Quality , standrads and ethics

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Quality , standrads and ethics

  1. 1. QUALITY OF CARE , STANDARDS OF CARE , ETHICAL AND LEGAL ISSUES IN HEALTH CARE By : AlJuhara AlMarzoog Medical-Surgical Master program 2013
  2. 2. Outlines  Introduction  What is quality ?  Key components of high quality of care  Measurement of quality  Quality indicators  ANA standards for nursing  Ethics in nursing
  3. 3. Quality  Joint commission defines Quality as “ the optimal achievement of therapeutic benefit and avoidance of risk and minimization of harm “ .  Institute of Medicine ( IOM ) defines Quality of Care as “ the degree to which health services for individuals and populations increase their likelihood of desired health outcomes and are consistent with current professional knowledge “
  4. 4. The ideal key components of high quality of health care 1- The system is safe : free from accidental injury for all patients , in all processes , in all time . 2- Effectiveness of care : care that , wherever possible , is based on the use of systematically obtained evidence to make determinations regarding whether a preventive service , diagnostic test , therapy , or no intervention would produce the best outcomes .
  5. 5. The ideal key components of high quality of health care 3- Patient – centered : this concept encompasses the following : respect for patients values , preferences , and expressed needs ; coordination and integration of care ; provide education ; physical comfort ; emotional support ; and involve family and friends . 4- Care delivered in timely manner : without long waits that are wasteful and often anxiety provoking .
  6. 6. The ideal key components of high quality of health care 5- Efficient care : uses resources to obtain the best value for the money spent . 6- Equitable : care should be based on an individual's needs , not on personal characteristics such as gender , race or insurance status .
  7. 7. Measuring of quality  The measurement of health care quality is an “ elusive but achievable goal “ . Health care quality is not a single product like a car , microwave . It is made up of unusually diverse components varying from mammography screening to performing surgery to counseling for depression . 1- Structure . 2- Process . 3- Outcomes .
  8. 8. Quality indicators  Fall / injury falls rate .  Hospital acquired pressure ulcer rate .  Central line associated blood stream infection rate .  Catheter associated UTI rate .  Documentation .  Staff satisfaction .  RN education / Certification .
  9. 9. Standards of care  “ Standards are professionally developed expression of the range of acceptable variations from a norm or criterion “ Avedis Donabedian .  Benchmark of achievement which is based on desired level of excellence .  Criteria are pre-determined elements against which aspects of the quality of nursing/medical services
  10. 10. Nursing standards All standers of practice provide a guide to knowledge , skills , judgment & attitude that are needed to practice safely .  They reflect a desired and achievable level of performance against which performance can be compared . Their main purpose is to promote , guide and direct professional on nursing practice .
  11. 11. Why are standards important ?  Outlines what the profession expects of its members .  Promotes , guides and directs professional nursing practice .  Aids in developing a better understanding and respect for the various and commentary roles that nurses have . ( Registered Nurses Association ( 2003 ) & College of Nurses of Ontario ( 2002 ) .
  12. 12. ANA standards of care  The standard of care are intended to be used in conjunction with the scope of practice , which addresses the role and bounders of practice for nursing .  The professional practice of the nurses is characterized by the application of relevant theories , research , and EBP guidelines to explain human behavior and related phenomena .
  13. 13. ANA standards of care  Such application also provides a basis for nursing intervention and evaluation of patient-oriented outcomes .  The nursing process is used as the framework and build upon ANA’s Nursing : Scope and Standard of Practice .
  14. 14. ANA standards of care 1- Assessment . 2- Diagnosis . 3- outcomes identification . 4- Planning . 5- Implementation . 6- Evaluation .
  15. 15. ANA standards of professional performance  Describes a competent level of behavior in the professional role , including activities related to quality of care , performance appraisla , education , ethics , collegiality , collaboration , research , and resources utilization .  Although the standards of professional performance delineate the expectations of all nurses , membership in professional organization , certification , CE , and pursuit of advanced degree are additional methods of demonstrating professionalism .
  16. 16. ANA standards of professional performance 1- Quality of practice . 2- Professional practice evaluation . 3- Education . 4- Collegiality . 5- Ethics . 6- Collaboration . 7- Research / Clinical inquiry . 8- Resources utilization . 9- leadership .
  17. 17. Ethics vs. Morality  Ethics : is the systematic study of moral conduct and provides the framework for examining and studying moral dilemmas .  Bioethics : also called biomedical ethics or medical ethics , is the study of moral conducts within the context of health care .  Morality : refers to norms about right and wrong
  18. 18. Ethics theory  Utilitarianism , one classical theory in ethics , is based on the concept of “ the greatest good for the greatest number “ .  The choice of action is clear under this theory , because the action that maximizes good over bad is the correct one .
  19. 19. Approaches to ethics 1-Meta-ethics  Analysis of the concept of informed consent . Nurses are aware that patient must give consent before surgery or any invasive procedure , but sometimes a question arises as to whether a 2-Applied ethics  Is when a specific discipline identifies ethical problem within that discipline’s practice .
  20. 20. Types of ethical problems in nursing  The ANA, in Nursing’s Social Policy Statement ( 2003 , p. 6 ) , defines nursing as “ the protection , promotion , and optimization of health , prevention of illness and injury , alleviation of suffering through diagnosis and treatment of human response , and advocacy in the care of individuals , families , communities , and populations “ .
  21. 21. Types of ethical problems in nursing 1- Confidentiality . 2- Restraints . 3- Trust issues . 4- Refusing to provide care . 5- End-of-life care .
  22. 22. Ethical and legal issues  Since nurses address complex ethical and human rights issues on a regular basis , the ANA Board of Directors and the Congress on Nursing Practice first initiated Code of Ethics for Nurses in 1985 .  The code was revised in 2001 to include issues of advancing nursing science .
  23. 23. Code of Ethics for Nurses  The ANA approved nine provisions that address ethical practice issues such as compassion and respect , commitment , patient advocacy , responsibility and accountability , duties , participation in the healthcare environment , advancement of the profession , and collaboration .

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