Development and Maintenance of Standards and

Accreditation in Nursing Education Programs:

Introduction:
India has a glorious past with enrichment of traditional learning
being regarded as the best pursuit (search) of the mankind. Education
imparts knowledge and skills, provides values and shapes attitudes.
Universities and Institutions are the places for wisdom of knowledge
and pursuit of excellence.
A nations growth & development directly proportionate with
national values, scientific & technical strength vis--vis industrial
temperament and development created through overall quality &
standard of University education provided by eminent and well reputed
teachers followed by internationally comparable & competitive quality
tools in the form of powerful infrastructure & facilities. For that there is
requirement of maintenance of standards, its done by different
councils, boards and universities.
Nursing education programs
accredited by Gujarat University, Indian nursing council and state
nursing council.

Accreditation:
Definition:
Accreditation refers to a voluntary review process of educational
programs by a professional organization. The organization called an
accrediting agency, is invited to compare the educational quality of
the program with established standards and criteria.
The concept of accreditation of educational program in nursing is
very important. Employers are only interested in hiring nurses who are
graduates of accredited program. Accreditation has four major
purposes which include the following:

Maintenance of adequate admission requirement.

Maintenance of minimum academic standards.
Stimulation of instructional self improvements.
Protection of instructions of higher education against
educationally and socially harmful pressures.

Accrediting agencies have been largely responsible for the

development and maintenancy of minimum academic standards and
quality of instructions of higher learning. Accrediting organizations in
higher education are generally classed in to three types:
i. National accrediting agency
ii. National professional accrediting agency
iii. State accrediting bodies
1. National Accrediting Agency:
National accrediting agencies are concerned with appraising the
total activities of the institution of higher learning and with
safeguarding the quality of liberal education, the foundation of
professional programs in colleges and universities. Nursing colleges is
affiliated with the university which accredited by University Grants
Commission and National Assessment and Accreditation Council.
The University Grants Commission (UGC) of India is a statutory
organization set up by Union government in 1956, for the
coordination, determination and maintenance of standards of
university education. It provides recognition for universities in India,
and provides funds for government-recognized universities and
colleges.
The NATIONAL ASSESSMENT AND ACCREDITATION COUNCIL
(NAAC) is an autonomous body established by the University Grants
Commission (UGC) of India to assess and accredit institutions of
higher education in the country.
characteristics of accreditation:
characteristics of accreditation are as follows:
a.) its prevailing sense of volunteerism
b.) its strong tradition of self-regulation
c.) its reliance on evaluation techniques
d.) its primary concern with quality
Criteria for Assessment

Any assessment and subsequent accreditation is made with

reference to a set of parameters so that the standing of an institution
can be compared with that of other similar institutions. NAAC has
identified the following seven criteria to serve as the basis of its
assessment procedures:

 Curricular Aspects
Teaching-Learning and Evaluation Research,
Consultancy and Extension
Infrastructure and Learning Resources
Student Support and Progression
Governance and Leadership
Innovative practices
During The Survey In The Particular Department They Are
Evaluated Following Areas:
Administration
Collections/Holdings
Personnel
Financial Support
Services and Use
Physical Facilities

Standards of Accreditation:

Compliance with each of the 14 standards and with the standards

as a whole requires interpretation by evaluators. Each standard should
be interpreted and applied in the context of the institutions mission and
purposes.

 Standard 1: Mission, Goals, and Objectives

Standard 2: Planning, Resource Allocation, and Institutional Renewal
Standard 3: Institutional Resources
Standard 4: Leadership and Governance
Standard 5: Administration
Standard 6: Integrity
Standard 7: Institutional Assessment
Standard 8: Student Admissions
Standard 9: Student Support Services
Standard 10: Faculty
Standard 11: Educational Offerings
Standard 12: General Education
Standard 13: Related Educational Activities
Standard 14: Assessment of Student Learning
Standard 1: Mission, Goals, and Objectives:
The institutions mission clearly defines its purpose within the
context of higher education and explains whom the institution serves
and what it intends to accomplish. The institutions stated goals and
objectives, consistent with the aspirations and expectations of higher
education, clearly specify how the institution will fulfill its mission. The
mission, goals, and objectives are developed and recognized by the
institution with its members and its governing body and are utilized to
develop and shape its programs and practices and to evaluate its
effectiveness.

Standard 2: Planning, Resource Allocation, and Institutional

Renewal:
An institution conducts ongoing planning and resource allocation
based on its mission and uses the results of its assessment activities
for institutional renewal. Implementation and subsequent evaluation of
the success of the strategic plan and resource allocation support the
development and change necessary to improve and to maintain
institutional quality.

