1

Tripura institute of paramedical sciences,

Nursing section

Subject: - Nursing education

Assignment on: - Development & maintenance of standards

& accreditation in nursing educational programme.

DATE OF SUBMISSION: 02/02/2024

SUBMITTED TO- SUBMITTED BY-

MS. RUPA GHOSH MRS SUSMITA SEN
(PROFESSOR) M.Sc NURSING, 1ST SEMESTER.
Obstetrics & Gynaecology ROLL NO- 12
dept.
TIPS, NURSING
TIPS, NURSING
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Introduction:-

All professionals have one thing in common, that is concern for the quality of their service,
which is ensured by developing and enforcing the standards. Two important ways of setting
standards are accreditation of the education programme and the professional licensure.

The programme of action of the national policy on education 1986, has proposed the
establishment of an accreditation and assessment council (ACC) for maintaining and raising
the quality of the institution of higher education. The University Grants Commission (UGC)
has constituted a committee with Dr. Vasant Gowarker as the convener in November 1986.
Institutional accreditation originated in the USA.

Nursing Education Programmes Nursing education programmes can be

mainly classified into following courses:

1. Certificate course ANM Course

2. Diploma GNM Course
3. Degree (undergraduate) A. B. Sc Nursing (Basic)
B. B.Sc Nursing (Post - certificate)
C. B.Sc Nursing (IGNOU)

4. Master's (post graduate) A. M.Sc Nursing

B. M.Phil in Nursing

5. Doctoral programmes PhD in Nursing

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Standard Requirements by Indian Nursing Council for Nursing

Education Programmes

AUXILLARY NURSE MIDWIFE PROGRAMME (ANM)

Minimum standard requirements

A school for training of the ANMS should be located in a community Health Centre (PHC
annexe) or a Rural Hospital (RH) having minimum bed strength of 30 and maximum 50 and
serving an area with community health programmes. The school should also be affiliated to a
district hospital or a secondary care hospital in order to provide experiences of secondary
level health care and an extensive gynae-obstertical care.

An organization having a hospital with 150 beds with minimum 30-50 obstetrics and
gynecology beds, and 100 delivery cases monthly can also open ANM School. They should
also have an affiliation of PHC/CHC for the community Health Nursing field experience.

Existing ANM schools attached to District Hospitals should have PHC annexe
(accommodation facility for 20-30 students) for community health field experience.

Physical Facilities

Office room 1
Class -room 2
Nursing laboratory 1
Nutrition laboratory 1
Library cum study 1
Audio visual aid 1

Clinical Facilities:-

 School has to be affiliated to district hospital or a secondary care hospital with

minimum 150 beds.
 Bed occupancy on the average to be between 60% - 70%.
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Teaching facility:- Teaching faculty for 20-40 annual admission:

Category Minimum qualification & experience

M.sc Nursing with 3 years of teaching experience or B.Sc (N)
Principal with 5 years of teaching experiences.
Nursing Tutor B.Sc Nursing/ Diploma in Nursing Education &
Administration/ Diploma in Public Health Nursing with 2 years
clinical experience.

GENRAL NURSING & MIDWIFERY COURSE (GNM)

PHYSICAL FACILITIES- TEACHING BLOCK

Sl Teaching block Area (figures in sq feet)

no
1. Lecture Hall 4 @ 1080 = 4320
i. Nursing foundation lab 1500
ii. CHN 900
iii. Nutrition 900
iv. OBG & Pediatrics lab 900
v. Pre- clinical science lab 900
vi. Computer lab 1500
2. Multipurpose Hall 3000
3. Common Room ( Male & Female) 2000
4. Staff Room 1000
5. Principal Room 300
6. Vice Principal Room 200
7. Library 2400
8. A.V.Aids Room 600
9. One room for each HOD 800
10. Faculty Room 2400
11. Provisions for Toilets 1000
Total 23720 Sqr. Ft.
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Hostel Block:-

Sl Hostel Block Area (Figures in Sq feet)

no.
1. Single Room 24000
Double Room
2. Sanitary One latrine & One bathroom
(For 5 students)- 500
3. Visitor Room 500
4. Reading Room 250
5. Store 500
6. Recreation Room 500
7. Dining Hall 3000
8. Kitchen & Store 2000
Total 30750 Sqr. Ft.

 Proportionately the size of the built-up area will increase according to the number of
students admitted.
 School and College of nursing can share laboratories. if they are in same campus
under same name and under same trust, that is the institution is one but offering
different nursing programmes. However they should have equipments and articles
proportionate to the strength of admission. And the class rooms should be available as
per the requirement stipulated by Indian Nursing Council of each programme

Clinical Facilities:-

School of nursing should have a 120-150 bedded Parent/ Affiliated Hospital for 40 annual
intake in each programme:

Distribution of beds in different areas--

 Medical 30
 Surgical – 300
 obstetrics & Gynecology – 30
 Pediatrics- 200
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 orthopedic 10
 Bed Occupancy of the Hospital should be minimum 75%.
 The size of the Hospital/Nursing Home for affiliation should not be less than 50 beds.
 Other Specialties/Facilities for clinical experience required are as follows:
 Major OT
 Minor OT
 Dental
 Eye/ENT
 Burns and Plastic
 Neonatology with Nursery
 Communicable disease
 Community Health Nursing
 Cardiology o Oncology
 Neurology/Neuro-surgery
 Nephrology etc. ICU/ICCU
 Affiliation of psychiatric hospital should be of minimum
 30-50 beds.
 The Nursing Staffing norms in the affiliated Hospital should be as per the
INC norms.
 The affiliated Hospital should give student status to the candidates of the
nursing programme.
 Affiliated hospitals should be in the radius of 15-30 kms.
 1:3 student patient ratios to be maintained. If the institution is having both
GNM and B.Sc (N) programme, it would require 240 bedded parent/affiliated
hospital for 40 annual intakes in each programme to maintain 1:3 student
patient ratio.

