Standards are important for healthcare quality and allow organizations to measure performance levels. Nursing standards describe the desired level of care and provide guidelines for safe practice. There are several types of standards including structure, process, and outcome standards. Standards are developed through collective judgment and should be based on values, reviewed periodically, and reflect changes over time. Nursing administrators play a key role in developing standards by creating awareness, facilitating the process, and ensuring education and review.
it explain about definition of supervisior, faculty and dual position. role of faculty and supervisior and characteristics of faculty and supervisior. different hospital who started concept of dual position. advantages and disadvantages of dual position.
The health care system and the nursing profession is expanding globally , there fore it is important for nurses to know the trends, issues and challenges in new millennium.
it explain about definition of supervisior, faculty and dual position. role of faculty and supervisior and characteristics of faculty and supervisior. different hospital who started concept of dual position. advantages and disadvantages of dual position.
The health care system and the nursing profession is expanding globally , there fore it is important for nurses to know the trends, issues and challenges in new millennium.
Nursing care plan based on self care deficit theory by Dorothea Orem. The process is on Medical Surgical Nursing. It is helpful for students of M.Sc Nursing.
“Let us never consider ourselves as finished nurses….. We must be learning all our lives”
-Florence Nightingale
The idea of continuing education in nursing is as old as organized nursing, but the concept of lifelong learning for the practitioner has developed slowly.
Nursing care plan based on self care deficit theory by Dorothea Orem. The process is on Medical Surgical Nursing. It is helpful for students of M.Sc Nursing.
“Let us never consider ourselves as finished nurses….. We must be learning all our lives”
-Florence Nightingale
The idea of continuing education in nursing is as old as organized nursing, but the concept of lifelong learning for the practitioner has developed slowly.
Quality assurance is a way of preventing mistakes and defects in manufactured products and avoiding problems when delivering products or services to customers; which ISO 9000 defines as "part of quality management focused on providing confidence that quality requirements will be fulfilled".
A NURSE IS A…..
Patient care consultant
Educator
Manager
Recruiter
Therapist
Researcher
Administrator
Case manager
The list goes on…
A simple definition
FIVE RIGHTS
THE RIGHT PATIENT,
AT THE RIGHT TIME,
IN THE RIGHT SETTING,
RECEING THE RIGHT CARE
AT THE RIGHTTIME
IN THE RIGHTCOST.
Quality assurance
“Quality assurance as the monitoring of the activities of client care to determine the degree of excellence attained to the implementation of the activities”. (Bull, 1985)
Quality assurance is the defining of nursing practice through well written nursing standards and the use of those standards as a basis for evaluation on improvement of client care (Maker 1998).
QA in nursing comprise of set of related elements such as
planning for quality,
development of objectives setting and
actively communicating standards,
developing indicators,
setting thresholds,
collecting data to monitor compliance with set standards for nursing practice
and applying solutions to improve care
UALITY ASSURANCE PROCESS:
Establishment of standards or criteria
Identify the information relevant to criteria
Determine ways to collect information
Collect and analyze the information
Compare collected information with established criteria
Make a judgment about quality
Provide information and if necessary, take corrective action regarding findings of appropriate sources
Determine ways to communicate the information
1) Credentialing:
2) Licensure:
3) Accreditation:
3)CERTIFICATION
1) Credentialing
It is the formal recognition of professional or technical competence and attainment of minimum standards by a person or agency. According to Hinsvark (1981) credentialing process has four functional components
a) To produce a quality product
b) To confer a unique identity
c) To protect provider and public
d) To control the profession.
2) Licensure
Individual licensure is a contract between the profession and the state, in which the profession is granted control over entry into and exists from the profession and over quality of professional practice. The licensing process requires that regulations be written to define the scopes and limits of the professional’s practice.
3) Accreditation:
The indian nursing council has established standards for inspecting nursing education’s programs in india(NLN-US). In the part the accreditation process primarily evaluated on agency’s physical structure, organizational structure and personal qualification
4. Certification
Certification is usually a voluntary process with in the profession. A person’s educational achievements, experience and performance on examination are used to determine the person’s qualifications for functioning in an identified specialty area.
