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 nation’s growth & development directly proportionate with national values,

scientific & technical strength vis-à-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, it’s 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 institution’s 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 institution’s mission clearly defines its purpose within the context of higher
education and explains whom the institution serves and what it intends to accomplish.
The institution’s 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 institution’s mission and goals are available and accessible. In the context
of the institution’s mission, the effective and efficient uses of the institution’s resources
are analyzed as part of ongoing outcomes assessment.

Standard 4: Leadership and Governance:

The institution’s 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 institution’s administrative structure and services facilitate learning and
research/scholarship, foster quality improvement, and support the institution’s
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 institution’s goals for students.

Standard 10: Faculty:

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

Standard 11: Educational Offerings

The institution’s 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 institution’s 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 institution’s 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 sub-committees.

 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 criteria during inspection and for accreditation:

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 criteria–with regard to pregnant women–One, 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 student’s 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 and institutionalize into hospital functioning.
 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. Patient’s
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:

 Website:
1. http://www.naac.gov.in/fees.asp
2. http://www.dpb.cornell.edu/IP_A_Process.htm
3. http://personal.babelred.com/ahe---access-to-indian-higher-
education/categoria.asp?idcat...
4. http://www.scribd.com/doc/28214701/Function-of-State-Nursing-Council
5. http://www.scribd.com/doc/36390273/Indian-Nursing-Council
6. https://docs.google.com/viewer?
a=v&pid=explorer&chrome=true&srcid=1EAnQEasp3uGX6w1u4Lt2LRTN_Se_ei-
UyLl0TUDHS8-7CRJ9YizLqwZZ1LwK&hl=en
7. http://www.dpb.cornell.edu/IP_A_Standards.htm
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9. http://www.naac.gov.in/criteria.asp
10. http://www.naac.gov.in/assessment.asp
11. http://www.naac.gov.in/committees.asp
12. http://www.4cpl.com/NABH-National-Accreditation-Board-for-Hospitals-
Healthcare-cert...
13. http://www.indianhealthcare.in/index.php?
option=com_content&view=article&catid=122...
14. http://www.qcin.org/nabh/hospitat_accre/nabh_stand.php
15. http://www.medicalnomad.com/Accreditation.jsp
16. http://cyberlectures.indmedica.com/show/110/1/National_Accreditation_Board_fo
r_Hosp...
17. http://cyberlectures.indmedica.com/show/110/2/National_Accreditation_Board_fo
r_Hosp...
Education plays a vital role in the growth and progress of the society vis-à-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.