Teaching Facility-

i. Principal
M.sc. Nursing With 3 Year Of Teaching
Experience Or B.sc.
Nursing (Basic) / Post Basic with 5 Years Of
Teaching Experience
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2 Vice- Principal M.sc. Nursing Or B.sc. Nursing (Basic) / Post

. Basic with 3 Years Of Teaching Experience.
3 Tutor M.sc. Nursing Or B.sc. Nursing
. (Basic / Post Basic) Diploma in Nursing
Education and Administration with 2 Years
of professional Experience

For school of nursing with 60 students (i.e., annual intake of 20 students):-

Teaching Facility No. Require

Principal 1
Vice- Principal 1
Tutor 4
Additional Tutor For Interns 1
Total 7

Note:- Teacher student ratio should be 1:10 for student sanctioned strength

College of Nursing Physical Facilities For B.Sc Nursing, P.C B.Sc, M.Sc
Nursing:-

Sl no Teaching Block Area (Figures in Sq

feet)
1. Lecture 4 @ 1080 = 4320
2. i. Nursing Foundation lab 1500
ii. CHN 900
iii. Nutrition 900
iv. OBG & Pediatrics Lab 900
v. Pre- clinical Science Lab 900
3. Pre-Clinical Science Lab 900
4. Computer Lab 1500
5. Multipurpose Hall 3000
6. Common Room (Male & Female) 2000
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7. Staff Room 1000

8. Principal Room 300
9. Vice Principal Room 200
10. Library 2400
11. A.V.Aids Room 600
12. One room for each HOD 800
13. Faculty Room 2400
14. Provisions for Toilets 1000
Total 23720 Sqr. Ft.

Departments:-

 Fundamentals of nursing including Nutrition

 Medical surgical nursing
 Community health nursing
 Obstetric and gynecological nursing
 Child health nursing
 Psychiatry and Mental health nursing

Laboratories:-

 Nursing foundations and Medical surgical

 Community health nursing
 Nutrition
 Biochemistry and Microbiology
 Computer lab with 10 computers
 A.V. Aids room
 Record room
 Store room
 Indoor games hall
 Safe drinking water
 Garage
 Fire extinguisher
 Playground
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 Proportionately the size of the built-up area will increase according to the number of
students admitted.
 College of nursing can share laboratories, if they are in same campus under same
name and under same trust, that is the institution is one but offering different nursing
programmes. However they should have equipments and articles proportionate to the
strength of admission. And the class rooms should be available as per the requirement
stipulated by Indian Nursing Council of each programme.

Sl Hostel Block Area (Figures in Sq feet)

no
.
1. Single Room 24000
Double Room
2. Sanitary One latrine & One bathroom
(For 5 students)- 500
3. Visitor Room 500
4. Reading Room 250
5. Store 500
6. Recreation Room 500
7. Dining Hall 3000
8. Kitchen & Store 2000
Total 30750 Sqr. Ft.

Departments:-

 Fundamentals of nursing including Nutrition

 Medical surgical nursing
 Community health nursing
 Obstetric and gynecological nursing
 Child health nursing
 Psychiatry and Mental health nursing

Laboratories:-

 Nursing foundations and Medical surgical

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 Community health nursing.

 Nutrition
 Biochemistry and Microbiology
 Computer lab with 10 computers
 A.V. Aids room
 Record room
 Store room
 Indoor games hall
 Safe drinking water
 Garage
 Fire extinguisher
 Playground
 Proportionately the size of the built-up area will increase according to the number of
students admitted.
 College of nursing can share laboratories, if they are in same campus under same
name and under same trust, that is the institution is one but offering different nursing
programmes. However they should have equipments and articles proportionate to the
strength of admission. And the class rooms should be available as per the requirement
stipulated by Indian Nursing Council of each programme.

Sl Post, Qualification & Experience

no.
1. Professor cum Principal
 Masters Degree in Nursing
 Total 10 years of experiences with minimum of 5 years of teaching
experience
2. Professor – cum Principal
 Masters Degree in Nursing
 Total 10 years of with minimum of 5 years of teaching experience
3. Reader / Associate professor
 Masters Degree in Nursing
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 Total 10 years of with minimum of 5 years of teaching experience

4. Lecturer
 Master Degree in Nursing
 3 years experiences
5. Tutor/ Clinical Instructor
 M.Sc (N) Or, B.Sc (N) with 1 years of experience or Basic B.Sc
(N) with Post Basic Diploma in Clinical Specialty.

Teaching Facilities For M.Sc Nursing Course

 If parent hospital is super-specialty hospital like cardio- thoracic hospital/cancer with

annual intake 10 M.Sc (N) in cardio thoracic/cancer.
 Professor cum coordinator 1 Reader / Associate Professor 1
 Lecturer 2
 The above faculty shall perform dual role.
 Annual intake of 60 students in B.Sc. (N) and 25 students for M.Sc. (N) programme.
 Professor-cum-Principal – 1
 Professor-cum-Vice Principal – 1
 Reader / Associate Professor – 5
 Lecturer – 8
 Tutor / Clinical Instructor - 19
=Total-34
 One in each specialty and the entire M.Sc (N) qualified teaching faculty will
participate in all collegiate programmes.
 Teacher Student Ratio = 1:10 for M.Sc (N) programme.

