Nursing Sensitive Quality Indicators Speech Paper

NURS-FPX4040 Nursing Sensitive Quality Indicators Speech Paper


Nursing Sensitive Quality Indicators (NSQI) describe the key values and elements used to measure the impact and the contribution of nurses on patients’ health outcomes. Today, patient satisfaction is a critical factor in assessing patient outcomes. The American Nurses Association has identified about ten critical NSQIs that are used in acute care settings. The quality indicator that I have chosen to discuss is patient satisfaction with pain management. Pain management is good for both parties (hospitals and patients) because of the rewards that each reaps from the process. Patients that are satisfied with how their situations have been handled give hospitals a high rating, a factor that directly affects profitability and growth.

Nursing Sensitive Quality Indicators Speech Paper

Patient Satisfaction with Pain Management.

Nursing Sensitive Quality Indicators Speech Paper

One of the most critical issues for patients is managing pain. Consequently, pain management has become an essential measurement tool for patient satisfaction. Being a subjective issue, healthcare facilities are judged by how satisfied patients are in terms of pain management. In acute settings, healthcare facilities employ numerous ways of managing pain such as using opioids. The use of opioids in chronic pain management, according to Miclette et al., (2018 Nursing Sensitive Quality Indicators Speech Paper), elicits mixed reactions among those who support its use and those who oppose it.

The same applies to other drugs and substances used in pain management, such as medicinal marijuana. One of the most advanced theories that have been used to explain as well as provide an effective framework for pain management is the Brain Theory of Social Attachment, BOTSA. This theory provides that managing physical and emotional pain can be achieved by managing social connections, and subjective experiences of patients within the healthcare setting.

There are other ways in which pain can affect one’s daily life such as being tired and being fatigued. Lack of sleep deprives one of the energies required to perform regular duties, chores, and work leaving one feeling weak, confused, and even disoriented in many instances. When one has not had enough sleep during the night, it is common to wake up with low levels of energy which in turn impacts negatively on one’s motivation. Another way in which pain can affect daily life is that one can become depressed and experience interruptions in their lives (Cohen, 2017 Nursing Sensitive Quality Indicators Speech Paper). Depression is likely to contribute to low quality of life because an individual is not able to operate optimally.

The lack of control and predictability is another side effect of pain that can affect the quality of life. Lack of control refers to one’s inability to control some functions of one body such as having slow reflexes leading to slow reactions. Lack of predictability on the other hand refers to a situation where mood swings make one’s behavior unpredictable because one moment they act fine and the next moment, their actions are not in line with what people expect of them. They become erratic in their behavior which becomes a bit unpredictable for many people to deal with. Nursing Sensitive Quality Indicators Speech Paper

According to Inagaki (2018), BOTSA theory holds that strong social connections or attachments can lead to reduced pain in patients. This means that patients or people under opioid treatment are encouraged to always be in the presence of friends or loved ones rather than live in separation (Scarborough & Smith, 2018 Nursing Sensitive Quality Indicators Speech Paper). Staying in isolation increases the urge in patients to use more opioids as a way of responding to social stressors.

Thus, the Brain Theory of Social Attachment asserts that social connection is related to wellbeing. Growing cases of mental disorders and medical conditions have been blamed on the ever-increasing cases of pain incidences. Pain has been found to expound medical conditions on individuals by making them worse. Medical doctors believe that by alleviating pain, many patients are able not only to witness their recovery but would also find their lives less stressful. Additionally, pain through chronic stress has been noticed to result in mental disorders where individuals are incapable of reasoning optimally.

Some of the common causes that lead to pain include, stress that is chronic, body pains which may make one not be able to fall asleep at night, depression, anxiety, and medical conditions and ailments such as asthma, diabetes, thyroid, cancer, and chronic pains which may cause one to have sleepless nights. Nursing Sensitive Quality Indicators Speech Paper

The Brain Theory of Social Attachment provides a clear framework for the treatment of opioid addiction. In this case, the issue of stopping opioid addiction is dependent on the allegiances or strong bonds formed by addicts (Inagaki, 2017, p. 4. Nursing Sensitive Quality Indicators Speech Paper). However, this process would require an effective grieving and or mourning process such as losing a loved one.

The social connection process is considered therapeutic and can help in the healing process among opioid addicts. However, this theory works on the assumption that for every addict, there will be a sufficient grieving process that may never occur (p. 149). On the other hand, even without the grieving process, the strong connections and bonds formed by addicts and their loved ones may be sufficient to control their opioid intake.

