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Nursing
 Heart of the responsibility to the public
Happy ,,,,,,,
Supporting a dying patient and
family,,,,,,
THE CONSUMER PROTECTION
ACT, 1986
 To protect the interests of
consumers in India.
 Medical services are covered under
the definition of “service” under the
Act.
 A deficiency in the duty results in
negligence.
 Reasonable degree of care and skill
 “ordinary competent member of the profession
who professes to have those skills would
exercise in the circumstance in question.”
 Need not necessarily conform to the highest
degree of care or the lowest degree of care
possible.
 The degree of care is a variable and depends
on the circumstance.
STANDARD
 The standard of care is a constant
 The same standard of care is expected
from a generalist and a specialist
 But what amounts to reasonable care
with regard to the specialist differs from
what amount of reasonable care is
standard for the generalist.
Standards??????????
Professional standards in
Nursing
Mrs Deepa P
Assistant Professor
GCNA
Standards - definition
 Predetermined levels of excellence that
serves as a guide for practice
Standards - definition
 Standards are professionally developed
expressions of the range of acceptable
variations from a norm or criterion
 Avedis Donabedian.
Standards - definition
 Criteria are pre-determined elements
against which aspects of the quality of
medical service may be compared.
Nursing standards
 Are needed to practice safely.
 They reflect a desired and achievable
level of performance against which
actual performance can be compared.
Their main purpose is to promote, guide
and direct professional nursing practice.
Nursing standards
 Broad statements of quality.
 Provide exact criteria with which clients,
nurses and employers can evaluate
care for effectiveness and excellence.
 Used as a measurement tool and hence
should be objective, measurable and
achievable.
Nursing standards
 There is no one set of standards, each
organization and profession must set
standards and objectives to guide
individual practitioners in performing
safe and effective care.
Why are standards important?
 Outlines what the profession expects of its
members.
 Promotes, guides and directs professional
nursing practice – important for self-assessment
and evaluation of practice by employers, clients
and other stakeholders.
 Provides nurses with a framework for
developing competencies
 Aids in developing a better understanding &
respect for the various & complementary roles
contd
 Provide a baseline for evaluating quality of
Nursing care.
 Helps supervisors to guide nursing staff to
improve performances.
 Help to clarify the Nurse’s area of
accountability.
 Help Nursing to clearly define different levels
of care.
 It is a device for quality assurance as Quality
Purposes of standards
Classification of standards
 Physical standards
 Cost standards
 Capital standards
 Revenue standards
 Program standards
 Intangible standards
 Goal standards
 Strategies plan standards
 End standards
 Mean standards
 Structural standards Things we use
 Process standards Things we do
 Outcome standards The result
Characteristics of Standards
Characteristics of Standards
contd
Based on current knowledge and scientific
practice.
Must be reviewed and revised periodically.
Directed towards optimal standard.
Sources of Nursing care
standards
 TNAI
 Licensing bodies like INC, MCI etc
 Departments of the institution
 Patient care unit
 Government at national, state and local
levels
 Individual personal standard
Identify this website
INTERNATIONAL COUNCIL OF
NURSES
 ICN is a federation of more than 130
national nurses associations (NNAs)
 Founded in 1899
 ICN is the world’s first and widest
reaching international organisation for
health professionals. 
 Operated by nurses
 ICN works to
 ensure quality nursing care for all
 sound health policies globally
 the advancement of nursing knowledge
 the presence worldwide of a respected nursing
profession
 a competent and satisfied nursing workforce.
National Accreditation Board for Hospitals
& Healthcare Providers (NABH)
 Constituent board of Quality
Council of India
 to establish and operate
accreditation programme for
healthcare organisations.
Objectives- NABH
Professionalization
 Professionalization is the process by
which an occupation achieves
professional status.
 Professional nursing practice involves
“specialized skills essential to the performance
of a unique, professional role”
 Accountability
 “to be answerable to
oneself and others
for one's own
actions.”
 Autonomy
 having the authority
to make decisions
and the freedom to
act in accordance
with one's
professional
knowledge base
 Professional standards ensure that the
highest level of quality nursing care is
promoted.