Qualifications & Experience Of Teachers Of College Of Nursing—

Sl Post Qualification & Experiences

no.
1. Professor-cum-  Masters Degree in Nursing
Principal  14 years experience after M.Sc. (N) in College of
Nursing
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 3 years experience in administration (Years of

experience is relaxable if suitable candidate is not
available) (If a candidate is not available, minimum 5
years of experience in college of nursing, with an
aggregate of 14 years teaching)
Desirable: Independent Published work of high standard / doctorate degree / M.Phil.
2. Professor-cum- Vice  Masters Degree in Nursing
Principal  14 years experience after M.Sc. (N) in College of
Nursing
3 years experience in administration (Years of experience is
relaxable if suitable candidate is not available) (If a
candidate is not available, minimum 5 years of experience in
college of nursing, with an aggregate of 14 years teaching)
Desirable: Independent Published work of high standard / doctorate degree / M.Phil.
3. Reader/ Associate  Masters Degree in Nursing
Professor  10 years after M.Sc.(N) in collage of Nursing (If a
candidate is not available, 5 years of experience in
college of nursing, with an aggregate of 1 years
experience)
Desirable: Independent Published work of high standard / doctorate degree / M.Phil.
4. Lecturer  Master Degree in Nursing.
 3 years teaching experience after M.Sc. (N)

NOTE:

 No part time nursing faculty will be counted for calculating total no. of faculty
required for a college.
 Irrespective of number of admissions, all faculty positions (Professor to Lecturer)
must be filled.
 For M.Sc. (N) programme appropriate number of M.Sc. faculty in each speciality
be appointed subject to the condition that total number of teaching faculty ceiling
is maintained.. All nursing teachers must possess a basic university or equivalent
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qualification as laid down in the schedules of the Indian Nursing Council Act,
1947. They shall be registered under the State Nursing Registration Act.
 Nursing faculty in nursing college except tutor/clinical instructors must possess
the requisite recognized postgraduate qualification in nursing subjects.
 Holders of equivalent postgraduate qualifications, which may be approved by the
Indian Nursing Council from time to time, may be considered to have the requisite
recognized postgraduate qualification in the subject concerned. All teachers of
nursing other than Principal and Vice-Principal should spend at least 4 hours in
the clinical area for clinical teaching and/or supervision of care every day

Guidelines to Start a Nursing Course:-

 Any organization under the Central Government, State Government, Local body
or a Private or Public Trust, Mission, Voluntary registered under Society
Registration Act or a Company registered under company's act wishes to open
any Nursing programme, should obtain the No Objection/ Essentiality certificate
from the State Government.
 The Indian Nursing council on receipt of the proposal from the Institution to start
nursing program, will undertake the first inspection to assess suitability with
regard to physical infrastructure, clinical facility and teaching faculty in order to
give permission to start the programme.
 After the receipt of the permission to start the nursing programme from Indian
Nursing Council, the institution shall obtain the approval from the State Nursing
Council and Examination Board/ University.
 Institution will admit the students only after taking approval of State Nursing
Council and Examination Board/University.
 The Indian Nursing Council will conduct inspection every year till the first batch
completes the programme. Permission will be given year by year till the first
batch completes.
 If the institution is recognized for B.Sc. (N) programme and if one batch has
passed out after found suitable by INC, then the institution will be exempted
from NOC/Essentiality certificate for M.Sc.(N) program from the State
Government.
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 Super Specialty Hospital can start M.Sc. (N) programme, however they have to
get NOC/ Essentiality certificate from respective State Government to start the
M.Sc. (N) programme.

Up gradation from School to College:-

Any "School of Nursing" can upgrade to "College of Nursing" provided one batch of
students have passed out after found suitable by INC. Further on up-gradation institution
has to stop GNM Programs. Documents to be submitted to INC for up gradation: 0
Decision of the management committee to upgrade school of nursing to college of
nursing. o Consent letter of the university to which the college needs affiliation.

 Definition of Quality Assurance:-

Quality assurance refers to the process of achieving excellence in the service
rendered to every Client. Quality assurance is the defining of nursing practice through
well written nursing standards and the use of those standards as a basis for evaluation
on improvement of client care (maker 1998).

Quality is defined as the extent of resemblance between the purpose of health care and truly
granted care (Donabedian1986).

Quality assurance originated in manufacturing industry. The idea was “to ensure that the
product consistently achieved customer satisfaction”.

Quality assurance as the monitoring of the activities of client care to determine the degree of
excellence attained to the implementation of the activities
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 Concept Of Quality In Health Care:-

Defining quality is difficult. The expense of quality is an interactive process between

customer and provider. The customer does not receive anything tangible, mostly only a piece
of paper with a promise for a better future e.g. Doctors write prescriptions.

 CONCEPT OF QUALITYASSURANCE:
 Quality is defined at the extent of resemblance between the purpose of healthcare and
the truly granted care.
 Quality assurance originated in manufacturing industry “to ensure that the product
consistently achieved customer satisfaction”.
 Quality assurance is a dynamic process through which nurses assume accountability
for quality of care they provide.
 PURPOSES OF QUALITY ASSURANCE:
 It is required to introduce code of ethics & professional conduct for nurses in India.
 To prepare staff nurse for implementation quality assurance model in nursing
 To provide best care to patients by maintaining standards.

 OBJECTIVES OF QUALITY ASSURANCE:

 To ensure the delivery of quality client care .

 To demonstrate efforts of health care providers to provide good results.

 To formulate plan of care.

 To evaluate achievement of nursing care.
 To support delivery of nursing care with administrative & managerial services.

 To explain quality assurance models as pre- requisite for quality nursing care.
 To state code of ethics & professional conduct for nurses in India.
 To appreciated importance of practicing standard safety measures.
 Plan & conduct patient teaching sessions.
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 To identify appropriate management techniques to be used for managing resources in

given situation.
COMPONENTS OF QUALITY ASSURANCE IN NURSING :-
There are four essential components of quality assurance are:
 Setting program objectives
 Promoting quality Quality control

 Activity monitoring

Quality supervision

Quality review

 Performance assessment Quality evaluation

Quality approval

 APPROACHES FOR QUALITY ASSURANCE PROGRAM :

Approaches of quality assurance are divided into 2 types: -

1. . General Approach
2. Specific Approach

1. General Approach :
It involves large governing of official body’s evaluation of person’s or agency’s ability to
meet standard at a given time.

i) Credentialing- It is process of determining & maintaining nursing standards.

