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Nursing Standards
Prepared by: Mr. Arun S Nadh,
MSc.Nursing, Manipal College of Nursing Manipal University
"Standards are
professionally developed expressions of the range of acceptable variations from
a norm or criterion"-Avedis Donabedian
Standards may be defined
as "Benchmark of achievement which is based on a desired level of excellence.
Criteria are
pre-determined elements against which aspects of the quality of medical service
may be compared.
What are Nursing
Standards?
All standards of practice
provide a guide to the knowledge, skills, judgment & attitudes that 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.(
Registered Nurses Association of BC (2003) & the College of Nurses of Ontario
(2002)
Why are Standards Important?
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Outlines what the profession expects of its
members.
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Promotes guides and directs professional nursing
practice – important for self-assessment and evaluation of practice by
employers, clients and other stakeholders.
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Provides nurses with a framework for developing
competencies
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Aids in developing a better understanding & respect for the various &
complimentary roles that nurses have. (
Registered Nurses Association of BC (2003) & the College of Nurses of Ontario
(2002) )
What is a profession?
Characteristics of a Profession according to
Houle (1980)
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Concept of mission open to change.
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Mastery of theoretical knowledge.
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Capacity to solve problems.
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Use of theoretical knowledge.
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Continued seeking of self-enhancement by its
members.
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Formal training.
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Credentialing system to certify competence.
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Creation of subculture.
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Legal reinforcement of professional standards.
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Ethical practice.
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Penalties against incompetent or unethical
practice.
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Public acceptance.
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Role distinctions that differentiate professional
work from that of other vocations and permit autonomous practice.
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Service to society.
Professionalization of nursing
Professionalization is the process by which an
occupation achieves professional status. The status of nursing as a profession
is important because it reflects the value society places on the work of nurses
and the centrality of this work to the good of society. a profession is
characterized by prolonged education that takes place in a college or
university. Values, beliefs, and ethics relating to the profession are an
integral part of the educational preparation. By definition, a professional is
autonomous in decision making and is accountable for his or her own actions.
Personal identification and commitment to the profession are strong, and
individuals are unlikely to change professions. In contrast, an occupation is
characterized by training that may occur on the job for varying lengths of time.
The training does not incorporate, as a prominent feature, the values, beliefs,
and ethics of the occupation. The workers are supervised, and ultimate
accountability rests with the employer. Thus commitment is not always strong,
and individuals often changes jobs (Chitty, 1993).
Professional nursing practice involves
“specialized skills essential to the performance of a unique, professional role”
the two main concepts that are in the forefront of professional nursing and its
services ideal are accountability and autonomy.
Accountability is the state of being responsible and answerable for one’s
own behavior. The sphere of a nurse’s accountability is to self, the client, the
employing agency, and the profession. The standards of clinical nursing practice
by ANA and standards of the various specialty nursing practices document the
professional nurse’s scope and limits of accountability. By virtue of these
standards, society holds nurses and those under their supervision
accountable for their actions.
Autonomy in nursing is the freedom and the
authority to act independently. It implies control over one’s practice, and it
applies to both decisions and actions.
An accountability based governance system is a
predominant feature of professional practice models. Responsibility and
authority are established in specified processes rather than in particular
individuals who, in turn, determine the placement of accountability. The nurse
is central to the organization and is supported by major service components such
as standards, quality assurance, continuing education, and peer process. Nursing
management has no legitimate role in practice-related decisions; rather,
management facilitates, integrates, and co-ordinates nursing operations to
support the practitioner.
Professional standards and nursing process
Professional standards ensure that the highest
level of quality nursing care is promoted. Excellent nursing practice is a
reflection of sound ethical standards. Client care requires more than just the
application of scientific knowledge. A nurse must be able to think critically,
solve problems, and find the best solution for client’s needs to assist clients
in maintaining, regaining, or improving their health. Critical thinking requires
the use of scientifically based and practice-based criteria for making clinical
judgments. These criteria may be scientifically based on research findings or
practice based on standards developed by clinical experts and quality
improvement initiatives.