A nursing care standard
is a descriptive statement of desired quality against which to evaluate nursing care.
It is guideline. A guideline is a recommended path to safe conduct, an aid to professional performance.
A NURSE IS A…..
Patient care consultant
Educator
Manager
Recruiter
Therapist
Researcher
Administrator
Case manager
The list goes on…
A simple definition
FIVE RIGHTS
THE RIGHT PATIENT,
AT THE RIGHT TIME,
IN THE RIGHT SETTING,
RECEING THE RIGHT CARE
AT THE RIGHTTIME
IN THE RIGHTCOST.
Quality assurance
“Quality assurance as the monitoring of the activities of client care to determine the degree of excellence attained to the implementation of the activities”. (Bull, 1985)
Quality assurance is the defining of nursing practice through well written nursing standards and the use of those standards as a basis for evaluation on improvement of client care (Maker 1998).
QA in nursing comprise of set of related elements such as
planning for quality,
development of objectives setting and
actively communicating standards,
developing indicators,
setting thresholds,
collecting data to monitor compliance with set standards for nursing practice
and applying solutions to improve care
UALITY ASSURANCE PROCESS:
Establishment of standards or criteria
Identify the information relevant to criteria
Determine ways to collect information
Collect and analyze the information
Compare collected information with established criteria
Make a judgment about quality
Provide information and if necessary, take corrective action regarding findings of appropriate sources
Determine ways to communicate the information
1) Credentialing:
2) Licensure:
3) Accreditation:
3)CERTIFICATION
1) Credentialing
It is the formal recognition of professional or technical competence and attainment of minimum standards by a person or agency. According to Hinsvark (1981) credentialing process has four functional components
a) To produce a quality product
b) To confer a unique identity
c) To protect provider and public
d) To control the profession.
2) Licensure
Individual licensure is a contract between the profession and the state, in which the profession is granted control over entry into and exists from the profession and over quality of professional practice. The licensing process requires that regulations be written to define the scopes and limits of the professional’s practice.
3) Accreditation:
The indian nursing council has established standards for inspecting nursing education’s programs in india(NLN-US). In the part the accreditation process primarily evaluated on agency’s physical structure, organizational structure and personal qualification
4. Certification
Certification is usually a voluntary process with in the profession. A person’s educational achievements, experience and performance on examination are used to determine the person’s qualifications for functioning in an identified specialty area.
A nursing care standard
is a descriptive statement of desired quality against which to evaluate nursing care.
It is guideline. A guideline is a recommended path to safe conduct, an aid to professional performance.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
1. RAJKUMARI AMRIT KAUR COLLEGE OF NURSING, NEW DELHI
Subject: Advanced Nursing Practice Ms. Sunita Thakur
Topic: Standards in General M.N. Final
INTRODUCTION
Standards are an important part of health care and have taken a new prominence in the trend to
address quality of care issues. Standards are important because they are the vehicle by which the
organization translates quality into operational terms and they also allow the organization to
measure its level of quality. Development of standards is a necessary precondition to improve
and sustain quality nursing care. A standard serves to establish norms and states what level of
performance is required to obtain a specific desired outcome. Standards provide protection to the
public by having criteria against which products and the performance of the practitioners can be
assessed. Standards of practice help identify the actual competencies required by the nurses in
routine normal practice. Standards influence the efficiency and effectiveness of performance,
enhance the accountability and ability to assess the performance and improve patient outcome
and satisfaction. Standards should be based on available infrastructure, resources, economic and
social conditions.
MEANING OF STANDARD
The dictionary meaning of standard is: standard is the level of quality or achievement. Another
meaning of standard is, required or agreed level of achievement.
Standard is a measure to serve as a basis of comparison.
In the word STANDARD each letter stands for:
S- Successful termination of helping relationship for client.
T- To have clear idea or conception of the distinct goal, nursing the patient and health needs of
society.
A - Assertive planning.
N - Nature of client-nurse interaction.
D - Directing others.
A - Analytical thinking.
R - Respect status and policies.
D - Data collection in accordance with goal.