Functional components:
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Credentialing Process According to Hinsvark (1981), credentialing process has 4 functional

components:-
 To produce a quality product .
 To confer a unique identity .
 To protect provider & public.
 To control the profession.
ii) Licensure-
Licensure is a specialized form of credentialing based on laws passed by a state legislature.
A license is a legal document that permits a person to offer to the public skills and knowledge
in a particular jurisdiction, where such practice would otherwise be unlawful without a
license.

iii) Accreditation -
State legislative bodies have authority to enact laws controlling occupational and professional
groups. Nursing is one of the groups operating under state laws that promote the general
welfare by determining minimum standards of education through accreditation of school of
nursing.

iv) Certification-
Where as licensure measures entry-level competence, certification validates specialty
knowledge, experience and clinical judgment. Nursing certification is offered by professional
organizations.

2. Specific approaches :
Quality assurances are methods used to evaluate identified instances of provider and client
interaction.

 Peer review committee:

These are designed to monitor client specific aspects of care appropriate for certain
levels of care. The audit is used by peer review committee to ascertain quality of care.
 Nursing audit process :
Follow up of problem. Topic study selected .It is a evaluation of patient care through
analysis of written records maintained by nurses in patient’s treatment profile. - Avtar
Brar.
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Goal of nursing audit :

 To improve quality of health care.
 To promote improved communication among nurses & other health team members.

 To improve quality of nursing care.

 To detect & analyze problems & errors.

Advantages of nursing audit process:

 Provides quality of nursing .
 A patient is assured of good services.
 It will give valuable and pertinent information for the staff.
 It will lead to between co-operation and communication among the nurse & health
team.
 It is help each professional nurse for her self evaluation.
 It helps the administration as better planning.
 It will reduce the incidence of medical legal complication.
 It will broaden and strengthen nursing service.

 Utilization review:
activities are directed towards assuring that care actually needed and that the cost
appropriate for the levels of care provided.
Three types of utilization review UR are there:
 Prospective: It is an assessment of the necessary of care before giving services.
 Concurrent: A review of the necessity of care while the care is being given.
 Retrospective: It is analysis of the necessity of the services received by the client
after the care has being given.

Advantages of utilization review:

 It is designed to assist clients to avoid unnecessary care.
 It can provide guidelines for staff of program development.
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 Evaluation Studies Donabedian’s Structure-Process-Outcome

model:

Donabedian introduced 3 major method of evaluating quality care:-

 Structural evaluation:
This method evaluates setting & instruments used to provide care such as facilities,
equipments & characteristics of administrative organization & qualification of health

provider. The data can be obtained from existing documents.

 Process evaluation:
This method evaluates activities as they relate to standards & expectations of health providers
in management of client care. Data is collected through direct observations, review of
records, audit etc.

 Outcome evaluation: Changes that occur as a result of health care or net results
of health care. The data of this method can be collected from vital statistics records
such as death certificate or telephone client interview, mailed questionnaire & client
records.

 Client satisfaction: Client satisfaction can be assessed using person or telephone

interviews and mailed questionnaire. Data from client satisfaction surveys are used to
measures structure, process, and outcome of care givers.

 Incident review:
During patient’s hospitalization several incidents may occur which have a bearing on
the treatment & patients final recovery. The critical incidents:
 Delayed attendance by a physician/ nurse.

 In correct medications.

 Risk management:
It can be defined in a program that is developed for propose of eliminating health care
situations that has the potential to create risk to client.
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 Malpractice litigation:
It results from client dissatisfaction with the provider and with the content of care

received.

Quality improvement:
Principles and conditions for total quality management.
Principles:
 Belief in people.
 Statistical analysis.
 Costs of poor quality.
Conditions in the work environment:
 Employer involvement
 Team work
 Improvement

 Group interaction skills.

Models of quality assurance:

1. A system model for implementation of unit based quality assurance:
The implementation of the unit based quality assurance program, like that of any other
program, involves making changes in organizational structure and individual roles.
The basic components of the system are:
 Input
 Throughput
 Output
 Feedback.

2. American nurses association model:

This Model Identify values Identify standards & criteria secure measurement Make
measurement, Identify course of action Choose action Take action Reevaluation.

The basic components of the ANA model are:

 Identify structure, process and outcome standards and criteria,
 Select measurement
 Make interpretation.
 Choose action
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 Take action

3. Re-evaluate
This Model Identify values Identify standards & criteria Secure measurement Make
measurement, Identify course of action Choose action Take action Reevaluation.

The basic components of the ANA model are:

 Identify structure, process and outcome standards and criteria,
 Select measurement
 Make interpretation.
 Choose action
 Take action

 Re-evaluate.

Quality assurance model in india:

 Nurses who are trained as per Indian nursing council regulations and registered with
state nursing registration councils are safe to provide care.
 INC has developed a quality assurance program for nurses in India.
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Quality assurance model in nursing:

 Quality assurance model in nursing is the set of elements that are related to each other
and comprise of planning for quality development of objectives setting & actively
communicating standards developing indicators, setting thresholds, collecting data to
monitor compliance with set standards for nursing practice & apply solutions to
improve care.

Factors affecting quality assurance:

o Lack of resources
o Personnel problems
o Improper maintenance
o Lack of nursing care records
o Lack of goods review procedures
o Lack of incident review procedures.

Components of quality assurance programs:

 Establish responsibility & accountability.
 Define scope of service for clinical area.
 Define key aspects of service for clinical area
 Develop quality indicators to monitor outcomes & appropriateness of care delivered.
 Establish threshold for evaluation of indicators.
 Collect & analyze data from monitoring activity.
The 10 step process in a Quality Assurance program:
Step1- Assign responsibility
Nursing departments and services must assigns overall responsibility for their monitoring and
evaluation activities.

Step 2-Delineate Scope of Care and Services

Intended to assure that all nursing activities are considered in monitoring and evaluation:

 Types of patients served

 Condition and diagnosis
 Types of nursing staff providing care and services
 All existing standards of patient care
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Step 3-Identify Important Aspects of Care and Services

It is important for nursing staff to remember that important aspects of care are activities of the
department that will be continually monitored and periodically evaluated to determine if care
can be improved or if problems are present. Nursing staff should identify those aspects of
care and services that:

 Occur frequently or affect large numbers of patients

 Place patient at serious risk (high risk).

