QUALITY ASSURANCE IN NURSING (INC)

1. INTRODUCTION

Quality assurance provides the mechanisms to effectively monitor patient

care provided by health care professionals using cost-effective resources.
Nursing programmes of quality assurance are concerned with the quantitative
assessment of nursing care as measured by proven standards of nursing practice.
In addition, they motivate practitioners in nursing to strive for excellence in
delivering quality care and to be more open and flexible in experimenting with
innovative ways to change outmoded systems.

The field of quality assurance is an old as modern nursing. Florence

Nightingale introduced the concept of quality in nursing care in 1855 while
attending the soldiers in the hospital during the Crimean war. It is a matter of
pride for nurses that the nursing profession has attained a distinct position in the
search for quality in health care. Quality is rapidly becoming concern to both
consumers and the providers of the services. In health care quality is being
demanded and expected and providers are judged by the quality of services.
And hence there is a need to sensitize and train nursing personnel to provide
quality care.

Quality assurance is a way of preventing mistakes or defects in

manufactured products and avoiding problems when delivering solutions or
services to customers. Quality assurance is applied to physical products in pre-
production to verify what will be made to meet specifications and requirements,
and during manufacturing production runs by validating lot samples meet
specified quality controls. Quality assurance is also applied to software to verify
that features and functionality meet business objectives, and that code is
relatively bug free prior to shipping or releasing new software products and
versions. Quality assurance refers to administrative and procedural activities

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implemented in a quality system

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so that requirements and goals for a product, service or activity will be fulfilled.
It is the systematic measurement, comparison with a standard, monitoring of
processes and an associated feedback loop that confers error prevention. This
can be contrasted with quality control, which is focused on process output.

2. TERMINOLOGIES:

1) Quality
Quality is defined as the capability of a product to fulfill its intended
purpose, produced with least possible cost.

2) Quality in health care

The quality is described as levels of excellence produced and
documented in the process of patient care, based on the best knowledge
available and achievable at the particular facility.

3) Assurance
It is statement or indication that inspires confidence.

4) Standards of care

A set of guidelines for providing high-quality nursing care and criteria

for evaluating care.

5) Quality assurance

Quality assurance is the process for evaluating patient care in a

particular setting by developing standards of care and implementing
mechanisms for ensuring that the standards are met.

- Coyne C. Killien M

6) Quality circle
Quality circle is a small group to perform quality control activities
within the same work place.

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 7) Nursing audit
It is a detailed review and evaluation of selected clinical records in
order to evaluate the quality of nursing care and performance by
comparing it with accepted standards.

8) Peer Review

An organized system by which peer professionals assess the quality of

care being delivered.

9) Credentiality
It is the formal recognition of professional or technical competence
and attainment of minimum standards.

10) Accreditation
It is the act of granting credit or recognition especially to an
educational institution that maintains suitable standards.

11) Licensure

It is usually a governmental / council approach to ensuring that

individuals and organizations meet minimum standards to protect the
health and well-being of the public.

3. DEFINITION:

QUALITY ASSURANCE IN NURSING

1) Quality assurance is a program adopted by an institution that is

designed to promote the best possible care
- Deloughery
2) Quality assurance is a judgement concerning the process of care based
on the extent to which that care contributions to valued outcomes.
- Donabedian, 1982.

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 3) Quality assurance is an ongoing, systematic comprehensive evaluation of
health care services and the impact of those on health care services.
- Kozhier
4. HISTORY OF QUALITY ASSURANCE IN NURSING:

Quality assurance have been evident in nursing since the days of Florence
Nightingale. She was a pioneer in setting standards for nursing care. In 1854
Florence Nightingale a leading nurse during the European Crimean war was the
first to notice the positive correlation between the introduction of adequate
nursing care to wounded soldiers and decrease in mortality rate among the
group.