Activities showing
professionalism
 Membership in professional
organizations
 certification in specialty or advanced
practice
 continuing education
 academic education
Various professional organizations
At centre level
Trained Nurses Association of India (TNAI)
International Council of Nurses (I C N)
The Commonwealth Nurses Federation
The Indian Nursing Council (INC)
The Red Cross Society
World Health Organisation (WHO)
At state level
The Student Nurses Association (SNA)
The Nurses League of Christian Medical Association
The Christian Medical Association of India
Trained Nurses Association of India (TNAI)
Standards of care ANA
 Scopes and Standards of practice
(2004) describe a competent level of
nursing care.
Standards of care ANA
Standards of care ANA
 Assessment
 The nurse collects comprehensive data pertinent to the
patients health or situation
 Diagnosis
 The nurse analyzes the assessment data to determine the
diagnoses or issues
 Outcome identification
 In terms of the patient, patient values, ethical
considerations, environment or situation considering
associated risks , benefits , costs, current scientific
evidence and clinical expertise
Standards of care ANA
 Planning
 The nurse develops a plan that prescribes
strategies and alternatives to attain expected
out comes
 Implementation
 The nurse implements the identified plan of 
care
 Evaluation
 The nurse evaluates progress towards
attainment of outcomes
Standards of professional performance
-describe the roles of all professional nurses
 Quality of care
 Performance appraisal
 Collegiality
 Ethics
 Collaboration
 Research
 Resource utilization
 Leadership
 Education
Standards of professional performance
 Quality of care
 The  registered nurse systematically enhances
the quality and effectiveness of nursing
practice
 Performance appraisal
 The nurse evaluates one’s own nursing
practice in relation to professional practice
standards and guide line, relevant statutes,
rules and regulations
Standards of professional
performance
 Collegiality
 The nurse interacts with and contribute to the
professional development  of peers and other
health care providers as colleagues
 Ethics
 The nurse integrates ethical provisions in all
areas of practice
 Collaboration
 The nurse collaborates with patient, family, and
others in the conduct of nursing practice
Standards of professional
performance
 Research 
 The nurse integrates  research findings in
practice
 Resource utilization
 The nurse considers factors related to
safety, effectiveness, cost, and impact on
practice in the planning and delivery of
nursing services
Standards of professional
performance
 Leadership
 The nurse provides leadership in the
professional practice setting and the
profession
 Education
 The nurse attains knowledge and
competency that  reflects current nursing
practice
 Fundamental to the nursing professions’
future is our ability to
 honor
 respect
 value each other
 value the inter-personal and inter-professional
relationships.
Nursing standard 26 Oct 2016
Conclusion
 Be committed to your
profession
 When you commit to continuously improving
your practice,
 you are committing to improving the
profession of nursing,
 and improving health.
References
 Potter PA, Perry AG. Fundamentals of Nursing. 6th edn. Mosby ;st
Louis.2005.
 Creasia J L, Parker B. Conceptual framework of professional
practice.2nd edn. Mosby;St.Loius.1996.
 Hall JK. Nursing ethics &law. W.B Saunders
company;Philadelphia.1996.
 Lillies C, Taylor C et al. Fundamentals of Nursing: The art & science of
nursing care. Lippincott publications; Philadelphia.2005.
 Potter PA, Perry AG. Basic Nursing; Essentials for practice. 6th edn.
Mosby ;st Louis.2007.
 Kockrow EO, Christensen BL. Foundatios of Nursing.4th
edn.mosby.2003.
 Danasu R. Standard nursing care: An Asset. The Nursing Journal of
India.  June 2007. VOL. XCVIII No. 6.
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779962/
Nursing standards and professionalism

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Nursing standards and professionalism

  • 1. Nursing  Heart of the responsibility to the public
  • 2.
  • 4. Supporting a dying patient and family,,,,,,
  • 5.
  • 6. THE CONSUMER PROTECTION ACT, 1986  To protect the interests of consumers in India.  Medical services are covered under the definition of “service” under the Act.  A deficiency in the duty results in negligence.
