INTRODUCTION

Nursing is a career that combines

scientific principles and
technical skills to achieve quality care.
For a nurse to be effective
within a dynamic complex health care
system and to help clients
achieve outcomes, nurses need to be
knowledgeable, resourceful
and able to work well with other health
care practitioners. This goal
is achieved through nursing education.
Nursing education is an
important and integral activity that
demands a thorough and
objective evaluation of its processes and
product. Nursing education
consist of a variety of disciplines engaging
in a variety of activities
carried out by a variety of staff in
varied settings. The disciplines
involved are nursing and midwifery, but
within these main groups
there are numerous sub-groupings such
as psychiatric nursing,
accident and emergency nursing, intensive
care nursing, to mention
but a few. Activities of nurse education
range from the formal
academic type of teaching to the
impromptu teaching and learning
that occurs spontaneously in the day-
to-day work. The formal
academic nurse education leads to a range
of academic awards like
diploma of higher education, bachelor’s
degrees, postgraduate
diplomas, master’s degrees and
research degree at master’s and
doctoral levels.
Nurse education comes under the
umbrella of post secondary
education and the principles of this
education are based upon the
theory and practice of adult learning
with instrumental curricula
whose purpose is the production of a
nursing work-force that is
equipped to deal with the demands of
the needs of their service
recipients (Quinn, 2001).
INTRODUCTION
Nursing is a career that combines
scientific principles and
technical skills to achieve quality care.
For a nurse to be effective
within a dynamic complex health care
system and to help clients
achieve outcomes, nurses need to be
knowledgeable, resourceful
and able to work well with other health
care practitioners. This goal
is achieved through nursing education.
Nursing education is an
important and integral activity that
demands a thorough and
objective evaluation of its processes and
product. Nursing education
consist of a variety of disciplines engaging
in a variety of activities
carried out by a variety of staff in
varied settings. The disciplines
involved are nursing and midwifery, but
within these main groups
there are numerous sub-groupings such
as psychiatric nursing,
accident and emergency nursing, intensive
care nursing, to mention
but a few. Activities of nurse education
range from the formal
academic type of teaching to the
impromptu teaching and learning
that occurs spontaneously in the day-
to-day work. The formal
academic nurse education leads to a range
of academic awards like
diploma of higher education, bachelor’s
degrees, postgraduate
diplomas, master’s degrees and
research degree at master’s and
doctoral levels.
Nurse education comes under the
umbrella of post secondary
education and the principles of this
education are based upon the
theory and practice of adult learning
with instrumental curricula
whose purpose is the production of a
nursing work-force that is
equipped to deal with the demands of
the needs of their service
recipients (Quinn, 2001).
Nursing is a career that combines
scientific principles and
technical skills to achieve quality care.
For a nurse to be effective
within a dynamic complex health care
system and to help clients
achieve outcomes, nurses need to be
knowledgeable, resourceful
and able to work well with other health
care practitioners. This goal
is achieved through nursing education.
Nursing education is an
important and integral activity that
demands a thorough and
objective evaluation of its processes and
product. Nursing education
consist of a variety of disciplines engaging
in a variety of activities
carried out by a variety of staff in
varied settings. The disciplines
involved are nursing and midwifery, but
within these main groups
there are numerous sub-groupings such
as psychiatric nursing,
accident and emergency nursing, intensive
care nursing, to mention
but a few. Activities of nurse education
range from the formal
academic type of teaching to the
impromptu teaching and learning
that occurs spontaneously in the day-
to-day work. The formal
academic nurse education leads to a range
of academic awards like
diploma of higher education, bachelor’s
degrees, postgraduate
diplomas, master’s degrees and
research degree at master’s and
doctoral levels.
Nursing is a career that combines
scientific principles and
technical skills to achieve quality care.
For a nurse to be effective
within a dynamic complex health care
system and to help clients
achieve outcomes, nurses need to be
knowledgeable, resourceful
and able to work well with other health
care practitioners. This goal
is achieved through nursing education.
Nursing education is an
important and integral activity that
demands a thorough and
objective evaluation of its processes and
product. Nursing education
consist of a variety of disciplines engaging
in a variety of activities
carried out by a variety of staff in
varied settings. The disciplines
involved are nursing and midwifery, but
within these main groups
there are numerous sub-groupings such
as psychiatric nursing,
accident and emergency nursing, intensive
care nursing, to mention
but a few. Activities of nurse education
range from the formal
academic type of teaching to the
impromptu teaching and learning
that occurs spontaneously in the day-
to-day work. The formal
academic nurse education leads to a range
of academic awards like
diploma of higher education, bachelor’s
degrees, postgraduate
diplomas, master’s degrees and
research degree at master’s and
doctoral levels.
Nursing is a career that combines
scientific principles and
technical skills to achieve quality care.
Nursing is a career that combines
scientific principles and
technical skills to achieve quality care.
Nursing is a career that combines
scientific principles and
technical skills to achieve quality care.
Nursing is a career that combines
scientific principles and
technical skills to achieve quality care.
QUALITY ASSURANCE IN NURSING
Introduction
Quality assurance (QA) / Total Quality Management (TQM) is an essential part of health care and nursing
education system that serves as a mechanism for effective monitoring of patient care provided by health
care professionals using cost-effective resources. While many nurses are familiar with the words "Quality
Assurance", most are not directly involved in the process, because of increased requirements for licensure
and accreditation, and an increased desire for cost-containment; but they are active participants in quality
assurance programs.