In 1900’s efforts were begun to set similar standards for all nursing
schools by various accrediting organization two of the most influential
organization are
I. ANA – American Nurses Association (1890)

II. NLN – National League for nursing (1952)

In 1972, the joint commission on accreditation of hospitals (JCAHO)

clearly stated the responsibilities of nursing in its description of standards
for nursing services.
In mid-1980 JCAHO began to control developing quality control
standards for home health nursing and hospital nursing.
1972 – Professional standards review organization (PSRO)
1974 – Health maintenance organization.
1983 – Diagnosis related grouping and prospective payment system.
1984 – peer review organization.

1986 – National health quality improvement

1986 – In India, A consumers protection act was implemented.

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5. NEED FOR QUALITY ASSURANCE IN NURSING:

Professional factors:

Code of conduct

 Autonomy
 Accountability
 Inter-professionalism
 Moral issues

Economic factors

 Demographic changes
 Resource-distribution

Social/political factor

 Public awareness
 Social expectation
 Legislation
 Accreditation
 International pressure

6. PURPOSES OF QUALITY ASSURANCE IN NURSING:

 To introduce code of ethics and professional conduct for nurses in India

to the nursing personnel.
 To prepare nursing personnel for implementation of quality assurance
model in nursing.
 It is to improve development and testing processes to prevent defects
from arising during the product development lifecycle.
 To increase complex of health care organizations
 Improvement of job satisfaction.

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  Highly informed consumers.
 To prevent rising medical errors.
 Accreditation bodies.

7. OBJECTIVES OF QUALITY ASSURANCE IN NURSING:

According to Jonas (2000), the two main objectives are:

 To ensure the delivery of quality patient care.

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

Other objectives are:

 To formulate plan of care.

 Attend the patients physical and non-physical needs.

 Evaluate achievement of nursing care

 To support delivery of nursing care with administrative and managerial

services.

8. PRINCIPLES OF QUALITY ASSURANCE IN NURSING:

1. Customer focus: It focuses on patient’s care with standard and recent

medical knowledge.
2. Leadership: It helps to inculcate qualities of leadership in staff.
3. Involvement of people: It should involve maximum nursing staff so that
standards can be maintained.
4. Process approach: There should be a systematic and planned approach
to provide quality care.
5. Factual approach to decision making: There should be fact or
appropriate reason in taking certain decision for quality assurance of
patient.

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9. APPROACHES TO QUALITY ASSURANCE:

1. Methods for measuring performance:

As a nursing care is delivered within a framework of independent
relationships with physicians and a multiplicity of other health care personnel.
The most commonly used methods of nursing care are task analysis and quality
control.
2. Measuring actual performance:
It is an ongoing repetitive process with the actual frequency dependant on
the type of activity being measured. It is better to clarify the purpose of the
measurement and to measure performance on a continuous basis.
3. Comparing results of performance with standards and objectives
and identifying strengths and areas for correction:
The standards and objectives and methods of measurement have been set,
if performance matches standards and objectives, managers may assume that
things are under control if performance is a contrary to standards and objectives,
action is necessary.
4. Acting to reinforce strengths or success and taking corrective action
as necessary:
Positive aspects needed to be identified in order that they may be
translated into encouragement and motivation for the nursing members involved
in achieving them.
10. DEVELOPMENT OF A QUALITY
ASSURANCE PROGRAM:
 Foster commitment of quality.
 Conduct a preliminary review of quality related activities.
 Develop the purpose and vision for the quality assurance effort.
 Determine level and scope of initial quality assurance activities.
 Assign responsibility for quality assurance.
 Allocate resources for quality assurance.
 Develop a written quality assurance plan.
 Critical management system.
 Disseminate quality assurance experience.
 Manage change.

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11. APPROACHES FOR A QUALITY ASSURANCE PROGRAM:

Two major categories of approaches exist in quality assurance they are

1. General.

2. Specific.

1) General Approach:

It involves large governing of official body’s evaluation of a persons or

agency’s ability to meet established criteria or standards at a given time.

