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Nursing standards

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Quality assurance in nursing
Quality assurance in nursing
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Nursing standards

  1. 1. SUBMITTED BY BALKEEJ KAUR MSC 1ST YEAR ACON,SRI MUKTSAR SAHIB
  2. 2. NURSING STANDARDS
  3. 3. Introduction: -  Standards are helping to plan, implement and assess the quality of services and to show that nursing is accountable to society, to consumers of nursing services and to governments, as well as to the profession of nursing itself. a standard is an agreed way of doing something. It could be about making a product, managing a process, delivering a service or supplying materials – standards can cover a huge range of activities undertaken by organizations and used by their customers.
  4. 4. Contd……  They are powerful tools that can help drive innovation and increase productivity. They can make organizations more successful and people’s everyday lives easier, safer and healthier. Standard setting includes establishing fundamental definition in nursing and determining qualifications for education and practice .Administration encompasses interpreting these standards ,developing mechanisms and tools for their enforcement,and conducting the actual processes for regulation.  Standard is a broad statement of quality
  5. 5.  MEANING OF STANDARD: a level of quality or attainment.  DEFINITION OF STANDARD:according to ANA :A standard is described as a criterion used by general agreement as acceptable level of practice or an established norm.  Norms: - Norm is the current level of performance of a particular criterion, as determined by description study of the target population. The Norm is an authoritative standard, a type, the ordinary the more frequent value of statement. The term norm is frequently used synonymously with standard in the literature.
  6. 6. DEFINITION OF NURSING STANDARD  Nursing practice standards are descriptive statements that effect the nature of current nursing practice current knowledge and current quality of nursing care.As such ,they are a means of establishing accountability of nursing care rendered by the professional nurse.
  7. 7. IMPORTANCE OF STANDARDS  Standards form the fundamental building blocks for product development by establishing consistent protocols that can be universally understood and adopted.  In summary standards fuel the development and implementation of technologies that influence and transform the way we live, work and communicate.  In the case of nursing practice ,standards are the established criteria for the practice of nursing. Standars are statements that are widely recognized describing nursing practice and are seen as having permanent value.A standard is a performance model that results from integrating criteria with norms and is used to judge quality of nursing objectives ,orders and methods.one method of nursing quality improvement is nursing audit ,in which patient outcomes are measured against nursing standards and performance criteria to determine the efficiency of nursing actions.
  8. 8.  As a professional body ,nursing must guarantee the quality of its service to the public and these standards are a concomitant and on assurance that the highest quality of care will be provided to all patient in all health care setting.(American hospital association-1995)  To evaluate the quality of care provided ,the nursing profession has established standards of practice through the American Nurse Association the professional body for all professional nurses in the country,and these standards serve as a guideline for peer evaluation ,employee assessment and self evaluation of nursing practice according to the latest theories and techniques advances associated with the practice of professional nursing.
  9. 9. PURPOSES OF STANDARDS  COMMUNICATION:communication provides for sharing a common language with nursing professional which can cross barriers .  RESEARCH:The standards provide a framework for further investigation,so that current practices are no longer based on intention “word of mouth”but are derived fronm theory developed by authorities with the nursing profession  LEGAL IMPLICATION:The nursing profession must be self regulating to maintain credibility as a profession .The courts use the professional standards “as a yard stick”to determine whether hospitals and health care professionals have provided quality patient care according to rationally acceptable standards.
  10. 10.  QUALITY ASSURANCE:Standards can be used as the criteria for quality assurance studies to assess the current levels of practice rendered by the health care services provided by the organization or both  PROFESSIONAL ACCOUNTABILITY:standards set guidelines for nursing practice ,providing uniform basis for collecting a conjvation with an established assurance programme and or performances appraisal system.  DECISION MAKING:Standards also help in decision making and choosing alternatives for delivering of health care,Helps in supervision and improving performance.
  11. 11. BASIC PRINCIPLES OF STANDARDS  Standards should be designed to achieve a stated purpose  standards should be based upon clear definitions of professional scope and accountability  Standards should promote the fullest development of the profession in accordance with its potential social contribution  Standards should be sufficiently broad and flexible to achieve their objective and at the same time permit freedom for innovation ,growth and change  Standards should promote universal levels of performance and encourage professional identity and mobility  Standards should recognize the equality and interdependence of professions offering essential services  Standards should be formulated according to requirement which facilities their applicability and use by the profession.