Standard 3: Institutional Resources:

The human, financial, technical, physical facilities, and other
resources necessary to achieve an institutions mission and goals are
available and accessible. In the context of the institutions mission, the
effective and efficient uses of the institutions resources are analyzed
as part of ongoing outcomes assessment.

Standard 4: Leadership and Governance:

The institutions system of governance clearly defines the roles of
institutional constituencies in policy development and decision-making.
The governance structure includes an active governing body with
sufficient autonomy to assure institutional integrity and to fulfill its
responsibilities of policy and resource development, consistent with the
mission of the institution.

Standard 5: Administration:

The institutions administrative structure and services facilitate

learning and research/scholarship, foster quality improvement, and
support the institutions organization and governance.

Standard 6: Integrity:
In the conduct of its programs and activities involving the public
and the constituencies it serves, the institution demonstrates
adherence to ethical standards and its own stated policies, providing
support to academic and intellectual freedom.

Standard 7: Institutional Assessment:

The institution has developed and implemented an assessment
plan and process that evaluates its overall effectiveness in: achieving
its mission and goals; implementing planning, resource allocation, and
institutional renewal processes; using institutional resources efficiently;
providing leadership and governance; providing administrative
structures and services; demonstrating institutional integrity; and
assuring that institutional processes and resources support appropriate
learning and other outcomes for its students and graduates.

Standard 8: Student Admissions:

The institution seeks to admit students whose interests, goals,
and abilities are congruent with its mission.

Standard 9: Student Support Services:

The institution provides student support services reasonably

necessary to enable each student to achieve the institutions goals for
students.

Standard 10: Faculty:

The institutions instructional, research, and service programs are
devised, developed, monitored, and supported by qualified
professionals.

Standard 11: Educational Offerings

The institutions educational offerings display academic content,
rigor, and coherence that are appropriate to its higher education
mission. The institution identifies student learning goals and
objectives, including knowledge and skills, for its educational offerings.

Standard 12: General Education

The institutions curricula are designed so that students acquire
and demonstrate college-level proficiency in general education and
essential skills, including oral and written communication, scientific
and quantitative reasoning, critical analysis and reasoning,
technological competency, and information literacy.

Standard 13: Related Educational Activities:

Institutional programs or activities that are characterized by
particular content, focus, location, mode of delivery, or sponsorship
meet appropriate standards.

Standard 14: Assessment of Student Learning

Assessment of student learning demonstrates that the
institutions students have knowledge, skills, and competencies
consistent with institutional goals and that student at graduation have
achieved appropriate higher education goals.

Process for Accreditation:

NAAC has formulated a three stage process for assessment
and accreditation as given below:

The First-Step: Institutional Eligibility for Quality Assessment

(IEQA): In the first step of Assessment and Accreditation,
Institutional Eligibility for Quality Assessment (IEQA) is required to
be obtained by an applicant institution at the beginning, while it is
still in the planning stage for assessment. The benefits of this step
for an applicant institution are:
To get recognized as eligible to apply for the second step
comprehensive Assessment and Accreditation process;
To get feedback from NAAC if it does not qualify in the first
step, about specific improvements to be made for reaching
the required quality level
To receive assistance and suitable mentoring from NAAC in
the latter case, for enabling it to qualify for IEQA in due course
of time.

Preparation of the Self-Study Report by the institution, its

submission to NAAC and in-house analysis of the report by NAAC.

 Peer Team Visit to the institution for validation of the Self-Study

Report followed by presentation of a comprehensive assessment
report to the institution.

Grading, Certification and Accreditation based on the

evaluation report by the peer team, the final decision given by the
Executive Committee of the NAAC.

Committees of NAAC:
NAAC functions through its General Council (GC) and Executive
Committee (EC) and other academic, advisory and administrative subcommittees.

Benefits of Accreditation
Helps the institution to know its strengths, weaknesses and
opportunities through an informed review process.
To identify internal areas of planning and resource allocation.
Enhances collegiality on the campus.
Outcome provides funding agencies objective data for performance
funding. Initiates institutions into innovative and modern methods of
pedagogy.
Gives institutions a new sense of direction and identity. Provides
society with reliable information on quality of education offered.
Employers have access to information on the quality of education
offered to potential recruitees.

 Promotes intra and inter-institutional interactions.

