nursing standard

1. Marwa Alsatary

2. What is a standard?
• Predetermined levels of excellence that serves as a guide for practice

3. Nursing standards

4. Why are standards important?
• Promotes, guides and directs professional nursing practice – important for self-
assessment and evaluation of practice by employers, clients and other stakeholders.
• Provide nurses with a framework for developing competencies
• Provide a baseline for evaluating quality of Nursing care.
• Helps supervisors to guide nursing staff to improve performance.
• Help to clarify the Nurse’s area of accountability.
• Help Nursing to clearly define different levels of care.

5. Purposes of standards

6. Session 2

7. NURSING CARE (NR) STANDARD 9:
9. Nursing services are provided by qualified nurses
• 9.1 The nursing director ensure the availability of adequate number of
licensed registered nurses to provide nursing care for all patients
• 9.2 Each unit has a head nurse/nurse manager with the required
nursing and managerial experience
• 9.3 Nursing services are provided by registered nurses in accordance
with their license and scope of practice
• 9.4 Qualified registered nurses are available to provide bedside nursing
care to all patients twenty four hours a day, seven days a week

8. Nursing services are provided by qualified
nurses
• 9.5 Nursing assistants are supervised by a registered nurse at all
times
• 9.6 Nursing assistants have clearly defined job description and
responsibilities
• 9.7 There is an education program for nursing assistant
performing patient-care services to orient them to their role

9. EXPECTED RESPONSE
• Awareness of staff regarding their own job descriptions.
• Staff must have valid credentials.
• Staff must have a copy of their job descriptions.
• New nurses are guided by preceptors.
• HCAs are guided by staff nurses.
• All nursing staff are required to attend educational
programs and activities.

10. NURSING CARE (NR) STANDARD 10:
10. There is a comprehensive nursing assessment for each patient upon admission
• 10.1 The nursing assessment is timely completed by a registered nurse
• 10.2 The scope and content of the nursing assessment is defined in the hospital policies and
may include:
• 10.2.1 History of the patient’s main complaint 10.2.2 Drug allergies
• 10.2.3 Physical condition 10.2.4 Psychosocial status
• 10.2.5 Pain assessment 10.2.6 Nutritional status
• 10.2.7 Discharge planning 10.2.8 Skin assessment
• 10.2.9 Fall-risk assessment

11. There is a comprehensive nursing assessment
for each patient upon admission
• 10.3 The nursing assessment identifies nursing care needs for each patient
upon admission
• 10.4 All patients are re-assessed at appropriate intervals (at least on every
shift) to determine their response to treatment and to plan for continued
treatment and discharge
• 10.5 The nursing assessment is documented in the patient’s medical record

13. EXPECTED RESPONSE
 Available as Hospital Wide Policy.
 Random checking of patient’s electronic medical record if these assessments
were documented.

14. NURSING CARE (NR) STANDARD 11:
11.There is a nursing plan of care for each patient
• 11.1 A nursing plan of care is developed for all inpatients
• 11.2 The nursing plan of care is consistent with the medical plan of care
• 11.3 The nursing plan of care is reviewed on every shift, upon any
significant change in the patient’s condition, and when new treatment
are added or current treatments are discontinued
• 11.4 The nursing plan of care is documented in the patient’s medical record

16. EXPECTED RESPONSE
 Plan of care is available in e-SIHI.
 Random checking of patient’s electronic medical record if these were
available and documented.

17. NURSING CARE (NR) STANDARD 12:
12. A policy and procedure guide the care of patients on restraints
• 12.1 The hospital implements a policy and procedure that defines the
indications for restraints
• 12.2 Monitoring requirements for both physical and chemical restraints are
clearly identified in the policy including equipment needed and the type and
frequency of monitoring and its documentation

18. A policy and procedure guide the care of
patients on restraints
• 12.3 Patients are restrained only after an order by the primary physician
• 12.4 The restraint order should be renewed at least every 24 hours
• 12.5 Patients are restrained as described in the relevant policy

19. EXPECTED RESPONSE
 Maintaining Safety of Patients requiring Restraint Policy (Hospital Wide)
 Orders must be renewed every 24 hours

20. NURSING CARE (NR) STANDARD 13:
13. Restraints are applied safely and in accordance with professional standards and
applicable laws and regulations
• 13.1 The most responsible physician assesses and decides on the indication, the
most suitable type and the time required for applying restraints
• 13.2 The most responsible physician performs periodic assessment and re-
assessment as dictated by the patient’s condition (particularly, blood circulation
to the limbs restrained)
• 13.3 The least restrictive and most effective means of restraints are always used

