Nursing Standards
Prepared by:
Mr. Arun S Nadh, MSN, Manipal College of Nursing, Manipal University
Last updated on
03/06/2009
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Introduction
"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?
-
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 & 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.
-
Use of theoretical knowledge.
-
Continued seeking of self-enhancement by its
members.
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Formal training.
-
Credentialing system to certify competence.
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Creation of subculture.
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Legal reinforcement of professional standards.
-
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.
-
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
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Definition
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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. |
|
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.
|
|
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 |
|
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 |
|
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 |
|
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. |
|
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 |
|
VIII: Resource utilization |
The nurse considers factors related to safety effectiveness,
cost, and impact on practice in the planning and delivery of nursing
services. |
1.Evaluates factors related to safety, effectiveness,
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
|
|
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. |
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
|
Standard |
Measurement criteria |
|
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
|
|
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 |
|
3.Outcomes identification:
The nurse identifies expected outcomes for a plan individualize
to the patient or the situation
|
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. |
|
4:Planning: The nurse develops a plan that prescribes strategies
and alternatives to attain expected out comes
|
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. |
|
5:Implementation
The nurse implements the identified plan of care
|
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 facilitates
change.
1.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.
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
|
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
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Plan
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Holistic Approach
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Appropriate Diagnosis
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Realistic Goal
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Selecting Appropriate Media
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Quality Care rather than quantity
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Economize Time, Material, Energy
Types of standard care
Characteristics of standard care
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Dynamic
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Reflects Changes
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Not Static
|
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
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Health team member
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Ethics
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Policies
Conceptual
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Health needs of society
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Nursing intervention
Effective use of nursing process
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Data collection
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Diagnosis
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Goal
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Intervention
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Evaluation
Unity
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Setting standards
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Planning individual patient care
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Monitoring and evaluating patient and environment
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Coordinating 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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