Importance of Pain Management in Patient satisfaction

Nurses must have an ethical responsibility for pain management to reduce patient suffering. If not managed well, pain adversely affects patients psychologically and physically. Based on this analogy, nurses must bear the responsibility of helping patients to find relief from their pain. Apart from physical pain, other adverse effects of pain in patients include depression and anxiety (Cohen et al., 2018 Nursing Sensitive Quality Indicators Speech Paper). Poor pain management by nurses has numerous adverse effects for both patients and healthcare facilities, hence the need for pragmatic interventions.

Poor pain management may put nurses/physicians at the risk of legal suits. The joint Commission on Accreditation of Healthcare Organizations (JCAHO) stipulates that pain in patients must be managed and addressed promptly. Poor pain management may make patients perceive it as neglect (Bonnie et al., 2019 Nursing Sensitive Quality Indicators Speech Paper). The fact that there are set standards for pain management makes hospitals more vulnerable to lawsuits from patients. It is the responsibility of healthcare facilities to have in place effective mechanisms for pain management.

Poor pain management may result in a poor reputation for hospitals. Patient satisfaction is directly tied to their experiences with pain. Higher levels of pain are often associated with poor patient satisfaction. When a healthcare facility fails to effectively manage pain in patients, the facility quickly loses reputation as many patients begin to avoid it (Wood, Simel, & Klimas, 2019 Nursing Sensitive Quality Indicators Speech Paper). The reputation of a hospital is based on the experiences of patients during their stay. Proper pain management boosts customer satisfaction which also directly affects profits and reputation.

Cheatle (2015), after a critical assessment of pain management, asserts the need to maintain the rights of patients receiving pain management by the use of relevant mechanisms (P.6). Cheatle further asserts that patients with acute pain should not be denied access to opioids based on the fears about the risks of addiction. According to Cheatle, administering opioids to patients should be accompanied by therapeutic management to help reduce addiction to opioids.

The shortcoming with Cheatle’s assertion is that he advocates for the continued use of opioids while completely ignoring the issue of dependency, neither does he provide a way out for a safe and effective alternative. According to Bolliger and Stevens (2019 Nursing Sensitive Quality Indicators Speech Paper), there is a need to recognize that dependency on opioids is a serious health hazard that practitioners ought not to ignore. Citing a study by WHO on efforts to reduce opioid addiction, Bolliger and Stevens asserts that the more a person is on opioids, the higher the chances of becoming dependent on the drug, a factor that should not be taken for granted if the millions of Americans currently addicted to the drug is anything to go by. Nursing Sensitive Quality Indicators Speech Paper

Hospital-Acquired Infections

As part of pain management control, hospitals are tasked with the responsibility of preventing patients from contracting new diseases while still in facilities. Nosocomial infections are a big threat to patient’s health and must be contained at all costs. In particular, patients suffering from infectious diseases must be separated so that there is no spread of such diseases. Secondly, hospitals must maintain high levels of hygiene for all facilities/types of equipment and patients. Proper handling procedures must be used, for example, nurses and doctors must use appropriate protective clothing such as gloves which must be discarded in the safest way possible.

Prevention of hospital-controlled infections is one of the best ways to help patients from going through additional pain. The safety and security of patients is another way to help patients from contracting additional pain. Based on this analogy, it is the responsibility of nurses and hospitals to ensure that patients’ current conditions are well managed and that they do not acquire new infections while still under the care of healthcare facilities. Nursing Sensitive Quality Indicators Speech Paper

The Joint Commission on Accreditation of Healthcare Organization (JCAHO) has created formal standards for assessing pain and managing it. JCAHO perceives pain as an integral component of care that impacts both patients and healthcare facilities. The organization asserts that unlike other components in healthcare, pain in patients requires very specific attention to deal with before it gets out of hand. Nursing Sensitive Quality Indicators Speech Paper

Some of the specific standards set by JCAHO in pain management include recognizing the right of individuals to choose or assent to appropriate methods of pain management. Secondly, JCAHO requires hospitals to create procedures and policies for prescribing the appropriate pain medications for patients. It is the responsibility of hospitals to accurately manage all kinds of pain effectively and responsibly. For example, hospitals must have ways of dealing with acute pain, chronic pain, malignant pain, and all other types of pain.

Effects of Pain in Patients and hospitals

Hospitals must know techniques used to manage pain apart from medication. There are numerous other technologies such as gentle exercises, using heat or cold packs, manual therapies, and relaxing. These modes of pain management can be used together with specific medications to produce better results for patients. The key issue in pain management is to ensure that patients are as comfortable as possible. Improperly managed pain leads to adverse psychological, emotional, and physical pain for patients and their families. Nursing Sensitive Quality Indicators Speech Paper

If uncontained for a long time, pain releases the pituitary-adrenal axis which often suppresses the immune system leading to physical pain and longer healing wounds. In the case of physical pain, cases of prolonged pain may lead to ischemia ileus which makes patients feel pain and discomfort (Vitz et al., 2017 Nursing Sensitive Quality Indicators Speech Paper). Besides, prolonged pain reduces patients’ mobility that leads to other complications such as vein thrombosis, pneumonia, and pulmonary embolus.