  • 7.  Reasonable degree of care and skill  “ordinary competent member of the profession who professes to have those skills would exercise in the circumstance in question.”  Need not necessarily conform to the highest degree of care or the lowest degree of care possible.  The degree of care is a variable and depends on the circumstance.
  • 8. STANDARD  The standard of care is a constant  The same standard of care is expected from a generalist and a specialist  But what amounts to reasonable care with regard to the specialist differs from what amount of reasonable care is standard for the generalist.
  • 10. Professional standards in Nursing Mrs Deepa P Assistant Professor GCNA
  • 11. Standards - definition  Predetermined levels of excellence that serves as a guide for practice
  • 12. Standards - definition  Standards are professionally developed expressions of the range of acceptable variations from a norm or criterion  Avedis Donabedian.
  • 13. Standards - definition  Criteria are pre-determined elements against which aspects of the quality of medical service may be compared.
  • 14. Nursing standards  Are needed to practice safely.  They reflect a desired and achievable level of performance against which actual performance can be compared. Their main purpose is to promote, guide and direct professional nursing practice.
  • 15. Nursing standards  Broad statements of quality.  Provide exact criteria with which clients, nurses and employers can evaluate care for effectiveness and excellence.  Used as a measurement tool and hence should be objective, measurable and achievable.
  • 16. Nursing standards  There is no one set of standards, each organization and profession must set standards and objectives to guide individual practitioners in performing safe and effective care.
  • 17.
  • 18. Why are standards important?  Outlines what the profession expects of its members.  Promotes, guides and directs professional nursing practice – important for self-assessment and evaluation of practice by employers, clients and other stakeholders.  Provides nurses with a framework for developing competencies  Aids in developing a better understanding & respect for the various & complementary roles
  • 19. contd  Provide a baseline for evaluating quality of Nursing care.  Helps supervisors to guide nursing staff to improve performances.  Help to clarify the Nurse’s area of accountability.  Help Nursing to clearly define different levels of care.  It is a device for quality assurance as Quality
  • 21. Classification of standards  Physical standards  Cost standards  Capital standards  Revenue standards  Program standards  Intangible standards  Goal standards  Strategies plan standards
  • 22.  End standards  Mean standards
  • 23.  Structural standards Things we use  Process standards Things we do  Outcome standards The result
  • 25. Characteristics of Standards contd Based on current knowledge and scientific practice. Must be reviewed and revised periodically. Directed towards optimal standard.
  • 26. Sources of Nursing care standards  TNAI  Licensing bodies like INC, MCI etc  Departments of the institution  Patient care unit  Government at national, state and local levels  Individual personal standard
  • 28. INTERNATIONAL COUNCIL OF NURSES  ICN is a federation of more than 130 national nurses associations (NNAs)  Founded in 1899  ICN is the world’s first and widest reaching international organisation for health professionals. 
  • 29.  Operated by nurses  ICN works to  ensure quality nursing care for all  sound health policies globally  the advancement of nursing knowledge  the presence worldwide of a respected nursing profession  a competent and satisfied nursing workforce.
  • 30.
  • 31.
  • 32.
  • 33.
  • 34. National Accreditation Board for Hospitals & Healthcare Providers (NABH)  Constituent board of Quality Council of India  to establish and operate accreditation programme for healthcare organisations.
  • 36. Professionalization  Professionalization is the process by which an occupation achieves professional status.
  • 37.  Professional nursing practice involves “specialized skills essential to the performance of a unique, professional role”
  • 38.  Accountability  “to be answerable to oneself and others for one's own actions.”  Autonomy  having the authority to make decisions and the freedom to act in accordance with one's professional knowledge base
  • 39.  Professional standards ensure that the highest level of quality nursing care is promoted.