  12. 12. FRAMEWORK OF STANDARDS The focus of the standards and the framework,within which the multiple activities of nursing are performed,need to be determined.Auseful and very commonly used framework for organizing standards is the structure process outcome model.  STRUCTURE STANDARDS focus on the setting and environment in which nursing is practiced  PROCESS STANDARDS focus on the practitioner and the activities carried out in delivering care  OUTCOME STANDARDS focus on the end result of the nursing services and activities carried out and changes which occurred  The second approach is based on the belief that structure,process and outcome are interdependent.This approach may be most suitable for standards developed at the local operational level and written within the framework of the broader standards developed at the national level  The development of standards and related criterion measures are then,guided by the basic principles,includes the general essential elements and addreses the specific elements according to the specified functional area of nursing,as illustrated in figure below.
  13. 13. ESSENTIAL ELEMENTS FOR STANDARDS FOR NURSING PRACTICE:  THE NURSE:standards should address,”who is the nurse”,specifying qualifications for practice and requirements for licensure,such as the determination of required competencies at,”entry to practice”level.The accountability and responsibility of the individual practitioner to consumers and employers is demonstrated by the behaviours of the nurse in carrying out the professional role.Accountabilty is also shown in the activities of the nurse in relation to the nursing profession and in participating in the advancement of the profession as well as to the nurse him/herself as shown by practicing and maintaining through continuing education of high quality in practice.Adherence to ethical principles or a code of ethics should be stressed as well as compliance with legal customs.  NURSING PRACTICE:as nursing practices are different in different countries ,the various levels of nurses and levels of practice need to be addressed.The regulation of nursing,who carries out this function as well as how thee function is carried out,will determine the scope of practice
  14. 14.  PEOPLE REQUIRING NURSING CARE:nursing and nurse only exist because people require nursing services .These may be individuals ,families,groups or communities with needs requiring nursing services  THE SETTING FOR NURSING PRACTICE:for nursing care to be delivered to people,there needs to be adequate facilities with sufficient resources to carry out safe practice of high quality.When this is not so ,standards will not be maintained  EVALUATION OF NURSING PRACTICE:focus on the practitioner requires standards regarding performances appraisal.The methods and underlying philosophy of appraisal should be stated whether disciplinary system and/ or merit or reward systems are used.
  15. 15. CHARACTERISTICS OF STANDARD:  statement must be broad enough to apply to a vide variety of settings  must be realistic,acceptable,attainable  the nurse care must be developed by members of the nursing profession,preferable nurses practising that the direct care level with consultation of experts in the domain.  should be resembled in positive terms and indicate acceptable performance i.e. good,excellence etc.  the nursing care must express what is desirable optional level  must be understandable and stated in unambiguous terms.  must be based on current knowledge and scientific practice  must be reviewed and revised periodically  may be directed towards an ideal,i.e. optional standards or may only specify the minimal care that must be attained ,i.e. minimum standard  standards that work are objective,acceptable,achievable and flexible
  16. 16. SOURCES OF NURSING CARE STANDARDS:  professional organization ,e.g,association,TNAI,GNAK  licensing bodies ,e.g,statutory bodies,INC,MCI,ETC.  Institutions/health care agencies  department of institutions,e.g Department of nursing  patient care units,  government units at national,state and local government units  individual e.g.personal standards
  17. 17. DEVELOPMENT OF STANDARDS:  Every profession is required to develop its own values of providing service to justify its existence.For nursing profession must establish ,maintain and improve wherever possible the standards of care and these standards must serve as the minimum level of acceptable performance by the professional and/or the organization.As a professional body ,nursing must guarantee the quality of its service to the public and these standards are a concomitant and on assurance that the highest quality of care will be provided to all patient in all health care setting.(American hospital association-1995)  To evaluate the quality of care provided ,the nursing profession has established standards of practice through the American Nurse Association the professional body for all professional nurses in the country,and these standards serve as a guideline for peer evaluation ,employee assessment and self evaluation of nursing practice according to the latest theories and techniques advances associated with the practice of professional nursing    
  18. 18. CLASSIFICATION OF STANDARDS:  NORMATIVE STANDARDS describe practices considered good or ideal by some authoritative group.ideal sides set by authoritative group.  EMPIRICAL STANDARDS describe practices actually observed in a large number of patient care setting.Here ,the norm active standards describe a higher quality of performance than empirical standards .generally,professional organizations (ANA/TNAI) promulgate normative standards where as law enforcement and regulatory bodies (INC/MCI)promulgate empirical standards.
