CLASS PRESENTATION ON DEVOLOPMENT

AND MAINTANENCE OF STANDARDS AND

ACCREDITATION IN EDUCATION PROGRAMS

SUBJECT: NURSING EDUCATION

UNIT XV

SUBMITTED TO SUBMITTED BY
Dr .K LALITHA DONA J XAVIER
PROFESSOR- DEPT. OF NSG I ST YR MSC NSG
NIMHANS NIMHANS

1
2
INTRODUCTION
Nursing Professional Development practice and standards has been
experiencing major changes in the last 10 years .During this time, we have seen
an escalation of online education, an expanded target audience, and increased
expectations for metrics and measurable outcomes. We have also seen changing
expectations for competency and patient safety, and the overall impact of
globalization, generational, and cultural diversity, creating a dynamic practice
and learning environment. Consequently, a new set of scope and standards
needed to be developed that could provide not only current but also future
direction
STANDARDS
Standards are professionally developed expressions of the range of acceptable
variations from a norm or criterion"-AvedisDonabedian.
Standards may be also defined as "Benchmark of achievement which is based
on a desired level of excellence.
NURSING STANDARDS
It is a set of guidelines for providing high quality nursing care and criteria for
evaluating care. Such guidelines help assure patients that they are receiving
high-quality care. The standards are important if a legal dispute arises over the
quality of care provided a patient.
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 2003)
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 the 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. If 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.

3
IMPORTANCEOF NURSING STANDARDS

It 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.

INPUT -THROUGHPUT- OUTPUT MODEL

INPUT THROUGHPUT
OUTPUT

FEEDBACK

A new framework was created which attempted to operationalize the former

domain model as a professional development system with inputs, throughputs,
outputs, that would be inclusive of all domains. This model accommodates all
practice and learning environments, and all settings and modes of learning. It
reflects the flexibility, diversity, and dynamic aspects in nursing specialty. The
specialist may function in one or more of the major throughput processes of the
practice, and may move in and out of the roles over time.

INPUT:Inputs include raw material, energy and resources processed to produce

the outputs of the system. Examples include information, money, nurses' effort,
physician's time, fuel, energy, time, individual effort, & any raw material of that
kind. This may be humans, material, equipment, etc.

THROUGHPUT:Throughput is the processes used by the system to convert

raw materials or energy (inputs) from the environment into products orservices

4
that are usable by either the system itself or by the environment. Examples
include, thinking, physical examination of patients, diagnosing,planning,
decision-making, writing prescription, taking vital signs, operating on a patient,
constructing, sorting, sharing information, meeting in groups, discussing,
shaping, hammering, etc.
OUTPUT: Output is the product or service which results from the system's
throughput or processing of technical, social, financial & human input.
Examples include health services, better health, decisions, laws, rules, money,
assistance, etc.
FEEDBACK:It is the information about some aspect of data or energy
processing that can be used to evaluate & monitor the organization& to guide it
to more effective performance. How many patients were are seen in 2 hours
clinic? How man medical errors were committed in a hospital? Why were
mistakes made?etc.

EXAMPLE: Below is the conceptual model developed by Asplin et al that

applies operations management concepts to patient flow within the acute care
system.

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 clients 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.

5
ANA Standards of professional performance.

Standards Definition Measurement criteria

I: quality of practice The registered nurse 1. Demonstrates quality by

systematically enhances the documenting the application
quality and effectiveness of of the nursing process in a
nursing practice 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 1. Participates in ongoing

and competency that reflects educational activities related
current nursing practice to clinical knowledge and
professional issues.

2.Demonstrates commitment

6
 to lifelong 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 The nurse evaluates ones 1.Engage in self-evaluation

practice evaluation own nursing practice in on a regular basis
relation to professional
practice standards and guide 2.Seeks constructive
line, relevant statutes, rules feedback regarding ones own
and regulations. 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 1.Shares knowledge and
contribute to the professional skills with peers and
development of peers and

7
 other health care providers as colleagues
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 1.Communicates with the

patient, family, and others in patient, significant others,
the conduct of nursing and health care providers
practice regarding patient care and
nursings 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

8
 effect change and generate
positive outcomes

4.Document referrals,
including provisions for
continuity of care, as needed

VI: Ethics The nurse integrates ethical 1.Practice is guided by code

provisions in all areas of of ethics for nurses with
practice 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 1.Utilize best available

research findings in practice evidence including research
findings to guide practice
decisions

2.Participates in research
activities as appropriate to the
nurses education and
position such as the

9
 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 The nurse considers factors 1.Evaluates factors related to

utilization related to safety safety, effectiveness,
effectiveness, cost, and availability and cost when
impact on practice in the practice options would result
planning and delivery of in the same expected patient
nursing services. 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

10
 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 1. Engages on team work.

in the professional practice
setting and the profession 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

11
 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.

ANA Standards of practice

Standard Measurement criteria

I. Assessment 1. Collects data in a systematic and ongoing

process.
The nurse collects
comprehensive data pertinent 2. Data collection involves the patient,
to the patients health or significant others, and health care
situation 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

12

2. Diagnosis: The nurse
analyses the assessment data to
determine the diagnoses or
issues
3.Outcomes identification:
The nurse identifies expected
outcomes for a plan
individualize to the patient or
the situation
5. Document relevant data in a retrievable
form
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
1. Derives 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
13
 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 1. The plan is individualized to the patient

develops a plan that prescribes
strategies and alternatives to
attain expected out comes
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 1.Interventions are consistent with the

14
 established plan of care
The nurse implements the 2.Implements interventions in a safe and
identified plan of care 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

CONCLUSION

Nursing Standards of Professional Performance describe the roles of all

professional nurses which each nurse has to follow. There are many other
responsibilities that are hallmarks of professional nursing. Thus nurses should
be self-directed and purposeful in seeking necessary knowledge and skills to
enhance their 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 nurses professionalism. Nurses trust ANA because of our dedication to
standards, guidelines, and principles. It works hard to elevate the nursing
profession by defining the values and priorities for registered nurses across the
nation. Through this work, ANA can provide direction to nurses across the
nation, influence legislation, and implement a framework to objectively
evaluate nursing excellence.

