The document summarizes a seminar presentation on quality assurance in nursing. It discusses key topics like the meaning of quality, quality assurance, and approaches to quality assurance programs. It describes credentialing methods like licensure, accreditation, and certification. Specific quality assurance approaches covered include peer review, nursing audits, utilization review, and evaluation studies. Models of quality assurance and the roles and responsibilities of nurses in ensuring quality are also summarized.

1. Seminar on:
Quality Assurance in
Nursing
PRESENTED BY:
RAHUL GUSAIN
M.SC (N) IST YEAR

2. Introduction
Quality is rapidly becoming a concern to both consumes and the provides of the services.
In the health care quality is being demanded and expected and providers are judged by the
quality of services and hence there is a need to sensitize and train nursing personal to provide
quality care.
Expense of quality is an interactive process between customers & providers quality assurance
usually focusses on material, good work and services provided effectively.

3. Quality
It is the degree to which health services for individual & population increase the likelihood of
desired health outcomes and are consistent with current professional knowledge.
-Joint commission on accreditation
of health care organization(2002, JCAHO)

4. Assurance
It is statement or indication that inspires confidence.
Quality assurance
Quality assurance is an on-going , systematic, comprehensive evaluation of health care services &
the impaired of those services on health care services.
-kozier
Quality assurance is defines as all activities undertaken to predate and prevent poor quality.
-Neetvert(1992)

5. Purposes
1. To introduce code of ethics and professional conduct for nurses in India.
2. To prepare nursing personal for implementation of quality assurance model in nursing.
3. To provide best care to patients by maintain standard.

6. Objectives
1. To ensure the delivery of quality client care.
2. To demonstrate efforts of health care provider to provide good results.
3. To formulate plan of care.
4. To evaluate achievement of nursing care.
5. To support quality of nursing care with administrative and managerial services
6. To explain quality assurance models as pre requisite quality nursing care.

7. Principles
1. Customer focus
2. Leadership
3. Involvement of people
4. Process approach
5. System approach to management
6. Continual improvement
7. Factual approach to decision making
8. Mutually beneficial supplier relationship

8. Contd..
1. Belief in people
2. Statistical analysis
3. Costs of poor quality
4. Continuous quality improvement
5. Knowledge of customer expectation needs

9. Approaches for a quality assurance
program
General approach
Involves large approach governing of person agency ability to meet established criteria or
standard at a given time.
Specific approach
Quality assurance are methods to evaluate identifies distances of providers and client interaction

10. Credentialing
Credentialing refers to way in which professional competence ensure
and maintained. There process are used for credentialing in nursing.
They are accreditation , licensure certification.

11. Licensure
licensure is a specialized form of credentialing based on laws passed by a state legislature.
A license is a legal document that permits a person to offer to the public skills & knowledge .In a
particular jurisdiction, where such practice would otherwise be unlawful without a license.

12. Accreditation
State legislature bodies have authority to enact laws controlling occupational and professional
groups.
Nursing is one of the groups operating under state laws that promote the general welfare by
determining minimum standard of education .

13. Certification
Licensure measures entry level competence,
certification validates specialty knowledge,
experience and clinical judgment. Nursing
certification is offered by profession organizational .

14. Specific approach
Peer review
These are designed to monitor client specific aspects of care to monitor appropriate for certain
levels of care.
The audit is used by peer review committee to as certain quality of care.
Nursing audit
Nursing audit is evaluation of patient care through analysis of written records maintained by
nurses in patients treatment.

16. Goals of nursing audit
•To improve quality of health care.
•To promote improve communication among nurses & other health team members.
•To improve quality of nursing care.
•To detect & analyze problem with errors.

17. Nursing audit process
1. Provide quality of nursing
2. A patient is assured of good services.
3. It will give valuable and pertinent information for the staff.
4. It will lead to between co operation and communication among the nurses & health team.
5. It will help each professional nurses for her self evaluation
6. It helps the administrative as better planning.
7. It will broaden and strengthen nursing service.

18. Utilization review
Utilization review activities are directed towards
assuring that care actually needed and that the cost
appropriate for the levels of care provided.

19. Types of utilization review
Prospective : It is an assessment of the necessary of care before giving services.
Concurrent :- A review of the necessity of care while the care is being given.
Retrospective :- It is analysis of the necessity of the services received by the client after the care
has being given.

20. Evaluation studies
Donabedian structure –process outcome model
Donabedian introduced 3 major method of evaluation quality care:-
1. Structure evaluation
2. Process evaluation
3. Outcome evaluation

21. Structure evaluation
It evaluates setting and instruments used to provide care such as facilities , equipment &
characteristics of administrative organization &
Qualification of health provider. The data can be obtained from existing documents.

22. Process evaluation
This method evaluates activities as they relate to standard & expectation of health providers in
management of client care.
Data is collected through direct observation, review of records audit etc.

23. Outcome evaluation
The net changes that occur as a result of health care or result of health care.
The data of this method can be collected from vital statistics records such as death certification
or telephone client interview mailed questionnaire & client records.

24. Framework for quality
The joint commission on accreditation of health care
organization (JACHO) 1997 defines quality improvement (QI)
as an approach to the continuous study &improvement of
the process of providing health care services to meet the
needs of clients and others.