  19. 19.  THE ENDS STANDARD are patient oriented .They describe the change as desired in a patients physical status or behavior.  THE MEANS STANDARD are nursing oriented ,they describe the activities and behavior designed to achieve the ends standard .ends or patient outcomes standards require information about the patient .A means standard call for information about the nurses performance.
  20. 20. CLASSIFICATION OF NURSING STANDARDS ACCORDING TO FRAME OF REFERENCES  STRUCTURE STANDARD  PROCESS STANDARD  OUTCOME STANDARD
  21. 21. STANDARDS FOR NURSING EDUCATION PROGRAMS:  Section1. 1)Statement of Purpose: -.The purpose of the board:  Serve as a guide for the development of new nursing education programs  Provide criteria for the evaluation and approval of new and established nursing education programs  Foster the continued improvement of established nursing education programs  Ensure that graduates of nursing education programs are prepared for safe nursing practice;
  22. 22. Section 2. Approval of Nursing Education Programme  (a) Provisional Approval  (i) Before a nursing education program is permitted to admit students, the program should submit evidence of the ability to meet the standards for nursing education.  (A) Proposal which includes at least the following information:  (1.) Documentation of the present and future need for the nursing education program in the state;  (2.) Rationale for the establishment of the nursing education program;  (3) Availability of qualified administrator and faculty;  (4.) Evidence of financial resources adequate for the planning, implementation and continuation of the nursing education program
  23. 23.  (B) Application for provisional approval shall be made: Once the proposal has been approved by the board and the following conditions have been met:  (I) A qualified nurse administrator has been appointed and there are sufficient qualified faculty to initiate the nursing education program;  (II) A written proposed nursing education program plan, developed in accordance with the standards for nursing, has been submitted; and  (III) A site visit has been conducted by the board if necessary by the board.  (C) Following board review of the proposed nursing education program, the board may grant or deny provisional approval  .(D) The parent institution and administrative head of the proposed nursing education program may be present at the meeting to clarify information contained in any of the reports.  (E) If provisional approval is denied, the institution may request a hearing before the board.  (F) Following board provisional approval, progress reports shall be made to the board as requested.  (G) Following graduation of the first class, a self-evaluation report of compliance with the standards for nursing education shall be submitted by the nursing education program. A site visit by the board shall occur for consideration of full approval of the nursing education program.
  24. 24.  . (b) Full Approval/Conditional Approval  ( I ) The board may grant varying levels of approval after provisional approval:  Full Approval: full approval is granted to a nursing education program after the first graduating class has taken the board approved licensing examination and the program has demonstrated compliance with the standards for nursing education  Conditional Approval: conditional approval may be granted for a limited time to a nursing education program that has had provisional or full approval and has now failed to meet the standard for nursing education. The board will determine the length of time and identify the deficiencies that must be corrected.
  25. 25.  Continued Full Approval.  All nursing education programs shall be reevaluated at least every 8 years, upon request of the nursing education program, to ensure continuing compliance with the standards for nursing education  Continuing compliance with the standards for nursing education involves the submission of a self-evaluation report by the nursing education program and a site visit by a board representative. Announcement of a site visit shall be sent to schools at least three months in advance of the visit. Ten copies of the nursing education program’s self-evaluation report of compliance with the standards for nursing education shall be submitted to the board 30 days prior to the scheduled site visit;
  26. 26. Section 3. Board Review of Nursing Education Programs  (a) Annual ReviewAll nursing education programs excluding those with provisional approval shall submit an annual report  (b) Site Visit Site visits may be conducted when the board receives evidence that indicates that the nursing education program is not in compliance with the standards for nursing education.  (c) Noncompliance  (1)The administrator of the parent institution and the administrator of the nursing education program receive a written notice of deficiencies from the board including a reasonable period of time, based upon the number and severity of deficiencies, to correct the deficiencies. No period for correction shall exceed 18 months.  (ii) Following a determination that a nursing education program is not in compliancewith the standards for nursing education programs the board may withdraw full approval and may place the program on conditional approval;
  27. 27.  .((A) The administrator of the nursing education program shall, within 10 days from the date of receipt of the notice of deficiencies, file a plan of correction with the board.  (B) The administrator of the nursing education program may, within 10 days from receipt of the notice of deficiencies, submit a written request for a hearing before the board to appeal the board’s determination of deficiencies.  (C) At any time during the correction period, the nursing education program may request restoration to full approval if the nursing education program demonstrates correction of the deficiencies.