DEFINITION OF STANDARD
A definition by WHO “Standard is a benchmark of achievement which is based on a desired
level of excellence.
Definition by Gillies, D.A. Standard can be defined as a descriptive statement of desired level of
performance against which the quality of structure, process or outcome can be judged.
“A standard is the desirable and achievable level of performance against which actual practice is
compared”.
A standard is an authoritative statement that sets out the legal and professional basis for nursing
practice.
A standard is a model of established practice that is commonly accepted as correct.
2. DEFINITION OF NURSING STANDARD
Nursing care standard is a descriptive statement of desired quality against which to evaluate
nursing care given to a patient or group of patients.
Nursing standards can be defined as statements that describe the desirable and achievable level
of performance expected of registered nurses in their practice, against which actual performance
can be measured, and serve as a guide to the professional knowledge, skills, and judgment
needed to practice nursing safely. The primary reason for having standards is to promote, guide,
direct and regulate professional nursing practice.
Nursing practice standards are the established criteria for the practice of nursing. A nursing care
standard is a descriptive statement of desired quality against which to evaluate nursing practice.
It is a guideline. A guideline is a recommended path to safe conduct and aid to professional
performance.
PURPOSE OF STANDARDS
The purposes of standards are:
1. To evaluate the quality of nursing practice in any setting.
2. To compare and improve the existing nursing practice.
3. To provide a common base for practitioners to coordinate and unify their efforts in the
improvement or practice.
4. To identify the element of independent function of nursing practices.
5. To provide a basis for planning and evaluating educational program for practitioners.
6. To inform society of our concern for the improvement of nursing practice.
7. To assist the public in understanding what to expect of nursing practice.
8. To assist the employers to understand what to expect of the practitioners.
9. To identify areas for developing core curriculum for practicing nurses.
10. To provide legal protection for nurses.
CHARACTERISTICS OF STANDARDS
The characteristics of standards are:
a. Objective, acceptable, achievable and flexible.
b. Must be framed by the members of the nursing profession.
c. Should be phrased in positive terms like good, excellent, etc.
d. Must be understandable and unambiguous.
e. Must be based on current knowledge and scientific practice.
f. Must be reviewed and revised periodically.
BENEFITS OF NURSING STANDARDS
Standards
Provide an essential key to organization development.
Provide legislation for controlling quality.
Provide means for systematic nursing care.
Promote better understanding among patient, nursing personnel and other health care
professionals.
Help in delivering quality patient care.
Enable achievement of better cost-effectiveness in delivery of care.
3. Pave a Code of Practice which establishes good practice in all field
CLASSIFICATION OF STANDARDS
Standards can be classified and formulated into different types of standards used to direct control
nursing actions:
According to the frames of references: These standards are used to direct and control nursing
practice.
A. STRUCTURE STANDARD
B. PROCESS STANDARD
C. OUT COME STANDARD
A. STRUCTURE STANDARD: The structure is related to the frame work that is care
providing system and resources that support for actual provision of care. They include
physical facilities, policies, goals, objectives, number of staff, type of training,
equipment, supplies, administrative set up, budgeting.
The use of standard based on structure implies that if the structure is adequate, reliable
and desirable standard will be met for quality care will be given.
B. PROCESS STANDARD: Process standards describe the behaviors of the nurse at the
desired level of performance. The criteria that specify desired method for specific
nursing intervention are process standards. A process standard involves the activities
concerned with delivering patient care. These standards measure nursing actions or lack
of actions involving patient care. The standards are stated in action verbs which are in
observable and measurable terms e.g.,
The focus is on what was planned, what was done and what was communicated or
recorded. Therefore, the process standards assist in measuring the degree of skill, with
which technique or procedure was between nurse and client.
In process standard, there is an element of professional judgment, i.e., determining the
quality or the degree of skill. It includes nursing care techniques, procedures, regimens,
process and recording etc.
