"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)
- Concept of mission open to change.
- Mastery of theoretical knowledge.
- Capacity to solve problems.
- Use of theoretical knowledge.
- Continued seeking of self-enhancement by its members.
- Formal training.
- Credentialing system to certify competence.
- Creation of subculture.
- Legal reinforcement of professional standards.
- Ethical practice.
- Penalties against incompetent or unethical practice.
- Public acceptance.
- 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.
Standards
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Definition
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Measurement criteria
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I: quality of practice
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The registered nurse systematically enhances the quality and effectiveness of nursing practice
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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
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The nurse attains knowledge and competency that reflects current nursing practice
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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
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The nurse
evaluates one’s own nursing practice in relation to professional
practice standards and guide line, relevant statutes, rules and
regulations.
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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
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The nurse
interacts with and contribute to the professional development of
peers and other health care providers as colleagues
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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
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The nurse collaborates with patient, family, and others in the conduct of nursing practice
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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
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The nurse integrates ethical provisions in all areas of practice
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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
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The nurse integrates research findings in practice
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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
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The nurse
considers factors related to safety effectiveness, cost, and impact on
practice in the planning and delivery of nursing services.
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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
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IX: leadership
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The nurse provides leadership in the professional practice setting and the profession
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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
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Measurement criteria
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I. Assessment
The nurse collects comprehensive data pertinent to the patients health or situation
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2. Diagnosis: The nurse analyzes the assessment data to determine the diagnoses or issues
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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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4:Planning: The nurse develops a plan that prescribes strategies and alternatives to attain expected out comes
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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
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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
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Structure -- Things we use
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Process -- Things we do
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Outcome -- The result
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
CONCLUSIONProfessional 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
- Coordinating services to the patient
“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.
REFERENCES
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Potter PA, Perry AG. Fundamentals of Nursing. 6th edn. Mosby ;st Louis.2005.
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Creasia J L, Parker B. Conceptual framework of professional practice.2nd edn. Mosby;St.Loius.1996.
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Hall JK. Nursing ethics &law. W.B Saunders company;Philadelphia.1996.
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Lillies C, Taylor C et al. Fundamentals of Nursing:
The art & science of nursing care. Lippincott publications;
Philadelphia.2005.
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Potter PA, Perry AG. Basic Nursing; Essentials for practice. 6th edn. Mosby ;st Louis.2007.
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Kockrow EO, Christensen BL. Foundatios of Nursing.4th edn.mosby.2003.
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Danasu R. Standard nursing care: An Asset. The Nursing Journal of India. June 2007. VOL. XCVIII No. 6.
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