Step 4-Identify Indicators

Indicators are measurable variables related to the structure, process or outcomes of care:

Structures- Elements that facilitate care (resources, equipment, numbers and qualification of
staff).

Process-Functions carried out by practitioners (assessment, treatment, planning and

medication administration).

Outcomes- Includes complications, adverse effects, short and long-term results of treatment.

Step 5-Establish Threshold for Evaluation

 Thresholds are accepted levels of compliance with any indicators being measured.
 Thresholds for evaluations are the level or point at which intensive evaluation is
triggered

Step 6-Collect and Organize Data

Some common date can be found in:

 Patients, records
 Medication sheets
 Infection control
 Meeting minutes
 Incident reports
 Laboratory report
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 Direct observation

Step 7-Evaluate Care

Once threshold for an indicator is reached, the critical step of evaluation is initiated. The most
important purpose of monitoring & evaluation is to foster overall continuous improvement in
the level of performance.

Examples:

 Lack of knowledge or skill

 Staff members knew what to do but did not do so

 Equipment deficiencies

 Deficiencies in medical record documentation

 Policy/procedure violation
 Lack of adequate staffing

 Infection control violation

Evaluation must be designed to identify the opportunities for improvement by:

1. Objectively examining the possible causes for the level of performance

2. Recommending action pertinent to those causes to improve the performance

Step 8-Take Actions to Solve Problems or Otherwise Improve

Staff should direct actions toward the root causes and should have an eye toward

Overall improvement in the quality of care and services.

Some possible actions if the problem involves deficiencies in systems, include:

 Changing communication channels

 Changing organizational structure
 Adjusting staffing or redistributing staff
 Revising job descriptions
 Reallocating resources
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 Adding or revising policies and procedures

Some possible actions, if the problem involves deficiencies in staff knowledge, include

 Modifying orientation procedures

 Providing focused in-service education
 Providing focused continuing education

Some possible actions, if the problem involves behavior or performance deficiencies,

include

 Revising job descriptions

 Informal counselling
 Formal counseling
 Changing assignments

Step 9-Assess the Effectiveness of Actions

Monitoring and evaluation does not end when actions are taken. Staff continues to monitor
the aspect of care for future opportunities for improvement, but they must determine whether
actions are taken successfully in improving care or service. If care does not improve within
the expected time, staff should re-examine the aspect of care and take further action.

Step 10-Communicate Relevant information to the Organization-Wide Quality

Assurance Program

It is essential that monitoring and evaluation information be communicated through

established channels. Appropriate dissemination of information helps to assure that quality
assurance activities are coordinated and that knowledge regarding monitoring, evaluation and
problem-solving methods is shared.

TOTAL QUALITY MANAGEMENT :-

 It focuses the production and service, i.e.: the environment must be customer
responsive.
 26

 It identifies and do the right things, the right way, the first time and the prevent
problems.
 In this, customer needs and experiences with the end product are constantly
evaluated.
Function of nurse in quality assurance:
 Encourage team members to be actively involved in the quality process
 Implement quality control
 Communicates standard of care to team members
 Evaluate quality assurance activities
 Attend and participate in workshops and seminars.

 Develop and implement appropriate plans of action to correct deficiencies.

Definition of standards:-

 Standard is an established rule as a basis of comparison in measuring or finding

capacity, quality context and value of objects in the same category standard as a broad
statement of quality.
 Standard is a predetermined baseline condition or level of excellence that comprises
a model to be followed and practiced. It is used as a measurement tool.
 ‘Standards are defined as authoritative statements that describe a common level of
care and performance by which the quality of practice can be determined or measured.
Standard helps define professional practice’ (Huber, 1996).

Importance of standards in nursing:-

It is an authoritative statement by which the quality of nursing practice, service and education
can be judged.

 In nursing practice, standards are established criteria for the practice of nursing.
 It is a guideline for a recommended path to safe conduct, an aid to professional
performance.
 It provides a baseline for evaluating quality of nursing care, increase effectiveness of
care and improve efficiency.
 Standards help supervisors to guide nursing staff to important performances.
 Standards may help to clarify nurses’ area of accountability.
 27

 Standards may help nursing to clarify and define different level of care.
 Standard is a device for quality assurance and quality control.
 Standards give direction and provide guidelines for performance of nursing staff.
 Standards may help to improve documentation of nursing care provided in
maintaining records of care.
 Standards may help to determine the degree to which standards of nursing care are
maintained and take necessary corrective action in time.
 Standards may help justify demands for resource association.

Purposes of standards:-

The purpose of publishing, circulating, and enforcing nursing care standards are to:

 Improve the quality of nursing.

 Decrease the cost of nursing.
 Determine negligence.

Characteristics of standards:-

 The statement must be broad enough to apply a wide variety of settings.

 Must be realistic, acceptable, and attainable.
 Nursing care must be developed by members of the nursing profession.
 Standards must be understandable and stated in unambiguous terms.
 Standards must be based on current knowledge and scientific practice.
 Standards must be reviewed and revised periodically.
 Standards must be directed towards an optimal standard.

Sources of nursing care standard:-

The standard can be established, developed, and reviewed as enforced by variety of sources
as follows:-

 Professional organization like TNAI.

 Licensing bodied INC, IMC, and DCI etc.
 Department of the institution, university, hospital, department of nursing.
 Patient care units, e.g., specific patient units.
 28

 Government units at national, state and local government level.

 Individual, e.g., personal standard.

Classification of standards:-

There are different types of standards used to direct and control nursing action.

 Normative: Normative standards describe practice considered good or ideal by

some authority group.
 Empirical: Standards describe practice actually observed in a large number of
patient care setting. Here the normative standards describe a higher quality of
performance than empirical standards. ANA/TNAI promulgates normative standards,
whereas law enforcement and regulatory bodies (INC/MCS) promulgate empirical
standards.
 Physical standard: This includes patient activity rating to establish nursing care
hours per patient per day.
 Cost standard: This includes the cost per patient/day.
 Capital standard: This includes the review of monitory investments at new
programmers.
 Revenue standard: This includes the revenue per patient day for nursing care.
 Programme standard: This guides the development and implementation of
programmes to meet client needs.
 Intangible standards: Which include staff development and personnel
orientation cost.
 Goal standard: Which outlines qualitative goal in short and long term planning.