C. OUT COME STANDARD: Descriptive statement of desired patient care results are
outcome standards because patient’s results are outcome of nursing interventions. Here,
outcome as a frame of reference for setting of standard refers to description of the results
of nursing activity in terms of the change that occur in the patient health status. This
change may be due to nursing care, medical care or as a result of variety of services
offered to the patient. Outcome standards reflect the effectiveness and results rather than
the process of giving care. These are related to patient health status, self care ability,
morbidity and mortality status, occurrence of complication, restoration of functions and
change in practices of health personnel.
Second classification of standards may be Normative and Empirical Standards.
NORMATIVE STANDARDS: These standards are descriptive of practices, which are
considered ideal by authority. These standards describe highest quality of practices. For
example, standards set by professional bodies e.g. set standards for the recruitment of
nurses working in any setting.
4. EMPIRICAL STANDARDS: These standards are description of practices which are
actual practice in large number of settings and which are agreed upon and achievable. For
example, standards set by law enforcement bodies and regulatory bodies.
The normative standards describe a higher quality of performance than empirical standards.
Generally professional organization ANA, TNAI promulgate normative standards where as
regulatory bodies INC, MCI promulgate empirical standards.
Standards can also be divided into End and Means Standards
END STANDARDS: These are patient oriented; they describe the change as desired in a
patient’s physical status or behavior.
MEANS STANDARDS: These are nursing oriented; they describe the activities and
behavior to achieve ends standards.
PROCESS OF SETTING STANDARDS
The major components of setting standards are:
1. COLLECTIVE JUDGMENT
2. VALUE BASED
3. DYNAMIC VS. STATIC
1. COLLECTIVE JUDGMENT: In health care, standards are developed and maintained
based on collective judgments. These include both organization and management and
standards for clinical/professional practice. The professional groups involved in the
delivery of health care must be the major determinants of their own professional practice
standards. Since hospitals are comprised of many professionals working together to
deliver patient care, it stands to reason that these professional should plays a major role in
determining the standards for organization, management and delivery of care with in the
hospital.
2. VALUE BASED ASSESSMENT: Standards are set to reflect value. In forming the
standards:
Care must be taken both to ascertain the individuals and society’s values which should
underlying them and then to reflect these values in the standards themselves.
Standards should be based on the responsibility to achieve maximum effectiveness of
area of service delivery through appropriate and efficient use of resources.
3. DYNAMIC VS. STATIC : In the mind of many, standards are seen to be something
which once they are set, is carved in stone. Yet, the contrary is actually true. Standards
are in fact, dynamic in nature and should change to reflect change in the collective
judgment about something or about values placed on it. Within health care, standards
may change due to change in technology, professional practice, economic conditions,
consumer expectations, treatment modalities and life expectations. Thus, after standards
are set, evaluation for their relevance and applicability must commence. If these are not
satisfactory, the standards must be revised, and the process of evaluation begins again.
STEPS OF STANDARD FORMULATION
The steps of standard formulation can be formulated as follows:
Organize in to small groups of nurses who work in the same field and meet periodically.
5. Decide on the area of nursing for which you want to work out standards.
Review philosophy, purpose and objectives of the institution.
Review existing nursing care practices, nursing process and identify your client for
nursing service, client’s role and strategies for nursing care services.
Write the statement considering all the frame of reference giving rationale and criteria in
assessment indicators see that the standards are relevant.
Discuss them with nursing service administrators to get their approval.
Device a method for determining achievement of standards. It may be through the use of
criteria checklist for making observation of care given, examining records, self evaluation
checklist, patient’s opinion etc.
Try out the standards to determine the feasibility.
The standards are put into practice and quality care is audited.
Update the standards periodically.
LEVELS OF NURSING STANDARDS
MINIMUM STANDARDS: Representing a level of acceptability below which, in the eyes of
those judging, lies the unacceptable, are the minimum standards.
OPTIMUM STANDARDS: Representing a degree of excellence which may only be achieved by
those who desired and determined to do so.
For example, in a hospital the minimum standard for nosocomial infection may be 7-10 per cent.
Anything above 10 per cent is unacceptable whereas the desired is 3 per cent.