Nursing profession and essential components
Nursing is a helping, independent profession that
provides services that contribute to the health of people. Three essential
components of professional nursing are care, cure and co-ordination. Caring
aspect is rational and requires as nurse to understand the patient’s needs at a
level that permits individualization of nursing therapies. To cure is to assist
patients in understanding their health problems and to help them to cope. The
cure aspect involves the administration of treatments and the use of clinical
nursing judgment in determining, on the basis of patient outcomes, whether the
plan is effective. Co-ordination of care involves organizing and timing the
medical and other professional and technical services to meet the holistic needs
of the patient. And often a patient requires many other services simultaneously
in order to be well cared for. A professional nurse also supervises, teaches,
and directs all of those involved in nursing care. So there are some guidelines
are essential to check how the nurses perform professionally and how they
exercise the care, cure and co ordination aspects of nursing. As an independent
profession, nursing has increasingly set its own standards for practice. This is
called standards of nursing care.
Clinical, administrative, and academic experts
have developed standards of nursing practice. The most widely accepted one is
American Nurses Association (ANA) 2004 within this document there are standards
of professional performance and standards of practice.
Nursing as a profession
Nursing is not simply a collection of specific
skills, and the nurse is not simply a person trained to perform specific tasks.
Nursing is a profession. No one factor absolutely differentiates a job or a
profession, but difference is important in terms of how nurse practice. When one
can say a person acts “professionally”, for example, we imply that the person is
conscientious in actions, knowledgeable in the subject, and responsible to self
and others.
As explained before a profession as have some
characteristics, one among this is the profession has a code of ethics and
standards.
Standards of Professional Performance
The ANA Standards of professional
Performance describes a competent level of behavior in the professional role,
including activities related to quality of care, performance appraisal ,
education, collegiality, ethics, collaboration, research, and resource
utilization, this document serves as objective guidelines for nurses to be
accountable foe their actions, their patients, and their peers . the standards
provide a method to assure clients that they are receiving high-quality care,
that the nurses know exactly what is necessary to provide nursing care, and that
measure are I n place to determine whether the care meets the standards.
ANA Standards of professional performance.
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Standards |
Definition |
Measurement criteria |
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I: quality of practice |
The registered nurse
systematically enhances the quality and effectiveness of nursing practice |
1. Demonstrates quality by documenting the
application of the nursing process in a responsible, accountable and ethical
manner.
2.Uses quality improvement activities to
initiate changes in nursing practice and health care delivery system
3.Uses creativity and innovation to improve
nursing care delivery
4. Incorporates new knowledge to initiate
changes in nursing practice if desired outcomes are not achieved.
5. Participates in quality improvement
activities. |
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II: education |
The nurse attains
knowledge and competency that reflects current nursing practice |
1. Participates in
ongoing educational activities related to clinical knowledge and
professional issues.
2.Demonstrates commitment
to life long learning
3.Seeks experiences to
maintain clinical skills
4.Seeks knowledge and
skills appropriate to the practice setting
5. Maintains professional
records that provide evidence of competency and lifelong learning.
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III:Professional practice
evaluation |
The nurse evaluates one’s own nursing practice
in relation to professional practice standards and guide line, relevant
statutes, rules and regulations. |
1.Engage in self evaluation on a regular basis
2.Seeks constructive feedback regarding ones
own practice
3.Takes action to achieve goals identified
during the evaluation process
4.Participates in systematic peer review as
appropriate
5.Practice reflects knowledge of current
practice standards, laws and regulations
6.Provides age appropriate care in culturally
and ethnically sensitive manner |
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IV: collegiality |
The nurse interacts with and contribute to the
professional development of peers and other health care providers as
colleagues |
1.Shares knowledge and skills with peers and
colleagues
2.Provides peers with feedback regarding their
practice
3.Interacts with peers and colleagues
4.To enhance ones own professional
nursing practice
5.Maintains compassionate and caring
relationships with peers and colleagues
6.Contributes to an
environment that is conductive to clinical education nursing students as
appropriate
7.Contributes to a
supportive and healthy work environment |
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V:Collaboration |
The nurse collaborates with patient,family,and
others in the conduct of nursing practice |
1.Communicates with the patient, significant
others, and health care providers regarding patient care and nursing’s
role in the provision of care
2.Collaborates with patient, family and others
health care providers in the formulation of overall goals and the plan
of care and in the decisions related to care and delivery of services
3.Partners with others to effect change
and generate positive outcomes
4.Document referrals, including provisions for
continuity of care, as needed |
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VI:Ethics |
The nurse integrates
ethical provisions in all areas of practice |
1.Practice is guided by
code of ethics for nurses with interpretive statement
2.Maintains therapeutic and professional
patient-nurse relationship
3. Delivers care in the manner of that
preserves patient autonomy, dignity, and rights.