Nursing care standard:-

End standard: The end standards are patient oriented; they describe the changes as
desired in a patient's physical status or behavior. End standards require information about the
patient.

Mean standards: The mean standards are nursing oriented, they describe the activities
and behavior designed to achieve end standards. Mean standards call for information about
the nurse's performance.
 29

Nursing care standards can be classified according to frame of references, relating to

nursing structure, process and outcome. Standards can be established to appraise care,
according to many approaches. The most common approaches are based on structure, process
and outcome. The nursing organization or structure is usually evaluated according to
structure standards, the activities or delivery of care are evaluated by process standards, and
the patient's status is evaluated by outcome standards.

 Structure standard: A structure standard involves the set up of the institution.

The philosophy, goal, and objectives, structure of the organization, facilities,
equipment and qualification of employee are some of the components of the structure
of the organization. Example: recommended relationship, between the nursing
department and other department in a health agency are structural standards, because
they refer to the organizational structure in which nursing is implemented. It includes
people, money, equipment, staffing policies, etc. The use of standards based on
structure implies that if the structure is adequate, reliable and desirable, standards will
be met as quality care will be given.
 Process standard: Process standards describe the behavior of the nurse at the
desired development of performance. A process standard involves the activities
concerned with delivering patient care, These standards measure nursing action or
lack of action involving patient care. The standards are stated in action verbs that are
observable and measurable terms. For example, the patient demonstrates the focus is
on what was planned, what was done, and what was communicated and recorded. In
process standard, there is an element of professional judgement, i.e., determining the
quality as the degree of skill. It includes nursing care technique, procedures,
regiments, and process.
 Outcome standards: Descriptive statements of desired patient care results are
outcome standard, because patients' results are outcome of nursing intervention. The
outcome standard measures changes in the patient health status. This change may be
due to nursing care, medical care, or as a result of variety of services offered to the
patient. Outcome standards reflect the effectiveness and results rather than process of
giving care.

Thus, structural standards are agency or group oriented, process standards are
nurse oriented, and outcome. Standards are patient oriented.
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Frame of reference for evaluation of nursing care, structure, process and outcome.

Standards for nursing education programs:-

Section1: statement of purpose

 Serve as a guide
 Provide criteria for evaluation and approval of new/established nursing education
program.
 Foster continued improvement of established nursing education program.
 Ensure that graduates are prepared for safe nursing practice.

Section 2: approval of nursing education programs

a) Provisional approval
 Proposal which involves the following:
 Documentation of the present & future needs for the nursing education program.
 Rationale for the establishment of nursing education program.
 Availability of qualified administrator &faculty.
 Evidence of financial resources.
b) Criteria before making application for provisional approval
 A qualified nurse administrator & sufficient qualified faculty.
 A written nursing education program plan, developed in accordance with standards of
nursing.
 A site visit has been conducted by the board if necessary.
c) Following board review of the proposed nursing education program, the board may
grant or deny the provision.
d) Administrative head of the proposed nursing education program may be present at the
meeting to clarify information in reports.
e) If provisional approval is denied, the institution may request a hearing
before the board.
f) Following provisional approval, progress reports shall be made to the board as
requested.
g) Following graduation of the first class, a self-evaluation report of compliance with the
standards for nursing education shall be submitted by the education.
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A. Full approval/Conditional approval

 Full approval
It is granted to a nursing education program after the first graduating class has taken
the board approval licensing examination and the program has demonstrated
compliance with the standards of nursing.
 Conditional approval
Conditional approval may be granted foe a limited time to a nursing education
program that has had provisional or full approval has now failed to meet the
standards. The board will determine the length of time and determine
the deficiencies.

B. Continued full approval

 All nursing education program shall be re- evaluated at least every 8 year to ensure
continuous compliance with standards for nursing education.
 It involves submission of self-evaluation report by nursing education program 30 days
prior to scheduled site visit.

Section 3: Board review of n education program

a. Annual review
b. Site visits

C) Non compliance

 The administrator of the nursing education program shall, within 10 days from receipt
of deficiencies, file a plan of correction with the board.

Administrator after receipt of notice submit a written request for hearing before the board to
appeal the board's determination of deficiencies.

At any time during correction period, the nursing education program may request restoration
to full approval if the nursing education program demonstrates correction of the deficiencies.
 32

Definition of accreditation:-

"Accreditation is the process whereby an organization or agency recognizes a college or

university or programme of study as having met certain predetermined qualifications or
standards" (Selden, 1962).

Accrediting is carried on mainly by voluntary organizations. Although these organizations are

advisory in nature and do not have legal power to control institutions of higher education they
do exert pressure.

Purposes of Accreditation:-

 For the maintenance of adequate administration requirement.

 Maintaining a uniform standard for nursing education and nursing service.
 Stimulation of institutional self-improvement by evaluation and inspection.
 It safeguards the institution from social education and political pressures.
 It helps in the registration of nurses.
 It prescribes the syllabus.
 It grants recognition to school and colleges.
 It guides the school/college of nursing, according to recommendation and criteria.
 It also services to prepare the competent to serve the public.

Functions of Accreditation:-

1. It aims to protect the autonomy of various health service progremmes. Eg. Nursing
education and medical education.

2. It preserves the quality of nursing education.

3. It protects the public from ill prepared nurses.

4. It protects the institutions unsound and unsafe political pressure.

5. It helps the practitioner for the broad scope of nursing practice.

Types of Accreditation Agencies

 33

Regional Professional

State National

Regional Accreditation Agencies

Regional agencies are concerned with as institution as a whole. They are general in nature.
They are concerned with appraising the total of the institution of higher learning and with
safeguarding the quality of education and foundation of professional programmes in colleges
and universities. Each agency establishes criteria for the evaluation of institution in its region.