  • 40. Activities showing professionalism  Membership in professional organizations  certification in specialty or advanced practice  continuing education  academic education
  • 41. Various professional organizations At centre level Trained Nurses Association of India (TNAI) International Council of Nurses (I C N) The Commonwealth Nurses Federation The Indian Nursing Council (INC) The Red Cross Society World Health Organisation (WHO) At state level The Student Nurses Association (SNA) The Nurses League of Christian Medical Association The Christian Medical Association of India Trained Nurses Association of India (TNAI)
  • 42. Standards of care ANA  Scopes and Standards of practice (2004) describe a competent level of nursing care.
  • 44. Standards of care ANA  Assessment  The nurse collects comprehensive data pertinent to the patients health or situation  Diagnosis  The nurse analyzes the assessment data to determine the diagnoses or issues  Outcome identification  In terms of the patient, patient values, ethical considerations, environment or situation considering associated risks , benefits , costs, current scientific evidence and clinical expertise
  • 45. Standards of care ANA  Planning  The nurse develops a plan that prescribes strategies and alternatives to attain expected out comes  Implementation  The nurse implements the identified plan of  care  Evaluation  The nurse evaluates progress towards attainment of outcomes
  • 46. Standards of professional performance -describe the roles of all professional nurses  Quality of care  Performance appraisal  Collegiality  Ethics  Collaboration  Research  Resource utilization  Leadership  Education
  • 47. Standards of professional performance  Quality of care  The  registered nurse systematically enhances the quality and effectiveness of nursing practice  Performance appraisal  The nurse evaluates one’s own nursing practice in relation to professional practice standards and guide line, relevant statutes, rules and regulations
  • 48. Standards of professional performance  Collegiality  The nurse interacts with and contribute to the professional development  of peers and other health care providers as colleagues  Ethics  The nurse integrates ethical provisions in all areas of practice  Collaboration  The nurse collaborates with patient, family, and others in the conduct of nursing practice
  • 49. Standards of professional performance  Research   The nurse integrates  research findings in practice  Resource utilization  The nurse considers factors related to safety, effectiveness, cost, and impact on practice in the planning and delivery of nursing services
  • 50. Standards of professional performance  Leadership  The nurse provides leadership in the professional practice setting and the profession  Education  The nurse attains knowledge and competency that  reflects current nursing practice
  • 51.  Fundamental to the nursing professions’ future is our ability to  honor  respect  value each other  value the inter-personal and inter-professional relationships.
  • 52.
  • 54. Conclusion  Be committed to your profession  When you commit to continuously improving your practice,  you are committing to improving the profession of nursing,  and improving health.
  • 55. References  Potter PA, Perry AG. Fundamentals of Nursing. 6th edn. Mosby ;st Louis.2005.  Creasia J L, Parker B. Conceptual framework of professional practice.2nd edn. Mosby;St.Loius.1996.  Hall JK. Nursing ethics &law. W.B Saunders company;Philadelphia.1996.  Lillies C, Taylor C et al. Fundamentals of Nursing: The art & science of nursing care. Lippincott publications; Philadelphia.2005.  Potter PA, Perry AG. Basic Nursing; Essentials for practice. 6th edn. Mosby ;st Louis.2007.  Kockrow EO, Christensen BL. Foundatios of Nursing.4th edn.mosby.2003.  Danasu R. Standard nursing care: An Asset. The Nursing Journal of India.  June 2007. VOL. XCVIII No. 6.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779962/

Editor's Notes

  1. To be a nurse is a calling and difficult to describe in words. Who can say why a person would want to do a nurses work, but those who do will tell you there is nothing as fulfilling or rewarding. Nurses stay by the side of those they serve through the worst times and celebrate with patients and families in the best times.
  2. Bolam v Friern Hospital Management Committee [1957] 1 WLR 582 is an English tort law case that lays down the typical rule for assessing the appropriate standard of reasonable care in negligence cases involving skilled professionals (e.g. doctors): the Bolam test. Where the defendant has represented him or herself as having more than average skills and abilities, this test expects standards which must be in accordance with a responsible body of opinion, even if others differ in opinion. In other words, the Bolam test states that "If a doctor reaches the standard of a responsible body of medical opinion, he is not negligent".
  3. representing the more than 16 million nurses worldwide.
  4. The two main concepts that are in the forefront of professional nursing and its services ideal are accountability and autonomy.