4.Seeks available resourced in formulating
ethical decisions
5.Reports illegal, incompetent or impaired
practice
6. Maintain patient confidentiality within
legal and regulatory parameters. |
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VII:Research |
The nurse integrates
research findings in practice |
1.Utilize best available evidence
including research findings to guide practice decisions
2.Participates in research activities as
appropriate to the nurse’s education and position such as the following:
3.Identifying clinical problems suitable for
nursing research
a. Participating in data collection
b.Participating in a unit, organization, or
community research committee
c.Sharing research activities with others
conducting research
d.Critiquing research for application to
practice
e.Uses research findings in the development of
policies, procedures, and practice guidelines for patient care
f.Incorporates research as a basis for
learning |
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VIII:Resource utilization |
The nurse considers factors related to safety
effectieveness, cost, and impact on practice in the planning and delivery of
nursing services. |
1.Evaluates factors related to
safety,effectieveness,availability and cost when practice options
would result in the same expected patient outcome
2.Assists the patient and family in
identifying and securing appropriate and available services to address
health related needs
3.Assigns or delegates tasks as defined by the
state nurse practice acts and according to the knowledge and skills of the
designated care giver
4.Assigns or delegate tasks based on the needs
and condition of the patient, the potential for harm, the stability of the
patients condition, the complexity of the task, and the predictability of
the outcome
5.Assists the patient and family in becoming
informed consumers about the cost ,risks, and benefits of treatment and care
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IX: leadership |
The nurse provides
leadership in the professional practice setting and the profession |
1. Engages on team work.
2. Works to create and
maintain healthy work environments.
3. Teach others to
succeed through mentoring.
4. Exhibits creativity
and flexibility during change.
5. Directs coordination
of care across settings and care givers.
6. Serves in key roles in
the work settings by participating on committees, councils, and
administrative.
7. Promotes advancement
of the profession.
8. Display the ability to define a clear
vision, the associated goals, and a plan to implement and measure progress.
9. Demonstrates energy, excitement and a
passion for quality work.
10. Willingly accepts mistakes by self and
others, thereby creating a culture in which risk-taking is not only safe,
but expected.
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Standards of care
The standards of care in the ANA nursing: Scopes and Standards of practice
(2004) describe a competent level of nursing care. The levels of care are
demonstrated through the nursing process. The nursing process is the foundation
of clinical decision making and includes all significant actions taken by nurses
in providing care to clients. Within these are the nursing responsibilities for
diversity , safety, education, health promotion, treatment , self care, and
planning for the continuity of care. Standards of care are important if a legal
dispute arises over whether a nurse practiced appropriately in a particular
case.
ANA Standards of practice
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Standard |
Measurement criteria |
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I. Assessment
The nurse collects comprehensive data
pertinent to the patients health or situation |
1. Collects data in a systematic and ongoing
process.
2.Data collection involves the patient,
significant others, and health care providers, when appropriate
3.Priorities data collection activities based
on the patients immediate condition or needs determine the priority of data
collection
4.Collects pertinent data using appropriate
assessment techniques
5.Document relevant data in a retrievable form
|
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2. Diagnosis: The nurse analyzes the
assessment data to determine the diagnoses or issues |
1.Derives diagnoses from the assessment data
2. Validates the diagnoses with patient,
significant others, and health care providers ,when possible.
3.Documents diagnoses in a manner that
facilitates the determination of expected outcomes and plan of care |
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3.Outcomes identification:
The nurse identifies expected outcomes for a
plan individualize to the patient or the situation
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1.Derieves outcomes from
the diagnoses
2. Formulates outcomes
mutually with the patient and the health care providers, when possible.
3.Outcomes are culturally
appropriate and realistic in relation to the patients present and potential
capabilities
4.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.
5.Outcomes are attainable
in relation to resources available to the person
6. Outcomes include a
time estimate for attainment for expected outcome.
7.Outcomes provide
direction for continuity of care
8. Modifies expected
outcomes based on changes in the status of the patient or evaluation of the
situation.
9. Documents outcomes as
measurable goals. |
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4:Planning: The nurse develops a plan that
prescribes strategies and alternatives to attain expected out comes
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1.The plan is
individualized to the patient and patients condition or needs
2. Develops the plan with
the patient, significant others, and health care providers, when
appropriate.
3. 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.
4. Provides for
continuity within the plan.