A.) Credentialing:

A person generally defines it as the formal recognition of

professional or technical competence and attainment of minimum
standards by a person or agency According to Hinsvark (1981)
credentialing process has four functional components

a) To produce a quality product

b) To confer a unique identity

c) To protect provider and public

d) To control the profession.

B.) Licensure:

Individual licensure is a contract between the profession and the state,

in which the profession is granted control over entry into and exists from
the profession and over quality of professional practice. The licensing
process requires that regulations be written to define the scopes and limits
of the professional’s practice. Law has mandated licensure of nurses since
1903.

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 C.) Accreditation:

National league for nursing (NLN) a voluntary organization has

established standards for inspecting nursing education’s programs. In the
part the accreditation process primarily evaluated on agency ‘s physical
structure, organizational structure and personal qualification. In 1990
more emphasis was placed on evaluation of the outcomes of care and on
the educational qualifications of the person providing care.

D.) Certification:

Certification is usually a voluntary process with in the professions. A

person’s educational achievements, experience and performance on
examination are used to determine the person‘s qualifications for
functioning in an identified specialty area.

2) SPECIFIC APPROACHES:

Quality assurances are methods used to evaluate identified instances of

provider and client interaction.

i. Peer review
To maintain high standards, peer review has been initiated to carefully
review the quality of practice demonstrated by members of a professional
group. Peer review is divided in to two types. One centres on the
recipients of health services by means of auditing the quality of services
rendered. The other centres on the health professional by evaluating the
quality of individual performance.
ii. Audit as a tool for quality assurance

Nursing audit may be defined as a detailed review and evaluation of

selected clinical records in order to evaluate the quality of nursing care and
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 performance by comparing it with accepted standards. To be effective a
nursing audit must be based on established criteria and feedback mechanism
that provide information to providers on the quality of care delivered. To
evaluate quality nursing care regularly, many staff nurses do indeed welcome
opportunity to develop criteria, to review nursing care retrospectively and
concurrently, and to discover methods of achieving higher levels of quality
nursing care.

iii. Utilization Review (UR):

Utilization review activities are directed towards assuring that care is

actually needed and that the cost appropriate for the level of care provided.

Three type of Utilization Review (UR) is there:

a) Prospective: It is an assessment of the necessity of care before

giving service.
b) Concurrent: A review of the necessity of care while the care is
being given.
c) Retrospective: Is analysis of the necessity of the services received
by the client after the care has being given. U.R has been used
primarily in hospitals to establish need for client admission and the
length of hospital stay. The UR process includes the development of
explicit criteria that serves as indicators of the need for services and
length of services.

Advantages of utilization review:

1. It is designed to assist clients to avoid unnecessary care.

2. It may serve to encourage the consideration of care options by
providers, such as home health care rather than hospitalization
3. It can provide guidelines for staff of program development.

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 4. It provides a measure of agency accountability to the consumer.

The major disadvantage to UR is that not all clients are fit for the classic
picture presented by the explicit criteria that serves as the basis for approval or
denial of care.

iv. Client satisfaction:

a. Client satisfaction can be assessed using person or telephone
interviews and mailed] questionnaire. Data from client satisfaction
surveys are used to measure structure, process and outcome of care
givers.
v. Incident review:

During a patient ‘s hospitalization several incidents may occur which

have a bearing on the treatment and patient’s final recovery. The critical
incidents may be: -

Delayed attendance by a physician /nurse.

In correct medications.
Lack of cleanliness and asepsis leading to infection.
Carelessness in carrying out nursing procedures e.g. Hot and cold
applications.
The report should contain the name, age exact time and place,
description of how it occurred any precaution taken, conditions of
patient before and after the incident etc. since these reports are of
legal value it should be written carefully given importance to all the
details and should be filed safely.

vi. Risk management: It can be defined in a program that is developed for

propose of eliminating or controlling health care situations that has the
potential to inure endangers or create risk to clients.