SOURCES OF NURSING CARE STANDARDS
The standards should be based on agreed up achievable level of performance considered proper
and adequate for specific purpose. The standards can be established, developed, reviewed or
enforce by variety of sources as follows:
Professional organization e.g. T.N.A.I., A.N.A. etc.
Licensing body’s e.g. statutory bodies like INC, MCI, etc.
Health institutions / health care agencies.
Department of institutions e.g. nursing department.
Patient care units, e.g. I.C.U.
Government health department at national, state and local level.
Individual’s e.g. personal standards.
FOCUS OF STANDARDS
Most of the health care standards existing today focus on two aspects.
Organization and Management Standards of Health Care
Clinical Practice Standards
a. ORGANIZATION AND MANAGEMENT STANDARDS: This standard tends to address
the ability of the health care facility to deliver quality care or service.
b. CLINICAL PRACTICE STANDARDS: This standard describes the precise nature of what
should be delivered. Practice standards are formulated by individual professional groups
who work within health care facilities and generally are used to guide those professionals
in ideal way to carry out patient care responsibilities given certain sets of circumstances
and patient diagnosis.
6. USES OF STANDARDS
Within health care setting, the standards are used in evaluation process:
A. Self Assessment
B. Inspection
C. Accreditation
A. SELF ASSESSMENT: Self assessment implies to be the evaluation of one’s own
performance. In this process, standards may be set by oneself or in collaboration with an
outside agent and then one evaluates how were the standards met or not met. It can be
tremendously valuable in learning experience, especially if there is commitment to
analyzing honestly the strength as well as weakness in performance.
B. INSPECTION: The second evaluation activity which may involve standards is the
inspection. Inspection usually implies some sort of official examination. With in health
care we generally think of inspections as being done by government agents. Those who
inspect most often have a conferred power to do so, which is generally derived from
some form of legislation. These inspections should also have concomitant power to
impose penalty in case of lack of compliance with standards. Inspection is generally not
voluntary and certainly is often fraught with negative connotations in the eyes of those
being inspected. Experience shows us that the standards that are used in the inspection
process may frequently not be determined in consultation with those who will be judged
against them. Care must be taken, that standards should be made jointly. It should be a
joint process.
C. ACCREDITATION: The meaning of accreditation is a process where in standards are set
and compliance with them is measured. The setting of the standards is done through a
consultative process in which consensus among those who will use them is sought
regarding the appropriate level of standards and how compliance with standards will be
judged. Standards are subjected to periodic and ongoing review to ensure their continued
appropriateness. The accreditation process also involve periodic visit from an accreditor
or an accreditation team, which comprise of trained and selected peers who will visit a
facility and determine level of compliance with standards. They may also provide advice
if required and usually visit in three years.
BARRIER AND CONSTRAINTS IN DEVELOPMENT OF STANDARDS FOR
NURSING PRACTICE
I. Related To Policies:
Absence of laid down standards for nursing practice.
Lack of written policies.
Lack of clear cut specific job descriptions.
Lack of political and professional will and support to improve standards.
Absence of policy for having nurses with specialty training to work in specialty care units.
I. Related To Manpower:
Inadequate nurse-patient ratio
Lack of awareness of the concept of standards, sensitivity to the need of standards in nursing
practice.
Lack of supervision and monitoring of nursing services.
7. Inadequate job descriptions.
Lack of adequately prepared nurse administrators for planning and organizing the nursing
services.
Lack of strategies for regular updating of knowledge and skills.
II. Related To Material Resources:
Lack of equipment and supplies to provide even basic nursing care.
Low quality equipment and supplies.
Lack of training in handling various equipments and resources.
Lack of maintenance and replacement of damaged or condemned equipments.
III. Related To Physical Set Up:
Inappropriate and inadequate physical set up of the hospital.
Shortage of water and electricity supplies, inappropriate drainage and waste disposal facilities.
IV. Related To Finance:
Uncertainty for commitment of adequate financial support for development and implementation
of standards for nursing practice at various levels.
REVIEW OF STANDARDS
It is very necessary to review the standards time to time for:
To remove obsolete and unnecessary practices.
To practice according to the new scientific and technological developments.
For patient safety.