5. Incorporates an
implementation pathway or timeline within the plan.
6. Utilizes the plan to
provide direction to other members of the health care team.
7. Defines the plan to
reflect current status , rules, and regulations and standards.
8. Integrates current
trends and research affecting care in the planning process.
9. Considers the economic
impact of the plan.
10. Uses standardized
language or recognized terminology to document the plan. |
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5:Implementation
The nurse implements the
identified plan of care
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1.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
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5A:Co-ordination of care
The registered nurse coordinates care
delivery
5B:Health teaching and
health promotion
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.
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.
6:Evaluation
The nurse evaluates
progress towards attainment of outcomes |
1.Coordinates
implementation of the plan.
2.Documentation of the
care.
1.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 .
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 fecilitates change.
1.prescribes
evidenced-based treatments , therapies, and procedures considering the
patient’s comprehensive health care needs.
2.presribes
phabmacological 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 !nd laboratory tests.
3.Evaluates therapeutic
and potential adverse effects and potential adverse effects of
pharmacological and non pharmacological treatmentc.
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.
1.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
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Code of ethics: Nursing has a code of ethics that defines the principles by
which nurse provide care to their clients. In addition, nurses incorporate their
own values and ethics into practice. The code of ethics for nurses with
interpretive statements provides a guide for carrying out nursing
responsibilities that provide quality nursing care and provides for the ethical
obligations of the profession.
Standard nursing care: An Asset
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In order to
ensure quality care the nursing care needs some standards. Standards are
degree of excellence. The aim of standard nursing care is to support and
contribute to excellent practices. The role of nurse is constantly
changing to meet the growing needs of health services.
Objectives
- Plan
- Holistic Approach
- Appropriate
Diagnosis
- Realistic Goal
- Selecting
Appropriate Media
- Quality Care rather
than quantity
- Economize Time,
Material, Energy
Types of standard care
- Structure -- Things
we use
- Process -- Things we
do
- Outcome -- The
result
Characteristics of standard care
- Dynamic
- Reflects Changes
- Not Static
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Brief description
of methods and procedure
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.
Standard:
Nursing practice requires that a conceptual model for nursing be the basis for
the independent part of that practice.
Elements:
Nurses are required to have clear idea or conception of the distinct goal
nursing, the patient, the health needs of the society, the source of client
difficulty, the focus, and modes of nursing intervention and the expected
consequences of nursing activities.
Standard:
Nursing practice requires the effective use of the nursing process.
Elements:
Nurses are required to collect data in accordance with their conception of the
goal of nursing, client, the source of client difficulty, the four and modes of
intervention conceptual models for nursing.
Standard:
Nursing practice requires that the helping relationship be the nature of client
nurse interaction.
Elements:
Nurses are required to increase the likelihood that the client will perceive the
health service experience as understandable, manageable and meaningful at the
outset.
Nurses are required to
ensure a successful termination of the helping relationship.
Standard:
Nursing practice requires nurses to fulfill professional responsibilities.
Elements:
Nurses are required to respect status and policies relevant to the profession
and the practice setting. Nurses are required to comply with the code of ethics
of their profession. Nurses are required to function as members of a health
team.
Standard in Nursing
Practice
Professional
Responsibilities
- Health team
member
- Ethics
- Policies
Conceptual
- Health needs of
society
- Nursing
intervention
Effective use of
nursing process
- Data collection
- Diagnosis
- Goal
- Intervention
- Evaluation
Unity
- Setting
standards
- Planning
individual patient care
- Monitoring and
evaluating patient and environment
- Co-ordinating
services to the patient.
CONCLUSION
“Nursing Standards of Care” pertain to
professional nursing activities that are demonstrated by the nurse through the
nursing process. These involve assessment, diagnosis, outcome identification,
planning implementation, and evaluation. The nursing process is the foundation
of clinical decision making and encompasses all significant action taken by
nurses in providing care to all consumers. While “Nursing Standards of
Professional Performance” describe the roles of all professional nurses, there
are many other responsibilities that are hallmarks of professional nursing.
These nurses should be self-directed and purposeful in seeking necessary
knowledge and skills to enhance career goals. Other activities-such as
membership in professional organizations, certification in specialty or advanced
practice, continuing education and further academic education, are desirable
methods of enhancing the nurse’s professionalism. Accountability for one’s
practice as a professional rests with the individual nurse.
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VOL. XCVIII No. 6
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