  28. 28. Section4. Denial or Withdrawal of Approval for Nursing Education Programs  The board may deny provisional approval when it determines that standards for nursing education have not been met  (b) The board may deny full approval when it determines that a nursing education program fails to meet the standards for nursing education.  (c) The board may withdraw full or conditional approval when it determines that a nursing education program has not provided sufficient evidence that the standards for nursing education are being met.  (d) If the board determines that an approved nursing education program is not meeting the criteria set forth in these regulations, the parent institution shall be given a reasonable period of time to correct the identified nursing education program deficiencies. If the nursing education program fails to correct the identified deficiencies within the time specified, the board may withdraw the approval
  29. 29.  (e) After the board has conducted the hearing, the board may take any of the followingactions:  (i) Grant provisional approval if the board finds that the proposed nursing education program meets the criteria as stated in the board’s standards for nursing education  (ii) Deny provisional approval if the board finds that the proposed nursing education program fails to meet the criteria as stated in the board’s standards for nursing education;  Grant conditional approval if the board identifies deficiencies in nursing education program that has been failed to meet the criteria as stated in the board’s standards for nursing education;  Grant full approval if the board finds that the nursing education program meets the criteria as stated in the board’s standards for nursing education;
  30. 30. Section 5. Appeal and Reinstatement A parent institution may appeal the board’s decision to withdraw approval of a nursing education program and may request a hearing to review the board’s decision. The hearing and all actions related to the appeal shall be affected in accordance with due process rights, administrative rules of the board.
  31. 31. Section 6. Closure of Nursing Education Program and Storage of Records.  (a) Voluntary Closing.  (i) When the parent institution decides to close a nursing education program, it shall notify the board in writing, stating the reason for closure, the plan for discontinuation and the intended date of closing.  (ii) The parent institution may choose one of the following options when closing a nursing education program:  (A) Continue the nursing education program until the last class enrolled is graduated, or  (B) Assist in the transfer of students to other approved nursing education programs.  (iii) The nursing education program shall continue to meet the board’s standards for nursing education until all of the enrolled students are graduated or until the last student is transferred.  (iv)The date of closure is the date on the degree, diploma or certificate of the last graduate or the date on which the last student was transferred.
  32. 32.  (b) Closing as a result of withdrawal of approval.  (i) When the board withdraws approval of a nursing education program, the parent institution shall comply with the following procedures:  (A) The parent institution shall prepare a written plan for termination of the nursing education program and shall submit the plan to the board within thirty (30) days of receipt of the notice of withdrawal of approval.  (B) The parent institution shall present a plan for the transfer of students to other approved nursing education programs within a time frame established by the board.  (C) The date on which the last student was transferred will be the date of closure  (c) Storage of Records.The board shall be advised of the arrangements for storage of permanent records.
  33. 33. Section 7. Standards of Nursing Education  a) The organization and administration of the nursing education program shall be consistent with the law governing the practice of nursing.  (i) The parent institution shall be accredited by the appropriate accrediting agency.  (ii) There shall be an organizational chart which demonstrates the relationship of the nursing education program to the administration and to comparable programs within the parent institution,  (iii) There shall be statements of purpose, philosophy and objectives which are consistent with those of the parent institution and nursing standards.  (iv)There shall be an organizational design with clearly defined authority, responsibility, and channels of communication which assure both faculty and student involvement.  (v) There shall be written policies, congruent with the policies of the parent institution, which are periodically reviewed.
  34. 34.  (vi)There shall be evidence of financial support and resources to meet the goals of the nursing education program. Financial resources include adequate educational facilities, equipment, and qualified administrative, instructional, and support personnel.  (b) Administrator Qualifications.  (i) The administrator of the nursing education program shall be a registered professional nurse, with the additional education and experience necessary to direct the nursing education program preparing graduates for the safe practice of nursing. The administrator is accountable for the administration, planning, implementation and evaluation of the nursing education program  (A)The administrator of the nursing education program shall:  (I) hold a current license to practice as a registered professional nurse.  (II) Have a minimum of a master’s degree experience.  (III) Have a total of 5 years in nursing which must include a minimum of two years of clinical experience and three years of teaching experience (and/or a combination of teaching and management experience).