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 a. The philosophical intent of such a program would be to do the
client no harm that is to administer safe care of whichever clients,
groups or populations are being served. Risk management
activities are directed towards the identifications, analysis and
evaluation of situations to prevent injury and subsequent financial
loss.
vii. Malpractice litigation:
a. It is a specific approach to be imposed on the health care delivery
systems by the legal systems. Malpractice litigation results from
client dissatisfaction with the provider and with the content of care
received.

12. MODELS OF QUALITY ASSURANCE:

12.1 A System Model for implementation of unit Based Quality assurance:

The implementations of the unit-based quality assurance program, like

that of any other program, and involve making changes in organizational
structure and individual roles. One method of facilitating and structuring the
change process is the system approach in which the task is broken down into
manageable components based on defined objectives.

The basic components of the system are

1. Input.
2. Throughput.
3. Output.
4. Feedback.
 Input: The input can be compared to the present state of systems.
 Throughput: It is developmental process.
 Output: It is finished product or result.
 Feedback: It is essential component of system because it maintains

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and nourishes growth.

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12.2 ANA Quality Assurance Model:

The ANA has developed QA model in 1977 which has wide spread
applicability in any healthcare setting and can be used as guide to implement
QA program.

The first step in developing QA program is continuing education. Many

staff nurses and supervisors have not been prepared in the academic setting to
develop standards of practice when a quality assurance program is
implemented, the continuing education needs of all staff should be ascertained.
Quality is not assured if only a small committee evaluates care and understands
quality assurance program.

The basic components of the ANA model can be summarized as follows: -

Reeval Identify
uation values
Identify
Take
standards &
action
criteria

Choose Secure
action measurement
Identify Make
course of measure
action ment

1) Identify values

2) Identify structure, process and outcome standards and criteria

3) Select measurement

4) Make interpretation
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 5) Identify course of action

6) Choose action

7) Take action

8) Revaluate

1) Identify Value: In the ANA value identification looks as such issue as

patient/client, philosophy, needs and rights from an economic, social,
psychology and spiritual perspective and values philosophy of the health
care organization and the providers of nursing services.

2) Identify structure, process and outcome standards and criteria:

 Identification of standards and criteria for quality assurance begins

with writing of philosophy, an objective of organization.
 The philosophy and objectives of an agency serves to define the
structural standards of the agency.
 Standards of structure are defined by licensing or accrediting agency.
 Evaluation standard of structure includes the organizational chart,
which shows supervisory methods, communication patterns, staff
patterns and sometimes staff assignments. A group internal or
external to the agency does evaluation of the standards of structure.
 The evaluation of process standards is a more specific appraisal of
the quality of care being given by agency care provides.

An agency can choose to use the standards of care set forth by the
providers, professional organization such as the ANA nursing standards or the
agency can use the nursing process and apply it to the activities of the nurses as
the activities correspond to the procedures of care defined by the agency. The
primary approaches for process evaluation include the peer review committee
and the client satisfaction survey. The techniques included are direct

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observation, questionnaire, and interview, written audit and videotape of client
and provide encounter.

The evaluation of outcome standards reveals the end results of nursing care.
To be able to identify the net changes in the client‘s health status as a result of
nursing care will give nursing profession data to show the contributors of
nursing to the health care delivery system. Research studies using the tracer
method or the sentinel method to identify client outcomes and client satisfaction
surveys are approaches that may be used to evaluate outcome standards.
Technique used in client classification systems that are admission data of the
clients, level of dependence or problems and discharge data that may show
changes in the level of dependence.

3) Select measurement needed to determine degree of attainment of criteria

and standards:

 Measurements are those tools used to gather information or

data, determined by the selections of standards and criteria.
 The approaches and techniques used to evaluate structural standards
and criteria are, nursing audit, utilization ‘s reviews, review of agency
documents, self-studies and review of physicals facilities.
 The approaches and techniques for the evaluation of process standards
and criteria are peer review, client satisfactions surveys, direct
observations, questionnaires, interviews, written audits and videotapes.
 The evaluation approaches for outcome standards and criteria
include research studies, client satisfaction surveys, client
classification, admission, readmission, discharge data and morbidity
data.

