Quality assurance in community health nursing

1. QUALITY
ASSURANCE IN
COMMUNITY HEALTH
NURSING

2. DEFINE QUALITY ASSURANCE
•Quality assurance can be defined as”
the promise or guarantee that
certain standards of excellence are
being met in care delivered.”

3. GOALS OF QUALITY ASSURANCE
•To ensure the delivery of quality
client care.
•To demonstrate the efforts of the
healthcare provider for the best
possible result

4. APPROACHES FOR A QUALITY
ASSURANCE PROGRAMME
•There are two major categories to
approach the quality assurance
programme:
•1) General approach
•2) Specific approach

5. 1)General Approach
•It involves examining the ability of the
person or the agency to meet the criteria and
standard.
• Assessing the credentials is defined as”
formal recognition of a person as a
professional with technical competence, or
an agency that has met minimal standard of
performance.”

6. The process of assessing the
credentials has four goals:
•1)To produce a quality product
•2)To confer a unique identity.eg.
registered nurse
•3)To protect the provider and
public
•4)To control the profession

7. The agencies or person who have been
found to possess sound credentials are
put through procedures like
•1) Licensing
•2) Accreditation
•3) Certification

8. • 1)Licensure
• Individual licensure is a contract between the profession and the
state in which the profession is granted control over entering in
and out of profession and over the quality of professional
practice.
• 2) Accreditation
• State boards of nursing accredit basic nursing programmes,
since the graduates become eligible for licensing examination.
• Accreditation function is a voluntary approach which is
connected to the governmental regulation that encourages
programmes to be involved in the accrediting process.
• 3)Certification
• It is another general approach which combines features of both,
accreditation and licensure. Educational achievements,
experience and performance in an examination determine a
person’s qualification for functioning in an identified specialty
area such as community health nursing.

9. •Other general approaches
•:1) Charter
•It is a mechanism by which a governmental
agency under state laws grants corporate
status to an institution with or without rights
to award degrees.
•2) Recognition
•It is the process whereby one agency accepts
the status of another agency as confirmed by
the assessment of its credentials from a
known person in the community or
organization.

10. •3) Academic degrees
•These are titles awarded to individuals by
recognised institutions as having apred-
determined plan in the branch of learning.
•There are four academic degrees awarded in
nursing, with some variation at each degree
level,
• i)Bachelor of Science in Nursing
•ii)Master’s Degree-Master’s of Science in
Nursing
•iii)Doctoral degrees-Doctor of Philosophy,
Doctorate of Nursing science and Doctorate in
Nursing.

11. •2)Specific approach
Goals of specific approach are as follows:
•To identify problems between provider
and client
• To intervene in problematic cases.
•To provide feedback regarding the
interaction between the client and the
provider.
•To document the interaction between
the service provider and the client.

12. •Specific approaches are usually
implemented by agents and service
providing groups who are interested in the
quality of interaction between the client
and the service provider
•Specific approaches to quality control are
as follows:
•1)staff review committees (Peer review)
•2)utilization review committees
•3)research studies
•4)Client satisfaction surveys
•5)malpractice litigation

13. • MODEL QUALITY ASSURANCE PROGRAMME
• Purpose:
• The primary purpose of a quality assurance
programme is to ensure the results of an organized
activity are consistent with Expectations.
• STEPS IN MODEL QUALITY ASSURANCE
• 1)identify the sources needed
• 2)Describe the nature of the personnel required to
handle resources, supplies, equipment’s, facilities
and finance.
• 3)Once the resources are identified, then policies,
procedures, job descriptions should be clearly laid
down for use.

14. • PROCESS
• The primary approach used for process evaluation
includes the peer group committee and the client
satisfaction survey.
• Technique used for process evaluation is direct
observation, questionnaire, interview, written audit
and videotape of client and provider.
• OUTCOME
• For the purpose of evaluation, the nurse uses
client’s admission data, acuity of the problem and
discharge data that may point out changes in the
level of dependence and activity.