It receives those institutions periodically and publishes from time to time a list of those
institution which it has accreditated.

Professional Accrediting Agencies:-

Professional accrediting agencies are specialized and each is concerned with particular
profession.

State Accrediting Agencies:-

Accreditation in certain stages may be the function of state agencies. It assumes the
responsibility mainly for teacher education. State universities commissions and other agency
are authorized in some state to evaluate college, to give initial approval to institutions to
higher learning to formulate standards, to issue licenses and to have various other
responsibilities. Many state agencies accept the accreditation of regional and national
accrediting agency as a basis for their approval of the institutions.

National Accrediting Agencies:-

 34

In 1904 started with the accreditation of medical school. Membership in some agencies
composed number of some combination of nurses and doctors. National Commission of
Accreditation.

As the number of accreditation agencies were established to control the activities of

accreditation agency.

Functions of National Commission of Accreditation:-

 To study and investigate the accreditation agency.

 Publish a list of accreditation agencies, it has approval.
 To collect and publish information on higher education, that is pertinent to
accreditation.

Important Features of the Accreditation Programme:-

The accreditation and the assessment council is proposed as a voluntary body of member
institutions. There are two categories of accreditation - institutional of professional. The
important concern of the accreditation and assessment council is to develop an institutional
accreditation mechanism.

Institutional accreditation is a means for the self-regulation of the academic institution.

Institutional accreditation is done in two parts. The first part starts with self-study by the
institution, involving in this activity all of its major constituents including facility, students
and the institutional management.

The second part of the institutional accreditation process involves an outside evaluation by a
team of professional educators constituted independently by the accrediting agency.

The institutional accreditation process involves the judgment of the responsible members of
the profession to see whether the institutional goals conceived are appropriate that is the
educational programme is intelligently planned and competently conducted, the institution is
fulfilling the professional goals and has the adequate resources to run the programme to be
effective in imparting quality education.

In order to be accredited an institution must fulfill the criteria set by the accrediting agency.
The institution will be assessed in each of the principle areas of the institutional functioning
and responsibility as follows:
 35

A. Institutional mission and objectives.

B. Evaluation and planning
C. Organization and governance
D. Programme of instruction
E. Special activities
F. Faculty
G. Student services
H. Library and learning resources.
I. Physical resources
J. Financial resources
K. Advertising and publication

The accreditation agency is not simply a body of assurance of the educational quality it is a
process which encourages institutional improvement through continual self-study and
evaluation and it also develops guide lines for assessing institutional effectiveness.

Before an institution is accredited, a provisional one- year candidate status is given to the
institutions after satisfying certain criteria and this can be extended to 3 years.

Accreditation bodies have the right to review the member institutions at any time and can
drop any institutions of their reorganization at any time which shows serious weaknesses.

The annual dues from the candidate and accredited institutions support accreditation
associations.

The accrediting bodies elect the accreditation commission, the bodies which make the final
decisions on accreditation after receiving the institutional self- study report and the evaluation
report of the evaluation team.

Though the accrediting agency are non-governmental, their accreditation has come to be
recognized as a necessary qualification for the federal government, which in turn recognizes
for a period of 4 years duration those accrediting agencies which it finds to be reliable
indicator of educational quality.

Purposes of Accreditation:-

1. To ensure safe practice of nursing by setting standards for schools and

colleges preparing the professionals.
 36

2. To encourage study and self-evaluation within the educational units for the
development and improvement of the educational programme.
3. To ensure maximum benefit for the students and to protect the students
interests.
4. To ensure the graduates of the accredited schools the eligibility for admission
to the licensing examinations.
5. It acts as a monitoring and controlling agency. 6. To provide a list of
accredited schools of nursing and this assist students and counselors in
selection of schools, which offer accredited programmes in nursing.

Accreditation in nursing education programs:-

Policies for Accreditation

A. Board Approval of the Initial Development of the Nursing Program

1. Letter of intention should be submitted to the board describing the reasons for
establishing the school and the predicted timetable of development.
2. Qualification forms to be submitted to the board, by the full time person responsible
for the program, who is qualified with the Master Degree in nursing accredited by the
national leaguer for nursing and with appropriate preparation for administration in
nursing education. Faculty qualification is to be on file in the board office on all nurse
faculty members.
3. The nurse director or chairman of the department nursing be employed on a full time
basis for one academic year before the admission of students to the nursing program.
This period is known as the "planning year". There should be funds available for the
departure chairman to have nurse faculty members participate in developing the
philosophy, objectives and course content in the nursing subjects prior to their full
appointment of the faculty.
B. Board Approval for the Admission of Students
1. A statement describing the philosophy, objectives nature of organization and
administration should be submitted to the board, at least three weeks prior to the
board meeting at which time the program will be reviewed. This must occur at least
6 months to the admission of the first batch.
2. The statement should contain descriptions of the following as well:
 37

a) Student body (number to be admitted to the first batch maximum number to be

admitted with projected time table containing source of qualified students
desiring this type program).
b) Faculty: Number to be employed, dates of appointment, for faculty recruitment,
qualification or appointed members.
c) Curriculum, educational and clinical facilities
d) Projected budget for a five year period
e) Plans for evaluation.

Further Procedures regarding Board Approval:-

1. An application for accreditation should be filled with concerned authority.

2. Request will be reviewed at regular board. Meeting and institution advised of board
actions.
3. Initial accreditation is granted for a period of one year, after which time an evaluation
visit is made, the evaluation determined on the basis of the total programme in
relation to the stated purposes and the degree to which these have been achieved.
4. Renewal accreditation is based on survey visits, conference and correspondence
during the period, the annual report etc.

Process of Accreditation:-

1. Applying for the institution to be accredited.

2. Preparing a report by the institutional head according to the criteria and format sent by
the accrediting agency. This report is referred to as self-study.
3. Visit to the site by the inspectors appoint by the accrediting agency to verify the self
study report.
4. Preparing a report by the visitors.
5. Report made by the visitors along with the institutional report is sent to the review
board of council.
6. The board of review on the basis of all data and reports makes the final decisions
whether accreditation should be granted or not.