QA Programme will help to improve the quality of nursing care and professional development including
nursing education. QA Programme ensures the standards of quality based on ‘‘ANA Standards of Nursing
Practice’’ as a device within the contemporary health care system. Nurses are the active participant of
interdisciplinary quality improvement team and also contribute innovations and improvement of patient
care, participating in improvement projects and patient safety initiatives. ICE and CNE are essential for an
update of professional knowledge and thereby QA in comprehensive nursing care. Quality assurance
system motivates nurses to strive for excellence in delivering quality care and to be more open and flexible
in experimenting with innovative ways to change outmoded systems.

Meaning of Quality Assurance in nursing

1. QA is a systematic and continuous process of establishing a target degree of excellence to ensure
that each patient receives agreed upon nursing care, and also to review, analyze, & evaluate the
compliance with standards set at local, national and international level.

2. QA is the maintenance of a desired level of quality in a service or education, especially by means of

attention to every stage of the process of delivery or production.
3. QA is a systematic review of educational programs to ensure that acceptable standards of
education, scholarship and infrastructure are being maintained.
 Purposes of Quality Assurance in nursing
1. To ensure the delivery of quality nursing care or nursing education

2. To demonstrate the efforts of health care providers to provide the best possible results

3. Formulate plan of nursing care or teaching learning

4. Attend the patient’s / student’s physical and non-physical needs

5. Evaluate achievement of nursing care / teaching learning activities

6. Support delivery of nursing care with administrative and managerial services

 7. effective monitoring of patient care / teaching learning activities using cost-effective resources

8. QA helps in defining different level of health care / teaching learning

9. QA helps in determining the level of degree to which standards of health care / teaching learning
are maintained

Approaches to Quality Assurance

There are two major categories of approaches exist in quality assurance. They are; General approach and
Specific to quality assurance in health care institutions (hospitals and nursing educational institutions).
1. General approaches to quality assurance : there are three major ways we regulate our profession, its
members, and their performance, namely; (1) licensure, (2) certification, and (3) accreditation. The
differences among these processes can be confusing. They have different purposes, unique philosophies,
and diverse legal standings.

a) Licensure: is an official permission or permit to do, use, or own something (as well as the
document of that permission or permit). In particular, a license may be issued by authorities, to
allow an activity that would otherwise be forbidden. For example; MNC Mumbai.
A registered nurse (RN) is individually licensed in a particular by testing that validates she/he has
acquired the basic knowledge required for safe practice. Licensure does not purport to do more
than that. The philosophy is one of protecting the client, public, from harm. This testing aims to
eliminate those not qualified for minimal safe performance.

b) Certification: Nurse Certification, like licensure for RNs, involves individual testing, in this case
testifying to status achieved by a nurse in some given specialty. Most certification programs are
limited to nurses but there are some certificates program open to health or human services
professionals from diverse fields. Almost all graduates of nursing want the status afforded by
certification. However, unlike licensure, it is up to the individual to decide whether or not to take a
certification exam. Although many jobs open to nurses holding desired certifications, the
certification process is voluntary.

c) Accreditation (external Audit):  the accreditation evaluates and judges institutions (hospitals or
educational institutions) rather than individuals. Most accreditation programs testify to the
institution's achievement, rather than merely guaranteeing safety. Accreditation, like nurse
certification, is voluntary. For hospitals, ‘’Joint Commission on Accreditation of Healthcare
Organizations’’ (JCAHO) is the accreditation body whereas for nursing, our chief accrediting body
over the years has been the ‘’National League for Nursing’’ (NLN).
However, in India, the hospitals need to be accredited voluntarily by National Accreditation Board
for Hospitals & Healthcare Providers (NABH) New Delhi; and, the educational institutions need to
be accredited by National Assessment and Accreditation Council (NAAC) Bangalore.