15. • Direct physical examination and interview will help a
lot measure the outcome.
• This will help one to identify the causes and
problems associated with health care.
• Evaluation, Interpretation and Action
• Interpretation is one of the major components of
quality assurance
• Evaluation of the process should be carried out at
major intervals and periodic reports should be
prepared.
• Action is the final step in quality assurance model.
• The action must be based upon their significance,
economic benefits and timeliness.

16. •HEALTH PROVIDER EVALUATION
•It is essential to determine the individual
service provider’s contribution to the quality
assurance programme.
•Punctuality and performance are needed to
evaluate the individual based on traditional
trait ratings.
•Objective oriented action tools are developed
in consultation with supervisor and the nurse.

17. • OBJECTIVES OF QUALITY ASSURANCE
• According to Jonas (2000), the two main objectives
are;
• •To ensure the delivery of quality client care
• •To demonstrate the efforts of the health care
providers to provide the best possible results
• Other specific objectives are;
• • Formulate plan of care
• • Attend the patients physical and non-physical
needs
• • Evaluate achievement of nursing care
• • Support delivery of nursing care with
administrative and managerial services

18. • PRINCIPLES OF QUALITY ASSURANCE
•• Customer focus
•• Leadership
• • Involvement of people
• • Process approach
•• System approach to management
•• Continual improvement
•• Factual approach to decision making
•• Mutually beneficial supplier relationship

19. •COMPONENTS OF QUALITY
ASSURANCE
• • STRUCTURE EVALUATION
•• PROCESS EVALUATION
•• OUTCOME EVALUATION

20. • QUALITY ASSURANCE PROCESS
• 1. Establishment of standards or criteria
• 2. Identify the information relevant to criteria
• 3. Determine ways to collect information
• 4. Collect and analyse the information
• 5. Compare collected information with
established criteria
• 6. Make a judgment about quality
• 7. Provide information and if necessary, take
corrective action regarding findings of
appropriate sources
• 8. Determine ways to collect the information
•

21. •MODELS OF QUALITY ASSURANCE
• 1. System Model
•1. Input 2.Throughput 3. Output 4. Feedback
• 2.Donabedian Model
• 3.ANA QualityAssurance Model
•4. Plan, Do, Check, Act cycle (PDCA)

22. •LEVELS OF EVALUATION OF
QUALITY OF CARE
•• National Level
••Trust or organization level
•• Local Level

23. • FACTORS AFFECTING QUALITY ASSURANCE IN NURSING
PRACTICE
• • Lack of resources
• • Personnel problem
• • Improper maintenance
• • Unreasonable patients and attendants
• • Absence of well-informed population
• • Absence of accreditation laws
• • Lack of incident review procedure
• • Lack of good hospital information system
• • Absence of patient Satisfaction Surveys
• • Lack of nursing care research
• • Miscellaneous Factors

24. • BARRIERS OF QUALITY IMPROVEMENT EFFORTS
• •The Nurse Manager might become pre occupied
with quality assessment
• • It is impossible to identify all factors that influence
nursing care quality.
• • Difficulty in defining outcome criteria that result
solely from nursing intervention
• • Nurse’s documentation of care measures is at
times vague, incomplete and lacking in objectivity
• •There is still no single, all purpose, all site quality
assessment tool that is universally appropriate for all
health agencies.
• • High cost

25. • ROLE OF NURSES IN QUALITY ASSURANCE
• • Nurses are the active participant of interdisciplinary quality
improvement team
• • Develop mechanism for continually monitoring the
effectiveness of nursing care both a collaborative and an
individual professional activity.
• • Contribute innovations and improvement of patient care
• • Participating in improvement projects and patient safety
initiatives
• • Participate continuing educational programs and in-
service educational programs for continuing professional
development
• • Periodic and continuing appraisal and evaluation of health
care situation of the patient
• • Participate research works related to quality assurance
• • Identify any area of needed improvement in delivery of care