ACCREDITATION OF EDUCATIONAL PROGRAMMES

Educational accreditation is a type of quality assurance process under which
services and operations of educational institutions or programs are evaluated by
an external body to determine if applicable standards are met. If standards are
met, accredited status is granted by the appropriate agency.

The concept of accreditation of educational programs in nursing is very

important. It predominantly focus whether the programs\institutions have met

15
certain predetermined qualifications and standard. It refers to a voluntary review
process of educational programs by a professional organization and the
organization is called an accrediting agency.

Accrediting is carried on mainly by voluntary organization.Although these

organizations are advisory in nature and do not have legal power to control
institutions of higher education, they do not exert much influence. Accrediting
agencies have been largely responsible for the development and maintenance of
minimum academic standards and quality of instructions of higher learning

Accreditations has four major purposes which include the following:

Maintenance of adequate admission requirements

Maintenance of minimum academic standards

Stimulation of institutional self-improvement

Protection of institutions of higher education against educationally and

socially harmful pressures

Accreditation is vital for the welfare of the institution of higher education.

Those institutions that fail to attain accreditation or removed from the list of
accrediting agency may be handicapped in a number of ways. For example, an
institution of higher learning that is not accredited by an accrediting agency,
may find difficulty in getting grants from the foundation in government sector.
Graduates from unaccredited professional programs in medicine, nursing,
veterinary medicine, law etc and certain other professional programs find it
difficult to obtain state licensure to practice that profession. Thus it becomes
vital important to the institutions and to the society that colleges and universities
attain and maintain standards that will make institutions of higher learning
eligible for accreditation.

Accrediting organizations in higher education are generally classed into 3 types

National accrediting agency

National professional accrediting agency

State accrediting bodies

16
NATIONAL AGENCIES

National accrediting agencies are concerned with appraising the total activities
of the institutions of higher learning and with safeguarding the quality of liberal
education. Each agencies establishes criteria for evaluation of institutions in its
region .It also reviews those institutions periodically and it publishes from time
to time a list of those agencies which it has accredited

India has the following educational councils:

Central educational board of education

All India council for elementary education

All India council for secondary education

University grants commission

All India council for technical education

National assessment and accreditation council

NATIONAL PROFESSIOANAL ACCREDITING AGENCY

Professional accrediting is supported by state licensure laws. Individuals who

hold a common body of knowledge and who have a desire to attain high
vocational status tends to form a professional organization. These professional
group aims to foster research, to improve service to the public and the number
of individuals admitted to the profession. Controlling admission is vital for a
professional group particularly in the early stages when the professional is
struggling for a status. Thus professional groups tend to restrict admissions
through state licensure laws and through the accreditation of colleges and
universities which offer the program.

In India, particularly in the field of health, national professional accrediting

agencies are :

Medical council of India

Indian nursing council

Dental council of India

17
 Pharmacy council of India

Central council of Indian system of medicine

Indian nursing council is the official accrediting agency for all programs of
nursing, which include diploma(GNM), BSc, post BSc, MSc\M Phil and PhD
(doctoral programs in nursing).

Accreditation of nursing schools and colleges in India grew out of concern

repeatedly expressed by the members of profession about the quality and
standards of nursing profession. An accredited programme voluntarily adhere to
standards, thus protect the quality of education, public safety and the profession
itself. Accreditation provides both mechanism and stimulus for the programs, to
initiate self-examination and self-improvement. It assures students that their
educational program is accountable for offering quality education for future
practice. Areas generally scrutinized in accreditation review are administration
and governance, finances and budget, faculty, students, curriculum and
resources.

Programs that do not meet standards, may be placed on warning and given a
specific time period to correct deficiencies. Accreditation can be withdrawn if
deficiencies are not corrected within the specified time.

STATE ACCREDITING BODIES

Within the higher education community, state regulatory agencies are also
involved in institutional oversight. State accrediting agencies are responsible for
determining educational quality within the state. State regulatory agencies are
responsible for granting the legal authority for institutions to operate in their
states and for consumer protection matters. Providing appropriate accrediting
criteria, enhancing services to its members, promoting quality standards, and
promoting ethical nursing practices are key accreditation services provided by
state accrediting bodies.

CONCLUSION

Accreditation is a deliberate and thorough process that strive towards

institutional enhancement. Accrediting agencies assess compliance with
published administrative and academic standards and seek a continuous striving
for excellence on the part of the institutions they accredit. As such, the
18
accrediting agencies serve students, society, higher education, as well as their
accredited institutions and entities by striving to ensure academic excellence
and ethical standards.

BIBLIOGRAPHY

1. Barbara Kozier, Glenora ERB, fundamentals of nursing, concepts process and

practice, seventh edition, Pearson education.

2. F.Saxton, Mosbys comprehensive review nursing, fourteenth edition, Mosby

publications.

3.BT.Basavanthappa, textbook of nursing education,

Jaypee publication, page: 255 -258
4. http://www.acics.org/accreditation/content.aspx?id=1916

5. http://eab.state.wi.us/resources/accreditation-difference.asp

6. http://www.wiche.edu/knowledge/14295

19