National Accreditation Board for Hospitals  & Healthcare Providers (NABH): is a constituent board
(formed 2005) of Quality Council of India (QCI), set up to establish and operate accreditation
program for healthcare organizations/hospitals. Benefits of NABH are; patients, staff and hospital.
 Patients are the biggest beneficiaries. Accreditation results in high quality of care and
patient safety. The patients get services by credential medical staff. Rights of patients are
respected and protected. Patient satisfaction is regularly evaluated.
 The Staff in an accredited hospital are 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 nurses and Paramedical staff and provides
leadership for quality improvement within medicine and nursing.
 Accreditation to a Hospital stimulates continuous improvement. It enables hospital in
demonstrating commitment to quality care. Raises community confidence in services
provided by the hospital.
National Assessment and Accreditation Council  (NAAC): It was established in 1994 as an
autonomous institution of the University Grants Commission (UGC) with its head quarter in
Bengaluru. The prime agenda of NAAC is to assess and accredit institutions of higher learning and
helping them to work continuously to improve the quality of education. Benefits of NAAC are –

 Helps the institutions to know strengths & weaknesses through an informed review

 Identifies internal areas of planning and resource allocations

 Initiates institution into innovative and modem methods of pedagogy

 Given the institution a new sense of direction and identity

 Provides society with reliable information on quality of education offered by institution

  Employers have access to information on standards in recruitment

 Promotes intra-institutional and inter-institutional interactions

2. Specific approaches (Internal Audit) : can be explained under tow categories. They are; (A) Peer review
as per ANA Standards, and (B) Internal Audit / Internal Quality Assessment Cell (as a tool for QA).

A. Peer review as per ANA Standards: Peer review is an evaluation of nursing care carried out by
one or group of nurses with equal status within the same institution who can expect to assess
quality of nursing services provided by the registered nurses. However, the services rendered by
the nurses are judged on the basis of ANA standards for Nursing Practice. They are –
Standard 1: The collection of data about health status of the patient is systematic and
continuous. The data are accessible, communicative and recorded.
Standard 2: Nursing diagnosis is derived from health status data.
Standard 3: The plan of nursing care includes goals derived from the nursing diagnoses.
Standard 4: The plan of nursing care includes priorities and the prescribed nursing
approaches or measures to achieve the goals derived from the nursing diagnoses.
Standard 5: Nursing actions provide for patient participation in health promotion,
maintenance, and restoration.
Standard 6: Nursing actions assist the patient to maximize his health capabilities.
Standard 7: The patient’s progress or lack of progress towards goal achievement is
determined by the patient and the nurse.
Standard 8: The patient’s progress or lack of progress towards goal achievement directs re-
assessment, re-ordering of priorities, new goal setting, and a revision of plan of nursing care.

B. Internal Nursing Audit / Internal Quality Assessment Cell (IQAC): Internal nursing audit may be defined
as a detailed review (scrutiny) and evaluation (appraisal) of selected clinical records in order to evaluate
the quality of nursing care and performance by comparing it with accepted standards. However, to
perform internal audit, every health care institute need to have a committee called, Internal Quality
Assessment Cell. The committee is formed by upper administration, and carried out by regular employees
of the organization. IQAC of the respective health care institute (hospital or educational institute) is
responsible for internal audit of nursing care / academic excellence to ascertain the quality in all
operations. Under IQAC, the following are carried out –
 Client care studies: there are usually of three types of audit; concurrent, retrospective and
prospective audit.
o Concurrent audit: is one in which the client care is observed and evaluated while the
client is receiving nursing care/ services in order to assess the quality of ongoing nursing
care is perceived by the clients.
o Retrospective audit: is one in which the client care is evaluated (in depth) after client
discharge from the hospital. Here, clients chart and profile is the main source of data.
o Prospective audit: attempts to identify how future performance will be affected by
current interventions / nursing services.
 Patient satisfaction survey / client opinion studies : the client is interviewed or they are given a
set of questions to answer in which the clients state how they experienced the hospital stay and
the services provided by the nursing personnel.
Process / Steps of Quality Assurance
1. Establishment of standards or criteria

2. Identify the information relevant to criteria

3. Determine ways to collect information

4. Collect and analyze the information

5. Compare collected information with established criteria

6. Make a judgment about quality

7. Provide information and if necessary, take corrective action regarding findings of sources

8. Determine ways to collect the information

  Factors affecting quality assurance in nursing care / nursing profession
 Lack of Resources and personnel problems / issues

 Absence of accreditation laws, and lack of policy and administrative manuals

 Lack of incident review procedures

 Lack of good hospital information system

 Lack of nursing care records

 Lack of good supervision and evaluation technique

 Absence of knowledge about philosophy of nursing care

 Sub-standard education and training

 Lack of written job description and job specifications

 Lack of in-service and continuing educational program