  35. 35.  (B) In baccalaureate nursing programs the administrator of the nursing education program shall:  (I) Hold a current license to practice as a registered professional nurse.  (II) Have a doctoral degree in nursing or related field; and  (III) Have a total of 5 years in nursing which must include a minimum of two years of clinical experience and three years of teaching experience (and/or a combination of teaching and management experience).  (ii) The administrator of the nursing education program shall not be assigned curriculum instructional duties that would impair nursing education program administration.  (iii) The administrator of the nursing education program shall have the authority to  administer the nursing education program in accordance with the policies of the parent institution.
  36. 36.  (c) Faculty.  (i) There shall be sufficient faculty with graduate preparation and nursing expertise to meet the objectives and purposes of the nursing education program.  (ii) Nursing faculty shall:  (A) Be currently licensed as a registered professional nurse.  (B) Have a minimum of a master’s degree.  (C) Have 2 years of clinical experience or national certification in clinical  (iii) Factors that shall be considered in determining the faculty/student ratio in clinical settings are clinical site, level of student, number of beds, type of clinical experience,  Faculty/student ratio shall be a maximum of 1:8 for clinical experiences.  When clinical preceptors (partners in education) are used in a clinical setting the ratio shall be 1:1 for the clinical preceptor/student ratio and no more than 1:15 for faculty/ student ratio.  (iv) Registered professional nurse faculty shall be responsible for:  (A) Developing, implementing, evaluating, and updating the purpose, philosophy, objectives, and organizational framework of the nursing education program;  (B) Developing, implementing and evaluating the curriculum;  (C) Developing, evaluating, and revising student admission, progression, retention, and graduation policies within the policies of the institution;  (D) Participating in academic advising and guidance of students;  (G) Evaluating student achievement related to nursing knowledge and practice;  (v) Faculty teaching non-clinical nursing courses, e.g., issues and trends, pharmacology, nutrition, research, management, and statistics, shall have preparation appropriate to these areas of content.
  37. 37.  d) Students.  (i) The nursing education program shall admit students to the program based upon the number of faculty, available educational facilities and resources, and the availability of clinical learning experiences for the student.  (ii) Students shall be admitted without discrimination as to age, race, religion, sex, national origin, or marital status, using an objective process applied uniformly.  (iii) The nursing education program shall establish written policies for admission, readmission, transfer, advanced placement, promotion, graduation, withdrawal, or dismissal.  (iv) A nursing education program shall establish written policies for student rights, responsibilities, grievances, health, safety, and welfare.  (v) Students shall be provided the opportunity to acquire and demonstrate the knowledge, skills and abilities for safe nursing practice.  (vi) The nursing education program or parent institution shall permanently maintain accurate records of scholastic achievement on each student.  (vii) The criteria for evaluating a student’s performance of each nursing ability (these criteria must be measurable, appropriate to the nursing ability, address the safety of the patient, and ascertain the accuracy of student performance). 
  38. 38.  (f) Clinical Facilities:  A written contract or agreement shall be executed by the parent institution conducting the nursing education program and the cooperating clinical facility or agency; the contract shall be signed by the responsible individual(s) of each party, and shall set forth the responsibilities of each party.  (g) Program Evaluation.  (i) The nursing education program shall have a written plan for the systematic evaluation of the total nursing education program and its outcomes. The plan shall include the methodology, frequency of evaluation, assignment of responsibility, and evaluative criteria.  The following areas shall be evaluated:  (A) Organization and administration of the nursing education program;  (B) Philosophy and objectives;  (C) Curriculum;  (D) Educational facilities, resources, and services;  (E) Clinical resources;  (F) Students’ achievement;  (G) Graduates’ performance on the licensing examination;  (H) Graduates’ nursing competence;  (I) Performance of the faculty;  (J) Protection of patient safety; and  (K) The methods and instruments used for evaluation purposes.
  39. 39. ANY QUERY
  40. 40.  Bibliography  Neerja KP,Textbook of Nursing Education, 1st edition, Jaypee Brothers Medical Publishers Put Ltd, New Delhi  Basavanthapa BT, Textbook of Nursing Education, 1st edition, Jaypee Brothers Medical Publishers Put Ltd, New Delhi  Nursing Administration and Management TNAI, Publication, 1st ed,2000- Section IV, Administration and Management of Nursing Schools  www.wikipedia.com 
  41. 41. THANKYOU

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