25. Components of Q.I (quality
improvement)program
1. Establish responding and accountability for a Q.I program.
2. Define the scope of service for a clinical area.
3. Define the key aspect of service for the clinical area.
4. Develop quality indicators to monitor the outcome & appropriateness of care delivered.
5. Establish thresholds for evaluation of indicators.
6. Collect and analyze data from monitoring activities.

26. Contd..
1. Evaluate results of monitoring activities to determine for change in practice.
2. Resolve problems through development of actions plans.
3. Reevaluate to determine if the plan was successful.
4. Communicate results to the organization.

27. Models of quality assurance
Basic components of system models
1. Input – The input can be compared to the present state of systems.
2. Through put- It is development process.
3. Output :- It is finished product or result.
4. Feedback- It is essential components of system because it maintains & nourishes.

28. Incident review
1. Incidents in the hospital bear on the quality of treatment & patients final recovery.
2. Incidents like – delayed attendance by physician /nurse.
3. Lack of cleanness
4. Incorrect medication
5. Asepsis leading to infection
6. Carelessness in carrying nursing procedure- hot and cold application
7. Reports are legal and should be written carefully.

29. Quality assurance model (American nurses
association quality assurance model)

30. Model of quality assurance

31. Development of a quality assurance
program
1. Foster commitment of quality
2. Preliminary review of quality
3. Develop the purpose & vision for the quality presence effort
4. Assign responsibility for quality assurance
5. Develop a written quality assurance plan
6. Critical management system
7. Manage change

32. Developing quality indicators
Quantitative measure of an important aspect of service that the determine whether the service
conforms to established standards or requirement
Focus for the quality improvement program and staff monitoring criteria

33. Three types of indicators
1. Structure indicators-Evaluate the structure or systems for delivering care.
2. Process indicators- evaluate the manner in which care is delivered (e.g – process of pain
assessment, recovery of clients from sedation)
3. Outcome indicators- evaluate the end result of care delivered (e.g incidence of nosocomial
infection )

35. Factors affecting quality
assurance in nursing care
1. Lack of resources
2. Personal problems
3. Improper maintenance
4. Unreasonable patients and attendants
5. Absence of accreditation laws
6. Lack of incident review procedures
7. Lack of good hospital information system

36. Contd..
•Absence of patient satisfaction
•Lack of nursing care records
•Lack of supervision
•Sub-standards education & training
•Lack of written job description & job satisfaction

37. Quality assurance model in India
Nurses who are registered to INC and state nursing council are safe provide care
Program is expected to develop mechanism for ensuring quality of nursing practice.

38. Quality assurance model in nursing
Set of elements that are related to each other and
comprise of planning for quality development of
objectives setting & actively communicating standards
developing indicators.

39. Philosophy of quality assurance
model in nursing
Indian nursing council believes that nurse will-
•Do good for person /receiver of care , do no harm,
•Be responsible and accountable for providing quality care in the line with set standards
•Be committed to understanding of dynamic nature of her/his role in interdisciplinary health
team
•Create public awareness

40. Contd..
•Work in conjugation with legislation, accreditation & political system
•Have obligation to promote education of self & others .
•Be committed to advancement of profession

41. Purpose of quality assurance model
Ensure quality nursing care provided by nurses in order to meet the expectation of the receiver ,
management and regulatory body
Also intends to increase the commitment of the provider and the management

42. Goals of quality assurance model
Develop confidence of the receiver that quality care is being rendered as per assurance.
Develop commitment of the management towards quality care.
Commitment to set standards for nursing practice and strive for excellence.
Strengthen documentation of nursing care.
Promote optimum utilization of resources in providing cost effective nursing care.

43. Research article

44. Development of an instructional quality assurance
model in nursing science
Abstract
Purpose of the study was to develop an instructional quality assurance model in nursing science.
It is divided in 3 phase
1. Study the information for instructional quality assurance model in nursing science
2. To develop an instructional quality assurance model in nursing science
3. Audit and the assessment of the development model.

45. Results
Factors which affected the instructional quality of nursing science more the instructional quality
assurance model the developed by the institutions
There were 3 models of instructional quality assurance
Instructional quality assurance model in nursing service was systematic consisting of input,
process & output. The operation based on 3 domains
1. Principles
2. Concepts
3. practice

46. Role of nurse in quality assurance
Active participants of interdisciplinary quality improvement team.
Develop mechanism for continuity monitoring the effectiveness of nursing care both a
collaborative and an individual professional activity.
Contribute innovation and improvements projects and patient safety initiatives.

47. Contd..
Periodic research works related to quality assurance
Identify any area of needed improvement in delivery of care.
Participate continuing educational program & insurance educational program for continuing
professional development

48. Summary

49. Conclusion
Quality assurance program will helps to improve the
quality of nursing care & professional development.
Individual with the profession must assume
responsibility for their professional actions & be
answerable to the recipients for their care.

50. Bibliography
Kozier, fundamental of nursing, Dorling kindersky put second edition, 2006 p.no 360-361
F.A Davis legal ethics and political issues in nursing. Davis company , second edition 1994, p.no.
231-244
Potter and perry, fundamental of nursing , Mosby publications, fourth edition , 1997, p.no-173-
176
Shabeer. P. basheer , advanced nursing practice, Emmess Ist edition , 2016, p.no 50-60

51. Internet refrences
http://currentnursing.com/nursing management /tool quality management healthcare.html
www.indiannursingcouncil.com/quality assurance in nursing standards