2. National Professional Accrediting Agency:
Professional accrediting is supported by state licensure laws.
Indian nursing council (INC) is the official accrediting agency for all
programs of nursing, which include diploma in nursing, basic and post
basic B.Sc. nursing, M.Sc. and PhD in nursing. An accredited program
voluntarily adhere, to standards thus protect, the quality of education,
public safety and the profession itself.
The Indian Nursing Council is a statutory body constituted
under the Indian Nursing Council Act, 1947. The Council is
responsible for regulation and maintenance of a uniform standard of
training for Nurses, Midwives, Auxillary Nurse-Midwives and Health
Visitors. Amongst other things, the Council is empowered to make
regulations for:
Prescribes the standard curricula for the training of nurses,
midwives and health visitors; and for training courses for
teachers of nurses, midwives and health visitors, and for training
in nursing administration.
Prescribes conditions for admission to above courses.
Prescribes standard of examination and other requirements to be
satisfied for securing reorganization.
Accreditation provides stimulus for programs to initiate periodic
self examination and self improvement. It assures the 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

Criteria or standards are established in each area, programs

under review prepare reports, than show how school or collage met
each criticism. Once accredited and in good standing, continuing
accreditation review take place every 8 years or 5years. The 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 specific time.
INC seen following
accreditation:

criteria

during

inspection

and

for

1.

Building School/College of Nursing Building

a. Running the nursing educational institution in rented building
affects quality in nursing education programme. It is therefore; it is
compulsory that nursing programmes should be started in their
own building. Institutions, which are functioning in rented building,
should ensure within the period of 2 years they should construct
their own building.
b. Minimum 3 acres of land is required to start nursing school/college
subject to the conditions that they have minimum 54470 sq. ft.
constructed area.

2.

Admission criteriawith regard to pregnant womenOne, of the

admission criteria for B. Sc (N) and P. B. Sc (N) programme is that the
candidate Should produce medical fitness certificate before joining the
course.

3.

Stay of students in the Hostel:

a. Provision of having hostel accommodation is compulsory for the
institution. However, Principal has the discretion to decide about
the students stay in the hostel or be made as day scholar.

4.

Teaching faculty:
a. It is mandatory to have a nursing teaching faculty irrespective of
nursing specialty as a guide from the same college for M. Sc (N)
programme. However a co-guide may be from outside the college
but should be within the city.
b. Many of the teaching faculties are leaving the institution during the
middle of the academic year, which affects the implementation of
curriculum and students will be put into inconvenience. It is,
therefore, in case teachers who will be leaving in middle of the

academic year such teaching faculty should be brought under the

disciplinary action by the State Nursing Council and also they may
be considered for withdrawal of license after following due
procedure.
5.

Clinical facilities:
a. 1:5 student patient ratio to be maintained
b. Minimum 300 bedded Parent/affiliated hospital is required to start
College of Nursing.
c. Minimum 200 bedded Parent/affiliated hospital is required to start
School of Nursing.

6.

Number of seats:
a. Maximum number of 100 seats can be sanctioned to those
institutions which are having 500 bedded Parent Hospital/ Parent
Medical College, provided that they have Physical and Teaching
facilities as per Indian Nursing Council norms.
b. Maximum number of 60 seats can be sanctioned to those
institutions, which are having less than 500-bedded Parent/
affiliated hospital, provided that they are having physical and
teaching facilities as per Indian Nursing Council norms.

7.

Institutions which are found Unsuitable consecutively three times,

their Compliance report should be submitted through State
Government & State Nursing Council.

8.

Up gradation of School of Nursing to College of Nursing:

a. To upgrade School of Nursing to College of Nursing essential
certificate for B. Sc (N) course is not essential, as they already
posses essential certificate for School of Nursing. However, the
private institutions has to produce document with regard to
resolution of the management for upgrading the School of Nursing
into College of nursing and creating the additional teaching position
as per Indian Nursing Council norms for the College of Nursing.

9.

Registration of Additional qualification:

a. State Nursing Registration Council should register additional
qualification like P B B.
Sc (N), M.Sc. (N) One-year specialty course prescribed by Indian
Nursing Council etc. The original Registration Number will remain
the same. Only the additional qualification will be added.

National Accreditation Board for Hospitals & Healthcare

Providers (NABH)
Introduction:
National Accreditation Board for Hospitals & Healthcare Providers
(NABH) is a constituent board of Quality Council of India, set up to
establish and operate accreditation programme for healthcare
organizations. The board is structured to cater to much desired needs
of the consumers and to set benchmarks for progress of health
industry. The board while being supported by all stakeholders including
industry, consumers, government, has full functional autonomy in its
operation. Currently it accredits Hospitals & Nursing homes, and is
expected to accredit ate Blood Banks, Diagnostic Centers (Imaging),
Dental Centers and Ayurvedic Hospitals/ Clinics in future.

