Nursing Administration

1. QUALITY CONTROLQUALITY CONTROL

2. Controlling is the function of management that involves,Controlling is the function of management that involves,
setting standards, measuring performance against thosesetting standards, measuring performance against those
standards, reposting the results and taking action.standards, reposting the results and taking action.
Quality control is a specific type of controlling, which refersQuality control is a specific type of controlling, which refers
to activities that evaluate, monitor or regulate servicesto activities that evaluate, monitor or regulate services
rendered to consumers .rendered to consumers .
Quality control has three basic steps:Quality control has three basic steps:
 Criterion or standard is determinedCriterion or standard is determined
 Information is collected to determine if the standard hasInformation is collected to determine if the standard has
been met.been met.
 Educational or corrective action is taken if the criterionEducational or corrective action is taken if the criterion
has not been met.has not been met.

3.  Accountability ; is the obligation to provide a reasoningAccountability ; is the obligation to provide a reasoning
for one’s actions to the persons who delegate authorityfor one’s actions to the persons who delegate authority
for that action.for that action.
 Nursing care outcome: is the end result of nursingNursing care outcome: is the end result of nursing
interventions ; a measurable change in the state of ainterventions ; a measurable change in the state of a
patient’s health that is occasioned by nursing action.patient’s health that is occasioned by nursing action.
 A criterion is the value free name of a variable that isA criterion is the value free name of a variable that is
known to be a reliable indicator of quality.known to be a reliable indicator of quality.
 A standard is the desired quality, quantity or level ofA standard is the desired quality, quantity or level of
performance that is established as criterion againstperformance that is established as criterion against
which worker’s performance will be measured.which worker’s performance will be measured.
 Objective is a goal towards which effort is directed. ToObjective is a goal towards which effort is directed. To
be effective, it should be expressed in observable,be effective, it should be expressed in observable,
measurable terms and should include a target date formeasurable terms and should include a target date for
fulfillment.fulfillment.

4.  Evaluation is a subjective judgement based on objectiveEvaluation is a subjective judgement based on objective
measurement.measurement.
 Feedback is the information about system performanceFeedback is the information about system performance
that is reflected back into the system on a basis forthat is reflected back into the system on a basis for
monitoring system operation.monitoring system operation.
 Continuous quality improvement : is the ongoing processContinuous quality improvement : is the ongoing process
of monitoring structure, process and outcome indicatorsof monitoring structure, process and outcome indicators
in order to identify signal events, significant trends, andin order to identify signal events, significant trends, and
opportunities for change that will guide health careopportunities for change that will guide health care
professionals in preventing patient care problems andprofessionals in preventing patient care problems and
improving already satisfactory patient services.improving already satisfactory patient services.
 Peer review:is the evaluation by a group of practisingPeer review:is the evaluation by a group of practising
professional nurse peers of the quality of nursign careprofessional nurse peers of the quality of nursign care
implemented by another nurse.implemented by another nurse.

5. Steps in quality controlSteps in quality control
 Establishment of control standards or criteria.Establishment of control standards or criteria.
 Identify the information relevant to criteria.Identify the information relevant to criteria.
 Determine ways to collect the information.Determine ways to collect the information.
 Collect and analyse the information.Collect and analyse the information.
 Compare collected information with establishedCompare collected information with established
criteria.criteria.
 Make a judgment about quality.Make a judgment about quality.
 Provide information and if necessary, takeProvide information and if necessary, take
corrective action regarding findings ofcorrective action regarding findings of
appropriate sources.appropriate sources.
 Determine ways to collect the information.Determine ways to collect the information.

6. STANDARD AS A DEVICE FOR QUALTIY CONTROLSTANDARD AS A DEVICE FOR QUALTIY CONTROL
Types of standards the most organisation must establishTypes of standards the most organisation must establish
(Koont & Weitrich;1988):(Koont & Weitrich;1988):
 Physical standardsPhysical standards: which include patient activity ratings: which include patient activity ratings
to establish nursing care hours per patient per day.to establish nursing care hours per patient per day.
 Cost standardsCost standards: which include the cost per patient per: which include the cost per patient per
day.day.
 Capital standardsCapital standards: include the review of monetary: include the review of monetary
investment or new programmes.investment or new programmes.
 Programme standardsProgramme standards: which guide the development: which guide the development
and implementation of programmes to meet client needs.and implementation of programmes to meet client needs.
 Intangible standardsIntangible standards: which include staff development or: which include staff development or
Personnel orientation costs.Personnel orientation costs.

7.  Goal standardGoal standard: which outline qualitative goals in short: which outline qualitative goals in short
and long term planning.and long term planning.
 Strategies plan standardStrategies plan standard: which outline check points in: which outline check points in
developing and implementing the organization’s strategicdeveloping and implementing the organization’s strategic
plan.plan.
AUDIT AS A TOOL FOR QUALITY CONTROLAUDIT AS A TOOL FOR QUALITY CONTROL
An audit is a systematic and official examination of aAn audit is a systematic and official examination of a
record, process or account to evaluate performance .record, process or account to evaluate performance .
Types of AuditTypes of Audit
 Outcome audit : end results of care. Eg: length of stay,Outcome audit : end results of care. Eg: length of stay,
morbidity, mortality.morbidity, mortality.
 Process audit : used to measure process of care or howProcess audit : used to measure process of care or how
the care was carried out.the care was carried out.