Pain also makes patients suffer physiologically. Common responses to pain physiologically include depression and anxiety. When patients cannot escape from their pain, they develop a sense of helplessness which exposes them to more risks such as acute depression. More importantly, patients whose pain has been inadequately addressed are often reluctant to seek medication for other conditions. For hospitals, poor management of pain in patients leads to poor reputation leading to loss of profits. Available research and evidence indicate that higher levels of pain in patients directly affect patient satisfaction. Nursing Sensitive Quality Indicators Speech Paper

Effect on Quality of Life

Numerous studies conducted by leading researchers show that pain directly impacts the physical and mental aspects of human beings. According to this study, Stein and co-authors found out that as many as 50% of all America’s workers had taken off-days from work due to pain-related problems (Wood, 2019). Further, Stein and co-authors assert that their study revealed that lack of sleep coupled with daytime fatigue give increased chances of low scores as far as physical functioning, physical health problems, mental health, and vitality are concerned. Nursing Sensitive Quality Indicators Speech Paper

According to the study, people with severe cases of pain were likely to experience some disruptions and impairments as far as daytime functioning is concerned. This comprehensive study by Leger found out that there was a “significant independent association between pain and Quality of Life” (Appleton et al., 2018). The study found out that even after several parameters such as health habits, sociodemographic factors, medical comorbidities, and threshold depressions had been statistically controlled, there was enough evidence to prove that there was a strong relationship between pain and Quality of Life.

The greatest observation from their study was that “Mild and severe pain was associated with diminished QOL across all SF-36 domains using logistic regression relative to patients without pain” (Fung 629 Nursing Sensitive Quality Indicators Speech Paper). Going by these facts, one can conclude that quality of life is directly proportional to the degree of pain that one experiences.


Pain management is a critical tool in measuring patient satisfaction. Nurses/physicians have to help in pain management for patients. There are different techniques that healthcare facilities can employ in inpatient pain management. One of the best but controversial methods of pain management is using opioids or medical marijuana. Yet, since patient satisfaction is directly tied to their experiences with pain, higher levels of pain are often associated with poor patient satisfaction. When a healthcare facility fails to effectively manage pain in patients, the facility quickly loses its reputation as many patients begin to question their approach to pain management. Nursing Sensitive Quality Indicators Speech Paper

Nursing Sensitive Quality Indicators Speech Paper References

  • Appleton, S. L., Gill, T. K., Lang, C. J., Taylor, A. W., McEvoy, R. D., Stocks, N. P., … & Adams, R. J. (2018). Prevalence and comorbidity of sleep conditions in Australian adults: 2016 Sleep Health Foundation national survey. Sleep health, 4(1), 13-19.
  • Bonnie, R. J., Schumacher, M. A., Clark, J. D., & Kesselheim, A. S. (2019). Pain Management and Opioid Regulation: Continuing Public Health Challenges. American Journal of Public Health, 109(1), 31–34. doi: 10.2105/ajph.2018.304881. Nursing Sensitive Quality Indicators Speech Paper
  • Cohen, J. B., Myckatyn, T. M., & Brandt, K. (2017). The importance of patient satisfaction: a blessing, a curse, or simply irrelevant?. Plastic and reconstructive surgery, 139(1), 257-261.
  • Miclette, M. A., Leff, J. A., Cuan, I., Samet, J. H., Saloner, B., Mendell, G., Bao, Y., Ashburn, M. A., Bachhuber, M. A., Schackman, B. R., Polsky, D. E., & Meisel, Z. F. (2018). Closing the gaps in opioid use disorder research, policy and practice: conference proceedings. Addiction Science & Clinical Practice, 13(1). doi: 10.1186/s13722-018-0123
  • Vilz, T. O., Stoffels, B., Strassburg, C., Schild, H. H., & Kalff, J. C. (2017). Ileus in Adults. Deutsches Arzteblatt International, 114(29-30), 508–518.
  • Wood, E., Simel, D. L., & Klimas, J. (2019). Pain Management With Opioids in 2019-2020. JAMA, 1. doi: 10.1001/jama.2019.15802
  • Scarborough, B. M., & Smith, C. B. (2018). Optimal pain management for patients with cancer in the modern era. CA: A Cancer Journal For Clinicians, 68(3), 182-196.

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