LEGAL SIGNIFICANCE OF STANDARDS
Standards of care are very important. Standards of care are guidelines by which nurses should
practice. If nurses do not perform duties within accepted standards of care, they may place
themselves in jeopardy of legal action. Malpractice suit against nurses are based on the charge
that the patient was injured as a consequence of the nurses failure to meet the appropriate
standards of care.
To recover from a charge of malpractice, a patient must prove that:
A nurse patient relationship existed such that the nurse owed to the patient a duty of due care.
The nurse deviated from the appropriate standards of care.
The patient’s damages resulted from the nurses deviations from the standard of care.
ROLE OF NURSE ADMINISTRATORS IN DEVELOPING STANDARDS
The expert committee of the WHO project in India which was conducted in RAKCON, in 1999,
on development of standards for nursing practice had discussed the role of nurse administrators
in developing standards for nursing practice.
The role of nurse administrators in developing nursing practice standards are:
Initiator: Creates awareness or sensitizes the nurses at first and second level leadership
positions on nursing standards.
Facilitator: She facilitates to develop, implement, monitor and evaluate standards for
nursing practice at all times. Make provision for necessary infrastructure for developing,
implementing, maintenance, monitoring of standards for nursing practice.
8. Forms a core group for developing, implementing, monitoring and maintaining standards
for nursing practice.
Assures on the job-orientation and in-service education to enhance implementation and
monitoring of standards for nursing practice.
Ensures auditing and reviewing of standards for nursing practice.
Educator: She as an educator
Gives orientation to nursing personnel regarding the need for standards of nursing
practice.
Stimulates and motivates the nurses to implement and maintain standards of nursing
practice.
Trains core group to develop, implement, monitor, maintain and evaluate the standards
for nursing practice.
Evaluator: She as an evaluator
Monitors the implementation of standards for nursing practice.
Evaluates the auditing and reviewing process for updating standards of nursing practice.
CONCLUSION
All health care providers will be required to identify standards and show how their own input is
related to achievement of the standards. Nurses will find it necessary to set realistic standards of
nursing care and utilize effective quality control and evaluation methods to ensure that the
standards are achieved and if not, show that appropriate action was taken to change the standard
or change the care to achieve it.
RESEARCH ARTICLES
Westra, B.L. et al. “Nursing Standards to Support the Electronic health record”. Nursing
Outlook. September-October, 2008. 56 (5). Page No. 258-265.
Quality and low cost health care that is free of medical mistakes requires continuity of person-
centric health care information across the life span and health care settings. Interoperable clinical
information systems that rely on the use of multiple standards to support health information
exchange and, in particular, nurse sensitive data, information, and knowledge are key
components to support high quality, safe care. A 2004 Executive order called for a national
health information network and the widespread adaptation of electronic health records (EHRs)
by 2014. While there are numerous standards influencing the exchange of health data, the
primary focus of this article is to synthesize the state-of-the-art in nursing standardized
terminologies to support the development, exchange, and communication of nursing data.
Research exemplars are described for information systems to supports nursing practice using
standardized terminologies and secondary use of standardized nursing data from EHRs for
knowledge development.
Little, B.B. “The use of standards for peer review of online nursing courses: a pilot study”.
Journal of Nursing Education. July, 2009. 48 (7). Page No. 411-415.
This article describes a pilot study on the use of online course standards for peer review of Web-
based nursing courses. A peer review team consisting of a nurse educator and an instructional
designer piloted the use of two sets of online course standards in two RN-to-baccalaureate
nursing course. The college of public health online course standards and the quality matters peer
course review Rubric were used to review the courses. The standards facilitated the peer review
process and supplied important criteria for measuring the quality of the courses. Analysis of the
9. Rubric scores revealed trends in criteria not met in either course, indicating the need for
educational program improvement and faculty training. The quality matters tool had more
consistent results among peer reviewers and was perceived as easier to use. So the quality
matters standards provided a useful mechanism for benchmarking against higher education
courses throughout the United States.
Miola, J. “Negligence and the legal standard of care: what is reasonable conduct”?. British
Journal of Nursing. June, 2009. 18 ( 12). Page No. 756-757.