  5. ollects data in a systematic and ongoing process. Data collection involves the patient, significant others, and health care providers, when appropriate Priorities data collection activities based on the patients immediate condition or needs determine the priority of data collection Collects pertinent data using appropriate assessment techniques Document relevant data in a retrievable form Derives diagnoses from the assessment data Validates the diagnoses with patient, significant others, and health care providers ,when possible. Documents diagnoses in a manner that facilitates the determination of expected outcomes and plan of care Derieves outcomes from the diagnoses Formulates outcomes mutually with the patient and the health care providers, when possible. Outcomes are culturally appropriate and realistic in relation to the patients present and potential capabilities Defines  expected outcomes in terms of the patient, patient values, ethical considerations, environment, or situation with such consideration as associated risks , benefits , costs, current scientific evidence, and clinical expertise when formulating expecting outcomes. Outcomes are attainable in relation to resources available to the person Outcomes include a time estimate for attainment for expected outcome. Outcomes provide direction for continuity of care Modifies expected outcomes based on changes in the status of the patient or evaluation of the situation. Documents outcomes as measurable goals
  6. The plan is individualized to the patient and patients condition or needs Develops the plan with the patient, significant others, and health care providers, when appropriate. Includes strategies within the plan that address each of the identified diagnosis or issues, which may include strategies for promotion and restoration of health and prevention of illness, injury, and disease. Provides for continuity within the plan. Incorporates an implementation pathway or timeline within the plan. Utilizes the plan to provide direction to other members of the health care team. Defines the plan to reflect current status , rules, and regulations and standards. Integrates current trends and research affecting care in the planning process. Considers the economic impact of the plan. Uses standardized language or recognized terminology to document the plan. .Interventions are consistent with the established plan of care 2.Implements interventions in a safe and appropriate manner, documents interventions 3. Utilizes evidence –based interventions and treatments specific to the diagnosis or problem. 4.Collaborates with nurse colleagues to implement the plan 5.Utilizes community resources and systems to implement the plan 5A:Co-ordination of care. The registered nurse coordinates care delivery. ---.Coordinates implementation of the plan. 2.Documentation of the care. Health teaching and health promotion-----.Provides health teaching that address such topics as healthy lifestyles , risk reducing behaviors, developmental needs, activities of daily living, and preventive self-care. 2. Uses health promotion and health teaching methods appropriate to the situation and the patient’s developmental level, learning needs , readiness, ability to learn , language preference , and culture. 3. Seeks opportunities for feedback and evaluation of the effectiveness of the strategies used . 5C:consultation:the advanced practice registered nurse and the nursing role specialist provide consultation to influence the identified plan, enhance the abilities of others and effect change.  -----1.Synthesizes clinical data, theoretical frameworks, and evidence when providing consultation. 2.Facilitates the effectiveness of a consultation by involving the patient in decision-making and negotiating role responsibilities. 3.Communicates consultation recommendations that facilitates change. 5D:Prescriptive Authority and Treatment :the advanced practice registered nurse uses prescriptive authority, procedures, referrals, treatments, and therapies in accordance with state and federal laws and regulations.----.prescribes evidenced-based treatments , therapies, and procedures considering the patient’s comprehensive health care needs. 2.presribes pharmacological agents based on a current knowledge of pharmacology and physiology and based on clinical indicators, the patient’s status needs , and the results of diagnostic and laboratory tests. 3.Evaluates therapeutic and potential adverse effects and potential adverse effects of pharmacological and non pharmacological treatment. 4.Provides patients with information about intended effects and potential adverse effects of proposed prescriptive therapies. 5.Provides information about costs, alternative treatments and procedures , as appropriate. .Evaluation is systematic, ongoing and criterion-based 2.Involves the patient, significant others ,and the health care providers in the evaluation process, when appropriate 3.Uses ongoing assessment data to revise diagnoses, outcomes and plan of care as needed 4.documents revisions in diagnoses, outcomes, and the plan of care 5. evaluates the effectiveness of interventions in relation to outcomes. 6.Documents the patients response to interventions