Criteria for Accreditation: report of the inspection of the college held on,

1. Type of training given.

2. Date of previous inspection.
 38

3. Recognition of the college by the government order no., date and no. of seats
sanctioned for the year. Number of the students admitted for the year after the cost
date of inspection and regarding the detail of staff qualification.

4. Register no, registration valid, non-nursing teachers. Other staff members, physical
facilities available in the school.

 No. of classrooms
 Demonstration room
 Library
 Office of principal, tutors
 Laboratory

Process of Registration of School/Colleges:-

Trial Basis-recognition given on the temporary basis based on the application submitted plus
pending inspection and is done after the favorable report accreditation.

Permanent recognition after the inspection and accreditation evaluation that is when the
school/college meets all the criteria prescribed by the INC permanent recognition is given.

Services rendered by accredited:-

 Registration and admission of students, Accredited institutions are also expected to

counsel students as to assist them in proper selection of the subjects.
 Distribution of study materials
 Organization of personal contact program
 Registering students for external examination.
 Distribution of marks sheets and certificates.

The School and Colleges are expected to Keep Ready the following:-

I. General Information
a) The name of the university it is affiliated.
b) Date of establishment of program
c) Date recognition by state nursing council, INC or university
d) Number of students graduating per year
II. Philosophy
 39

 Aims and objectives of the institution and departments

III. Organization and Administration

 Organization chart of institution and colleges

 Placement of principal
 Line of authority
 Teaching staff and non-teaching staff

IV. Teaching Staff

 Internal lectures
 External lectures
 . Staff selection procedures
 Staff development programme
 Seminars attended

V. Administration and Physical set up

 Office and room for principal

 Staff, clinical staff, number of classrooms, nutrition lab etc.
 Hostel, cafeteria, dining hall, reading hall, toilet facility etc.
 Number of books, periodical

VI. Finance

 Total budget sanctioned

 Drawing offices - separate and combined
 VII. Committees
 Advisory committee, development committee, student welfare committee

VIII. Staff Teaching

 Monitoring technique

IX. Construction and Institution Facilities

 Syllabus, prospectus, application forms, bond paper, etc.

X. Health Facilities for Students and Staff

 40

1. Medical checkup

XI. Clinical set-up

1. Community experience, family people co- curricular activities

2. Research of students, application forms and bond paper signed
3. Attendance registers, practical record, leave record
4. Evaluation form, master plan, examination results and assignments
5. Drug study, lesson plans, nursing care plans and clinical presentation.

CONCLUSION;-

The nursing staff and managers are the ones responsible for the problem. The lack of
leadership skills is one major factor. In order to solve this problem, focus should be given to
the nursing leaders and managers. Leadership training programs should be offered and
nursing managers and leaders should be required to attend. These managers and leaders in
 41

turn should perform their responsibilities of teaching and guiding the rest of the staff in
promoting a healthy work environment.

Nursing profession is the largest force in health care system holding the central role as health
care providers. People's health depends on competent and highly educated nurses. Nursing
profession needs dynamic, visionary, educated and committed leaders who can protect
nurses. Effective nursing leaders also ensure the quality nursing education for safe nursing
practice. In addition they advocate for the public and the professional's rights. Effective
nursing leadership supports the collaborative, innovative and evidence based work
environment that helps nurses to feel respected and valued in their positions.

Journal:-

Development of accreditation standards for midwifery clinical

education in Iran
Sara Abedian, Mojgan Javadnoori, Simin Montazer, Shahla Khosravi, Abbas
Ebadi and Roshan Nikbakht

Abstract
 42

Background: Accreditation is one of the most important methods of quality assurance and
improvement in medical education. In Iran, there are no specific midwifery education
accreditation standards. This study was designed to develop accreditation standards for
midwifery clinical education in Iran.
Methods: This study was performed in Iran in 2021. It consisted of two phases. In the first
phase, accreditation standards for midwifery education in the United Kingdom, the United
States, Australia and the International Confederation of Midwives were thoroughly examined
through a narrative review. The domains obtained from this phase were
used as a framework for coding in the second phase. In the second phase, a qualitative study
was conducted with a directed content analysis approach to determine standards and criteria
for clinical midwifery education accreditation in Iran. Participants were policymakers and
senior managers of midwifery education, faculty members of midwifery departments with
clinical teaching experience, and final year undergraduate midwifery students. The
participants were selected by purposive sampling method, and data collection continued until
data saturation.
Results: The standards and accreditation criteria of midwifery education from the review
study were formed 6 domains: Mission and goals; Curricula; Clinical instructors; Students,
Clinical setting; and Assessment. In the second phase, data analysis led to the extraction of
131 codes, which were divided into 35 sub-subcategories, 15 sub-categories, and 6 main
categories.
Conclusion: Implementing the specific and localized standards of clinical midwifery
education in Iran can lead to improved quality of clinical education programs.

Keywords: Accreditation standards, Accreditation program, Clinical education,

Midwifery.

Bibliography:-

1. D.Elakkuvana Bhaskara raj, Nima Bhaskar.“TEXT BOOK OF NURSING

EDUCATION”. 2nd edition. EMMESS medical publisher. Page No-467 to 472.
2. Sodhi J. k, Kaur S. “TEXT BOOK OF NURSING EDUCATION”. 1 st edition 2017.
JAYPEE the health science publisher. Page No-485 to 496.
3. Sudha R. “NURSING EDUCATION PRINCIPLES AND CONCEPT”. 1 st edition
2013. JAYPEE Brothers medical Publishers (P) LTD. Page no-344 to 381.
 43

4. Veerabhadrappa Gm. “THE SHORT TEXT BOOK OF NURSING EDUCATION”.

1st edition 2011. JAYPEE Brothers medical Publishers (P)LTD. Page no- to
5. 5.https://www.researchgate.net/publication/
364988099_Development_of_accreditation_standards_for_midwifery_clinical_educat
ion_in_Iran