Medical negligence has become a big issue for medical Practioners. Fear of the law, and of
litigation, has led to clams of defensive medical practice among doctors and nurses. At the heart
of this lies the legal definition of the standard of care, where the law seeks to determine when
conduct is ‘reasonable’ or ‘unreasonable’. In this article the author clarifies what the law means
by ‘reasonableness’ with respect to nurses, drawing on both the law and the NMC Code.
Furthermore, the article shall demonstrate that the law is not something to be fearful of but,
rather, demands a standard no higher than that of the NMC.
BIBLIOGRAPHY
Nicholls M.E. and Wessells V.G. Nursing standards and Nursing Process. U.S.A. 1977.
Contemporary Publishing, Inc. Wakefield, Massachusetts.
Jernigan, D.K. and Young, A.P. Standards, Job Descriptions, and Performance Evaluations for
Nursing Practice. USA. 1983. Appleton-Century-Crofts. Page No. 9-27.
Basavanthappa, B.T. Nursing Administration, 1st Edition, New Delhi. 2008. Jaypee Brothers
Medical Publishers Private Limited. Page No. 432-449.
RAK College of Nursing. Report on Development of Standards for Nursing Practice. New
Delhi.1999. Ministry of Health and Family Welfare.
Sansburg, R.C. and Swansburg, R.J. Introduction to management and leadership for nurse
managers, Canada, 2002, Jones and Bartlett Publishers, Page No. 520-522.
Gillis, D.A. Nursing management a Systems Approach. U.S.A. 1982. W.B. Saunders company,
1982. Page No. 97-107.
Heidemann, E.G. The Contemporary Use of Standards in Health Care. Geneva.1993. W.H.O.
Page No. 1-30.
Little, B.B. “The use of standards for peer review of online nursing courses: a pilot study”.
Journal of Nursing Education, July, 2009. 48 ( 7 ). Page No. 411-415.
Miola, J. “Negligence and the legal standard of care: what is reasonable conduct”?. British
Journal of Nursing. June, 2009. 18 ( 12). Page No. 756-757.
Westra, B.L. et al. “Nursing Standards to Support the Electronic health record”. Nursing
Outlook. September-October, 2008. 56 (5). Page No. 258-265.
Soni, M. “A study to assess the knowledge and practice of nursing personnel on standards of
nursing practice for selected nursing activities (Thermoregulation and orogastric feeding) with a
view to develop and evaluate the effectiveness of manual on standards of nursing practice in
neonatal care unit for these selected nursing activities in selected hospitals of Delhi”
Unpublished Master of Nursing Thesis, R.A.K. College of Nursing, University of Delhi, May
1999.
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10. EXAMPLE
Standards for nursing practice
Standard Ref. No. - 1
Topic : Basic Nursing care
Subtopic : Eat and drink adequately
Care Group : Hospitalized patients
Unit/Ward : Orthopedic ward
Standard Statements : All Hospitalized patients will receive adequate fluid and nutrition
Prepared By : Professional Organizations
Standard implemented by : Nursing personnel
Standard Audited By : NS/DNS
Standard reviewed By : Committee
STRUCTURE GUIDELINES
The structure guidelines for helping patients eat and drink adequately are:
a. Assess fluids nutritional needs of patient.
b. Evaluate patient’s environment:
Need for privacy
c. Assess patients readiness to eat
Need for oral care
General hygienic needs
Elimination needs
d. Assess patients ability to eat or need for assistance to take food.
e. Assist with oral hygiene and washing hands.
f. Provide water, soap, and towel for patients hand and face, if needed.
g. Serve prescribed diet.
h. Encourage patient to do as much as possible for self.
i. Remove tray when patient has finished meals.
j. Record amount and type of food consumed.
k. Record intake in intake/output chart.
l. Record any untoward response to diet.
m. Educate patient/relative regarding prescribed diet.
STRUCTURE PROCESS OUTCOME
S1. Nurse with adequate
knowledge on fluid and
nutritional needs of patients.
P1. Nurse assesses fluid and
nutritional needs of patients.