4) Make interpretations:

 The degree to which the predetermined criteria are met is the basis
for interpretation about the strengths and weaknesses of the program.
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  The rate of compliance is compared against the expected level of
criteria accomplishment.

5) Identify Course of Action:

 If the compliance level is above the normal or the expected level, there
is great value in conveying positive feedback and reinforcement.
 If the compliance level is below the expected level, it is essential
to improve the situations.
 It is necessary to identify the cause of deficiency. Then, it is important
to identify various solutions to the problems.

6) Choose action:

Usually, various alternative course of action are available to remedy a

deficiency. Thus, it is vital to weigh the pros and cons of each alternative while
considering the environmental context and the availability of resources. In the
recent findings if more than one cause of the deficiency has been identified;
action may be needed to deal with each contributing factor.

7) Take Action:

 It is important to firmly establish accountability for the action to be taken.

 This step then concludes with the actual implementation of the
proposed courses of action.

8) Revaluate:

 The final step of QA process involves an evaluation of the results of the

action.
 The reassessment is accomplishment in the same way as the
original assessment and begins the QA cycle again.
 Careful interpretation is essential to determine whether the course
of action has improved the deficiency or the deficiency was
remedied,
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 positive reinforcement is offered to those who participated and the
decision is made about when to again evaluate that aspect of care.
 If the deficiency is not remedied, the problem-solving process is repeated.

12.3 DONABEDIAN MODEL

Donabedian quality framework is recognized as a method of measuring

quality as structure, process and outcome in the mid of 1960’s. Structure leads
to process, and process leads to outcome.

a) Structural evaluation:

This method evaluates the setting and instruments used to provide care such
as facilities, equipment’s and characteristics of the administrative organization
and qualification of the health providers. The data for structural evaluations
can be obtained from the existing documents of an agency or from an inspector
of a faculty.

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b) Process evaluation:

This method evaluates activities as they relate to standards and expectations

of health provider in the management of client care, data for this can be
collected through direct observations of provider encounters and review of
records, audit, check list approach and the criteria mapping approach are used to
establish the client encounter protocol.

c) Outcome Evaluation:

The net changes that occur as a result of health care or the net results of
health care. The data of this method can be collected from vital statistical
records such as death certificates or telephone client interviews, mailed
questionnaire and client records.

12.4 WILSON (1987) MODEL

He redefined it as inputs, methods or procedure and outcomes. He described

inputs as people, equipment and environment, Eg. The resources need to attain a
defined level of care. Methods or procedure became the everyday practice that
is required, Eg. The professional or technical skill or expertise. Outcomes are
the targets of care or services as measured by productivity, quality, and client
satisfaction.

12.5 QUALITY HEALTH OUTCOME MODEL

According to this model, there are dynamic relationships with indicators that
not only act upon, but also reciprocally affect the various components.

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 System

Individual, group, organization

Intervention Outcome

Clients

(Individual, Family & community)

12.6 QUALITY MANAGEMENT MODEL

This model is based on ‘Theory Q’, because it contains two fundamental ideas
about cause and effect in long term care:

a) The higher the quality of care received by the patient, the higher his or
her level of functioning.

b) the higher the level of quality of life experienced by the patient, the
higher his or her level of experiences.

ASSESSMENT CARE PLANNING SERVICE DELIVERY

QUALITY ASSURANCE -

Standards

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12.7 FOCUS-PDCA MODEL FOR QUALITY IMPROVEMENT

FOCUS-PDCA is one of the easiest and most used tools to improve quality
in the CQI process. It’s a simple tool that can be used for any quality
improvement undertaking.

