Discussion: Quality Indicators

Discussion: Quality Indicators

Nursing-sensitive indicators refer to the criteria for health status changes likely to be directly affected by nursing care. The nursing-sensitive indicators are thus used in the objective assessment of care, improvement of clinical practice, evaluation of performance and quality of care, and also to inform the patient when choosing the hospital to receive care (Nash et al., 2019). Utilization of the nursing-sensitive indicators defines the processes and structure of nursing care and hence affects the outcomes of nursing care (Oner et al., 2021). This discussion will discuss patient falls and healthcare-associated infections as the nursing-sensitive indicators and the influence of early quality improvement theories and philosophies on these two indicators.

Two Nurse-Sensitive Indicators of Quality

Patient falls and hospital-acquired infections are the selected nurse-sensitive indicators of quality. Patient falls and the resulting injuries are attributable to the quality of nursing care in a hospital setting. Falls reduce the quality of life for the patients, increase healthcare costs, lengthen the period of stay in the hospital, cause injuries and complications, and can also cause death (LeLaurin & Shorr, 2019). Without proper assistance, appropriate interventions, and effective treatments, patients are susceptible to falls (LeLaurin & Shorr, 2019). Falls are thus preventable and avoidable and hence they are categorized as adverse events. A low rate of patient falls is an indicator of high-quality nursing care, while a high fall rate, may indicate poor quality of nursing care. Hospital-acquired infections (HAIs) are infections patients acquire while receiving patient care and they can indicate a lack of the appropriate care bundles and infection-control measures (Haque et al., 2020). For example, the rate of catheter-associated urinary tract infections increases if they remain in place for a long time while failing to properly observe infection-control measures such as hand hygiene leads to hospital-acquired infections.  

Influence of Early Quality Improvement Theories and Philosophies

Florence Nightingale and early quality improvement theories such as Lewin’s change model and Ottawa model of health care research use have significantly influenced indicators such as patient falls and HAIs. These theories support the implementation of quality improvement initiatives. For example, Lewin’s change model is a theory that starts by identifying the need to implement change, behavior change, and adopting the new behavior (Harrison et al., 2021). For instance, this model can be used to identify the need to reduce the rate of HAIs and falls and hence support the implementation of the appropriate interventions.

How these Indicators may Influence Practice Setting

Patient falls and hospital-acquired infections as indicators may significantly influence a practice setting. As the evidence indicates, patient falls and hospital-acquired infections are some of the indicators that point out the quality of care and high rates are associated with increased mortality rate, increased healthcare costs, reduced quality of life, and lengthened hospital stay (LeLaurin & Shorr, 2019; (Haque et al., 2020). As a result, during practice, it would be important to implement and support the implementation of quality improvement initiatives and care bundles that aim to reduce the rate of HAIs and patient falls.


Haque, M., McKimm, J., Sartelli, M., Dhingra, S., Labricciosa, F. M., Islam, S., Jahan, D., Nusrat, T., Chowdhury, T. S., Coccolini, F., Iskandar, K., Catena, F., & Charan, J. (2020). Strategies to Prevent Healthcare-Associated Infections: A Narrative Overview. Risk management and healthcare policy, 13, 1765–1780. https://doi.org/10.2147/RMHP.S26931

Harrison, R., Fischer, S., Walpola, R. L., Chauhan, A., Babalola, T., Mears, S., & Le-Dao, H. (2021). Where Do Models for Change Management, Improvement, and Implementation Meet? A Systematic Review of the Applications of Change Management Models in Healthcare. Journal of healthcare leadership13, 85–108. https://doi.org/10.2147/JHL.S289176

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing Falls in Hospitalized Patients: State of the Science. Clinics in geriatric medicine, 35(2), 273–283. https://doi.org/10.1016/j.cger.2019.01.007

Oner, B., Zengul, F. D., Oner, N., Ivankova, N. V., Karadag, A., & Patrician, P. A. (2021). Nursing‐sensitive indicators for nursing care: A systematic review (1997–2017). Nursing Open, 8(3), 1005-1022.

Nash, D. B., Joshi, M. S., Ransom, E. R., & Ransom, S. B. (Eds.). (2019). The healthcare quality book: Vision, strategy, and tools (4th ed.). Health Administration Press.


Florence Nightingale introduced research to the field of nursing, and with this introduction, a focus on improving patient care has continued to be at the forefront of nursing practice. Improving patient care lends itself to the study of quality care and patient safety, and nurse-sensitive quality indicators highlight the elements of healthcare in which patients are directly impacted by the care provided by nurses.

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What are nurse-sensitive indicators? What elements of a patient’s care are directly impacted by the role and delivery of care of nurses? How might these nurse-sensitive indicators change healthcare delivery and the nursing profession for a future DNP-prepared nurse?

For this Discussion, you will explore your understanding of nurse-sensitive indicators of quality by reflecting on those quality indicators that may pertain most to your practice setting. You will conduct a literature search for articles that address these quality indicators and reflect on the connections between the quality indicators and quality improvement theories and philosophies.

To Prepare:

Addressed each of the bullets below with a subtopic, all the references used must have an in-text citation in each paragraph. All Articles MUST BE PEER REVIEWED ARTICLES THAT MUST BE USED AND should come from USA and must be within last four years only that is from 2017 to 2021. Please do not begin a paragraph with author name(s) (PLEASE USE parenthetical/in-text citations APA format and 7 edition)

  • Posta brief description of the two nurse-sensitive indicators of quality that you selected.
  • Analyze the influence of early quality improvement theories and philosophies on the development of the quality indicators you selected. Be specific.
  • Then, cite the two (2) nursing research articles you selected, and explain how these indicators may influence your practice setting. Be specific and provide examples.



Nash, D. B., Joshi, M. S., Ransom, E. R., & Ransom, S. B. (Eds.). (2019). The healthcare quality book: Vision, strategy, and tools (4th ed.). Health Administration Press.

  • Chapter 3, “Variation in Medical Practice and Implications for Quality” (pp. 75–101)
  • Chapter 7, “Health Information Technology in Healthcare Quality and Safety: Prevention, Identification, and Action” (pp. 189–211)

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