O1. Patient take adequate
amount and type of food and
fluid.
S2. Nurse possess adequate
skill in meeting fluid and
nutritional needs of patients.
P2. Nurse identifies and set priority
in meeting fluid and nutritional
needs.
O2. Patient does not have
any untoward response after
eating.
S3. Devices for serving food
and assisting in eating/feeding
are available in the unit.
P3. Nurse explains the importance of
eating appropriate diet to patient /
family.
O3. Patient express
satisfaction with the food.
11. S4. Diet as per nutritional
needs of the patient is available
from hospital/home.
P4. Prescribed diet is arranged and
served appropriately.
O4. Patient / relatives
describe appropriate diet
required for him / her.
S5. Diet charts for different
disease condition are available
in the unit or therapeutic diet
charts are available.
P5. Nurse documents quantity of
fluid and food intake.
O5. Amount and type of
fluid and food intake and
any untoward response if
any is recorded correctly.
S6. Structure guideline is
available in the unit.
P6. Any untoward response such as
dislike, nausea, vomiting, gastric
discomfort or diet is documented
and reported by the nurse.
P7. Nurse takes remedial action for
any untoward response.
CHECKLIST ON MEETING FLUID AND NUTRITIONAL NEEDS OF PATIENT
Objective: To assess skill of nurses in meeting fluid and nutritional needs of patient.
S.No
.
Activities Yes No
1. Nutritional need assessed.
2. Identified and prioritized the nutritional need.
3. Explained the need of well balanced diet/diet as prescribed for
specific disease condition.
4. Well balanced diet/prescribed diet provided.
5. Remedial action taken for untoward response if any.
6. Amount of food and fluid intake recorded.
7. Documented and reported any untoward response to diet.
AUDIT FORM
Audit objective: Do all hospitalized patients will receive adequate fluid and nutrition.
TARGET METHOD CODE
NO.
AUDIT CRITERIA YES/NO
Nurse Ask S1 Does the nurse have required level of
knowledge to assess nutritional status of
the patients?
Nurse Ask and
Observe
S2 Does the nurse have the skill to assess
nutritional needs?
Ward Ask and
Observe
S3 Are proper devices available for serving
and eating food?
Ward Observe S4 Is diet available as per the nutritional
need from hospital/home?
Ward Ask and
Observe
S5 Are diet charts for different conditions
available?
Ward Observe S6 Is structured guideline available?
Nurse Observe P1 Dose nurses assess nutritional needs of
12. patients?
Nurse Ask and
Observe
P2 Does nurse prioritize dietary needs?
Patient Ask P3, O4 Does the patient/relative understand the
need of well balanced diet/prescribed
diet?
Patient Observe and
Ask
P4 Does patient receive the prescribed diet
in clean utensils as per meal schedule?
Nurse Check record P5,O5 Dose nurse record the food and fluid
intake?
Nurse Check record P6,O5 Are untoward responses recorded by
nurse?
Patient Observe and
Ask
O1 Does patient take adequate and
appropriate nutrition?
Patient Observe and
Ask
O2 Does patient experience any discomfort
after eating?
Patient Observe and
Ask
O3 Does patient express satisfaction with
the food?
PATIENT SATISFACTION DATA
INSTRUCTIONS:
Please tick mark ( ) against each of the following items in the column provided.
Satisfied : If the patient is completely satisfied with the nursing care and has no complaints, or
problems then give three score.
Partially Satisfied : If the patient is fairly satisfied with the nursing care and has some complaints
give score two.
Not satisfied : If the patient is not satisfied with nursing care and has number of complaints give
score one.
S.
No.
Statements Satisfied
(3)
Partially
(2) Satisfied
(1) Not
Satisfied
1. Did the nurse assess and prioritize nutritional
needs?
2. Did diet available as per the nutritional needs?
3. Did you receive your food as per diet schedule?
4. Did the nurse provided proper clean utensils for
the serving and eating food?
5. Did your food was adequate and appropriate
according to your nutritional needs?
6. Did you satisfy with your food?
7. Did the nurse record food and fluid intake and
untoward response of food?
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