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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.


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)


IMPORTANCE 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


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

Cont……………d :

Cont……………d Legal reinforcement of professional standards. Creation of subculture. 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 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


Cont……….d 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 .

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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. 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

Professional standard & nursing process :

Professional standard & 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 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.

Standard of professional performance:

Standard 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:

ANA Standards of professional performance Standards Definition Measurement criteria 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.

cont…..d :

cont…..d 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.


Cont………d 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


Cont……..d 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


Cont..d 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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VII: Research 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

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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

Standard of care :

Standard 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.

Code of ethics :

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  :

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

Objective :

Objective 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 :

Characteristics of standard care Dynamic Reflects Changes Not Static

Brief description of methods and procedure :

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.


CONT…………D 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.


CONT……….D 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


CONT…..D 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.


CONT…..D 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.

Professional Responsibilities :

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


Cont……..d Unity Setting standards Planning individual patient care Monitoring and evaluating patient and environment

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