21. Restraints are applied safely and in accordance with
professional standards and applicable laws and regulations
• 13.4 Use of restraints must be appropriate and safe for patient and staff,
used as a last resort, and in conformance with applicable laws and regulations
• 13.5 Patient’s dignity and rights are protected and preserved, including
preventing visibility by others and covering the patient when attending to the
patient’s physical needs
• 13.6 Nursing staff provide periodic monitoring of the restrained patient

22. Restraints are applied safely and in accordance with
professional standards and applicable laws and regulations
• 13.7 Patients are re-assessed on a frequent basis (at least hourly and as
appropriate)
• 13.8 Appropriate interventions are performed when the patient’s circulation
is being impaired.
• 13.9 Appropriate interventions are performed for side effects related to
major tranquilizers.

23. EXPECTED RESPONSE
• Random checking of patient’s electronic medical record if these assessments
were documented.
• Nursing staff must undergo use of restraint competency annually.

24. NURSING CARE (NR) STANDARD 14:
14. A nursing pre-operative checklist is completed to control the transfer and
handover of patients to the operating room
• 14.1 The nursing pre-operative checklist that is completed by the assigned
nurse
• 14.2 The checklist uses the “Yes,” “no,” and “not applicable” format
• 14.3 Patients are not transferred to the operating room if the checklist is not
completed except in dire emergencies

25. A nursing pre-operative checklist is completed to control
the transfer and handover of patients to the operating room
• 14.4 The assigned nurse endorses all the findings of the pre-operative
checklist to the receiving nurse in the operating room
• 14.5 The receiving nurse in the operating room reviews all the findings of
the pre-operative checklist with the assigned nurse and confirms in writing

26. The nursing pre-operative checklist contains the following
elements as a minimum
• 14.6 The nursing pre-operative checklist contains the following elements as a minimum
14.6.1 Evidence of completed relevant consents
14.6.2 Evidence of completed history and physical examination by medical and nursing staff
14.6.3 Evidence of site marking
14.6.4 Availability of results of requested investigations
14.6.5 Availability of requested blood or blood products
14.6.6 Evidence of removal of dentures and loose objects such as eye lenses, eyeglasses and
removable nails
14.6.7 Evidence of removal of jewelry and patient’s valuables

29. EXPECTED RESPONSE
 Checklist is available in e-SIHI.
 Random checking of patient’s electronic medical record if these assessments
were documented.

30. NURSING CARE (NR) STANDARD 15:
15.The nursing department ensures adequate supplies and equipment for the safe and effective
provision of care
• 15.1The nursing department ensures the availability of equipment and supplies necessary for the
safe provision of care. This includes, but is not limited to the following:
• 15.1.1 Scales appropriate to the age group and mobility needs of the patient
• 15.1.2 Stretchers with safety straps
• 15.1.3 Equipment for taking vital signs
• 15.1.4 Wheelchair with safety straps 15.1.5 Sharp boxes
• 15.1.6 Foot stools 15.1.7 Soft restraints
15.1.8 Bed rails
• 15.1.9 Devices for treatment and prevention of skin breakdown
• 15.1.10 Patient call bell 15.1.11 Oxygen and suction
• 15.1.12 Glucometer 15.1.13 Nebulizers
• 15.1.14 ECG machines

31. The nursing department ensures adequate supplies
and equipment for the safe and effective provision
of care
• 15.2 The nursing department has a process to maintain adequate
supplies and linen to meet patient needs.
15.2.1 Critical levels /re- order level are identified
15.2.2 Ordering requests are made when critical levels are reached and as needed
15.2.3 There is an emergency backup process when there are issues/delays receiving supplies
15.2.4 There is a method to track issues with supplies and linen so that patterns can be studied
for quality improvement

32. EXPECTED RESPONSE
 Availability of equipment and supplies in the units.
 All equipment are in working condition.
 PPM must be updated.
 Stickers placed on the equipment
 Nursing staff may demonstrate how to use the equipment.
 Available in Biomedical icon (Computer Desktop)
 Communication book or equipment book is available.

33. EXPECTED RESPONSE
 Availability of inventory list in the unit.
 PAR Levels Policy (Hospital Wide)
 Ocular inspection on ward supplies