Cardinal principles of assessment are:

Hospital operations are based on sound principles of system
based organization
NABH standards are implemented
hospital functioning.

and

institutionalize into

Patient safety and quality of care, as core values, are established

and owned by management and staff in all functions and at all
levels.
There is structured quality improvement programme based on
continuous monitoring of patient care services.
NABH Standards for Hospitals:
NABH Standards for hospitals, 2nd Edition, November 2007 has
been released. This standard has been accredited by International
Society for Quality in Healthcare (ISQua). The approval of ISQua
authenticates that NABH standards are in consonance with the global

benchmarks set by ISQua. The hospitals accredited by NABH will have

international recognition. This will provide boost to medical tourism.
The standards provide framework for quality assurance and
quality improvement for hospitals. The standards focus on patient
safety and quality of care. The standards call for continuous monitoring
of sentinel events and comprehensive corrective action plan leading to
building of quality culture at all levels and across all the functions.
Patient Centered Standards:
Access, Assessment and Continuity of Care (AAC)
Care of Patients (COP)
Management of Medication (MOM)
Patient Rights and Education (PRE)
Hospital Infection Control (HIC)
Organization Centered Standards:
Continuous Quality Improvement (CQI)
Responsibilities of Management (ROM)
Facility Management and Safety (FMS)
Human Resource Management (HRM)
Information Management System (IMS)

Benefits of NABH Accreditation:

Benefits for Patients:

Patients are the biggest beneficiary among all the stakeholders.

Accreditation results in high quality of care and patient safety. The
patients are serviced by credential medical staff. Rights of patients
are respected and protected. Patients satisfaction is regularly
evaluated.
Benefits for Hospitals:
Accreditation to a hospital stimulates continuous improvement. It
enables Hospital in demonstrating commitment to quality
community Confidence in the services provided by the hospital. It
also provides opportunity to healthcare unit to bench.
Benefits for Hospital Staff:
The staff in an accredited hospital is satisfied lot as it provides for
continuous learning, good working environment, leadership and
above all ownership of clinical processes. It improves overall
professional development of Clinicians and Para Medical Staff and
provides quality improvement with medicine and nursing.
Benefits to paying and regulatory bodies:
Finally, accreditation provides an objective system of
empanelment by insurance and other third parties. Accreditation
reliable and certified information on facilities, infrastructure and
level of care.

Committees of NABH Accreditation:

NABH has on its panel, qualified and trained assessors for
objective evaluation of hospitals. The assessment team will include two
or more healthcare professionals. The team will comprise of clinicians,
healthcare administrators, nursing supervisors, specialists (where
required) depending on the size and scope of services being rendered
by hospitals. For example in a team having two assessors, one will be
clinician and one hospital administrator. The team of three or more

assessors will comprise amongst clinicians, administrators, nursing

supervisors, specialists (where required).

Criteria for NABH Assessors:

For clinician: MBBS with 10 years of experience of which 5 years
should be in a hospital
For
administrator:
PG
in
Management
or
Hospital
Administration with minimum of 10 years of experience of which
5- years being in the hospital administration.
For Nursing assessor: B. Sc. / M. Sc. Nursing with 10 years of
experience or diploma in general nursing and midwifery with 15
years of experience. In both the cases, minimum of 5 years
experience should be in supervisory capacity in a hospital.
The persons having credentials, as above would need to
qualify in 5 days NABH assessors training programme. NABH
would conduct these programmes as per schedule published from
time to time. The successful candidates from the training
programme would be formally empanelled with NABH as per
criteria of registration.
Assessment Process in general:

Accreditation is a voluntary process. Its standards are usually

regarded as optimal and achievable. It provides a visible commitment
by an organization to improve the quality of patient care, to ensure a
safe environment and to continually work to reduce risks to patients
and staff. Accreditation has gained worldwide attention as an effective
quality evaluation and management tool.

Ten steps to accreditation:

Obtain copy of NABH standards Step
Carry out self assessment on status of compliance with the NABH
standards.
Identify gap areas and prepare action plan to bridge the gaps.
Ensure that NABH standards are implemented and integrated with
hospital functioning.
Obtain copy and submit application form for assessment.
Pay the accreditation fee.

 Receive from NABH the assessment programme including dates and

names of assessors.
Facilitate the assessment.
Receive recommendation on accreditation.
Maintain quality improvement programme based on continuous
monitoring of patient care services.
Bibliography:
Books:
1. Basvanthappa B. T., Nursing Education;2nd edition; Jaypee
Brothers publication; New Delhi; Pp:649, 837-838
2. Basvanthappa B. T., Nursing Administration;2nd edition; Jaypee
Brothers publication; New Delhi; Pp:

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Education plays a vital role in the growth and progress of the society
vis--vis the nation and is recognized as an important aspect of human
capital building either in areas of Arts, Science & Technological human
innovation. or in human capital strength or stocks determining speed
of absorbing Arts, Science & Technology and related areas followed by
inculcation of continuous knowledge and information working as a
newly understood asset.