, there is need to increase number of nurses in the care facility as a permanent solution to wrongful administration of drugs to hypertensive adults. This intervention will have positive outcomes in the management of hypertensive patients.
Evaluation
The intervention will be evaluated using the sensitive nurse outcomes, with the current situation at the facility used as the base reference. Currently, the nurse-patient ratio is 1:15 during the day and 1:25 at night. This is four and eight times above the recommend nurse-patient ratios in critical care facilities. The staff at the facility is disgruntled, strained, and experience work-related stress and burnout. The current mortality rate at the facility due to heart attack and heart failure is five patients in a week. Following the intention, the nurse-patient ratio will be 1:4 during the day and 1:10 at night. The effectiveness of increasing this ration will be evaluated through the feedback from the staff as well as observing their work performance. Reduction in the patient mortality and increased patient satisfaction will also indicate that the intervention has had positive impacts.
The Role of the American Nurses Association in Staffing
The American Nurses Association (ANA) notes with concern that facilities are understaffed, mainly due to cost-cutting strategies, an aging population, and increased need for personalized care ( Pearce et al., 2018) . The elevated pressure on nurses has reduced patient outcomes, as it reduces the ability of nurses to deliver quality and safe care, which translates into malpractice. ANA is committed to meeting the international standards on healthcare by educating its members on safe practice even when working under pressure and advocating for increased training of nurse aides, such that nurses only do what their assistants cannot do. ANA is also involved in the policymaking process on the expectations of nurses by the International Council of Nurses, to ensure that the policies are fair to American nurses.
Conclusion
One of the goals of Healthy People 2020 is to reduce disparities among populations, such that all Americans have equal awareness and access to hypertension care. Senior Care Center offers these services but strains in various ways due to understaffing. One of the major concerns is the wrong dosage and administration of hypertension drugs, which increases the risk of death. The suggested interventions and expected outcomes are centered on the adequacy of nurses, which makes staffing a priority of all Senior Care Centers.
References
Alexander, G. L. (2016). An analysis of nursing home quality measures and staffing. Quality management in health care , 17 (3), 242.
Berman, A., Snyder, S., & Frandsen, G. (2016). Kozier & Erb's Fundamentals of Nursing: Concepts, process, and practice . Boston, MA: Pearson.
Hughes, C. M., & Lapane, K. L. (2015). Pharmacy interventions on prescribing in nursing homes: from evidence to practice. Therapeutic advances in drug safety , 2 (3), 103-112.
Pearce, P. F., Morgan, S., Matthews, J. H., Martin, D. M., Ross, S. O., Rochin, E., & Welton, J. M. (2018). The Value of Nurse Staffing: ANA Principles Redevelopment and Direction for the Future. Nursing Economics , 36 (4), 169-177.
Yoon, S. S., Gu, Q., Nwankwo, T., Wright, J. D., Hong, Y., & Burt, V. (2015). Trends in blood pressure among adults with hypertension: 2003 to 2012. Hypertension , 65 (1), 54-61.