8.  Structure audit: monitors the structure or setting in which patientStructure audit: monitors the structure or setting in which patient
care occurs, such as the finances, nursing services, medical recordscare occurs, such as the finances, nursing services, medical records
and environment.and environment.
Nurse manager’s roles in quality controlNurse manager’s roles in quality control
 Encourage staff to be actively involved in the quality controlEncourage staff to be actively involved in the quality control
process.process.
 Clearly communicate standards of care to subordinates.Clearly communicate standards of care to subordinates.
 Encourage the setting of high standards to maximize quality insteadEncourage the setting of high standards to maximize quality instead
of setting minimum safety standards.of setting minimum safety standards.
 Implement quality control proactively instead reactively.Implement quality control proactively instead reactively.
 Use control as a method of determining why goals were not met.Use control as a method of determining why goals were not met.
 Be positively active in communicating quality control findings.Be positively active in communicating quality control findings.
 Act as a role model for followers in accepting responsibility andAct as a role model for followers in accepting responsibility and
accountability for nursing actions.accountability for nursing actions.

9. Functions of nurse manager in quality control.Functions of nurse manager in quality control.
 In union with other personnel in the organisationIn union with other personnel in the organisation
establish clear cut , measurable standards of care andestablish clear cut , measurable standards of care and
determine the most appropriate method for measuring ifdetermine the most appropriate method for measuring if
those standards have been met.those standards have been met.
 Select and use process, outcome and structure auditsSelect and use process, outcome and structure audits
appropriately as quality control tools.appropriately as quality control tools.
 Assesses appropriate sources of information in dataAssesses appropriate sources of information in data
gathering for quality control.gathering for quality control.
 Determine descrepancies between care provided andDetermine descrepancies between care provided and
unit standards and seeks further information regardingunit standards and seeks further information regarding
why standards were not met.why standards were not met.

10.  Use quality control findings as a measure of employeeUse quality control findings as a measure of employee
performance and reward, coach, counsel or disciplineperformance and reward, coach, counsel or discipline
employees accordingly.employees accordingly.
 Keep abreast of current government and licensingKeep abreast of current government and licensing
regulations that affect quality control.regulations that affect quality control.
TOTAL QUALITY MANAGEMENTTOTAL QUALITY MANAGEMENT
This is a philosophy developed by Dr. Edward Deming.This is a philosophy developed by Dr. Edward Deming.
PrinciplesPrinciples
 Create a constancy of purposeCreate a constancy of purpose for the improvement offor the improvement of
the products and service.the products and service.
 Adopt a philosophy of continual improvement.Adopt a philosophy of continual improvement.

11.  Focus on improving processes, not on inspection ofFocus on improving processes, not on inspection of
products.products.
 End the practice of awarding business on price alone,End the practice of awarding business on price alone,
instead minimise total cost by working with a simpleinstead minimise total cost by working with a simple
supplier.supplier.
 Improve constantly every process of planning,Improve constantly every process of planning,
producting and service.producting and service.
 Institute job training and retraining.Institute job training and retraining.
 Develop leadership in the organisation.Develop leadership in the organisation.
 Drive out fear by encouraging employees to participateDrive out fear by encouraging employees to participate
actively in the process.actively in the process.
 Foster inter-departmental cooperation, and breakdownFoster inter-departmental cooperation, and breakdown
barriers between departments.barriers between departments.

12.  Eliminate slogans, exhortations and targets for theEliminate slogans, exhortations and targets for the
workforce.workforce.
 Focus on quality and not just quantity.Focus on quality and not just quantity.
 Promote team work rather than individualPromote team work rather than individual
accomplishments .accomplishments .
 Educate employees to maximize personal development.Educate employees to maximize personal development.
 Charge all employees with carrying out the total qualityCharge all employees with carrying out the total quality
management package.management package.

13. NURSING AUDITNURSING AUDIT
Nursing audit is the assessment of the quality of nursingNursing audit is the assessment of the quality of nursing
care and uses records as an aid in evaluating the qualitycare and uses records as an aid in evaluating the quality
of patient care. It is an evaluation of the nursing service.of patient care. It is an evaluation of the nursing service.
Purposes:Purposes:
 Evaluating nursing care givenEvaluating nursing care given
 Achieves deserved and feasible quality of nursing care.Achieves deserved and feasible quality of nursing care.
 Stimulant to better recordsStimulant to better records
 Focuses on care provided and not on care provider.Focuses on care provided and not on care provider.
 Contributes to research.Contributes to research.

14. Methods of nursing auditMethods of nursing audit
 Retrospective view:Retrospective view:
 Concurrent review:Concurrent review:
Advantages of nursing audit:Advantages of nursing audit:
 Can be used as a method of measurement in all areas ofCan be used as a method of measurement in all areas of
nursing.nursing.
 Scoring system is fairly simple.Scoring system is fairly simple.
 Results are easily understood.Results are easily understood.
 Assesses the work of all those involved in recordingAssesses the work of all those involved in recording
care.care.
 May be a useful tool as part of a quality assuranceMay be a useful tool as part of a quality assurance
programme in areas where accurate records of care areprogramme in areas where accurate records of care are
kept.kept.

15. Disadvantages of nursing auditDisadvantages of nursing audit
 Appraises the outcomes of the nursing process, so it isAppraises the outcomes of the nursing process, so it is
not so useful in areas where the nursing process has notnot so useful in areas where the nursing process has not
been implemented.been implemented.
 Many of the components overlap making analysisMany of the components overlap making analysis
difficult.difficult.
 Is time consuming.Is time consuming.
 Requires a team of trained auditors.Requires a team of trained auditors.
 Deals with a large amount of information.Deals with a large amount of information.
 Only evaluates record keeping. It only serves to improveOnly evaluates record keeping. It only serves to improve
documentation, not nursingz care.documentation, not nursingz care.

16. NURSING CARE STANDARDS IN WARD MANAGEMENTNURSING CARE STANDARDS IN WARD MANAGEMENT