F – Find a process to improve

O – Organize a team that knows the process at

hand C – Clarify current knowledge of the said

process U – Understand all sources of variation

S – Select the improvement

P – Plan the improvement, and continue collecting data

D – Implement the improvement, and collect and analyze the data

C – Check and study the results

A – Take steps to sustain any gains from the improvement, and continue
improving

12.8 JOINT COMMISSION 10 STEP MODEL

1. Establish responsibility and accountability for a Q.I program.

2. Define the scope of service for a clinical area

3. Define the key aspects of service for the clinical area.

4. Develop quality indicators to monitor the outcomes

and appropriateness of care delivered.

5. Establish thresholds for evaluation of indicators.

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 6. Collect and analyse data from monitoring activities.

7. Evaluate results of monitoring activities to determine the need

for change in practice.

8. Resolve problems through development of action plans.

9. Revaluate to determine if the plan was successful

10. Communicate Q.I results to the organization

12.9 QUALITY CARING MODEL

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12.10 MARKER’S UMBRELLA MODEL

The marker model is a system for providing continuity, consistency and

competency in clinical patient care. The goal is to provide the above by
developing a structure to standardize professional nursing clinical practice,
while maximizing patient outcomes, preventing untoward occurrence, and
controlling healthcare costs. The model describes connecting characteristics for
a comprehensive quality assurance model are:

 Standard development
 Continuous advanced training
 Confirmation of technical authority
 Evaluation of the execution of cares measures
 Examination
 Parallel examination
 Risk management
 Control of the demand resources
 Active problem identification.

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13. FACTORS AFFECTING QUALITY ASSURANCE IN
NURSING CARE:

13.1) Lack of Resources:

Insufficient resources, infrastructures, equipment, consumables, money for

recurring expenses and staff make it possible for output of a certain quality to be
turned out under the prevailing circumstances.

13.2) Personnel problems:

Lack of trained, skilled and motivated employees, staff indiscipline affects

the quality of care.

13.3) Improper maintenance: Buildings and equipment’s require

proper maintenance for efficient use. If not maintained properly the
equipment’s
cannot be used in giving nursing care. To minimize equipment down time it is
necessary to ensure adequate after sale service and service manuals.

13.4) Unreasonable Patients and Attendants:

Illness, anxiety, absence of immediate response to treatment, unreasonable

and uncooperative attitude that in turn affects the quality of care in nursing.

13.5) Absence of well-informed population:

To improve quality of nursing care, it is necessary that the people become

knowledgeable and assert their rights to quality care. This can be achieved
through continuous educational program.

13.6) Absence of accreditation laws:

There is no organization empowered by legislation to lay down standards in

nursing and medical care so as to regulate the quality of care. It requires a
legislation that provides for setting of a stationary accreditation / vigilance
authority to
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 a) Inspect hospitals and ensures that basic requirements are met.

b) Enquire into major incidence of negligence

c) Take actions against health professionals involved in malpractice

13.7) Lack of incident review procedures:

During a patient ‘s hospitalizations reveal that incidents may occur which

have a bearing on the treatment and the patient’s final recovery. These critical
incidents may be

a) Delayed attendance by nurses, surgeon, physician

b) Incorrect medication

c) Burns arising out of faulty procedures

d) Death in a corridor with no nurse / physician accompanying the patient etc.

13.8) Lack of good and hospital information system:

A good management information system is essential for the appraisal of

quality of care.

a) Workload, admissions, procedures and length of stay

b) Activity audit and scheduling of procedures.

13.9) Absence of patient satisfaction surveys:

Ascertainment of patient satisfaction at fixed points on an ongoing basis.

Such surveys carried out through questionnaires, interviews to by social worker,
consultant groups, and help to document patient satisfaction with respect to
variables that are

a) Delay in attendance by nurses and doctors.

b) Incidents of incorrect treatment

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13.10) Lack of nursing care records:

Nursing care records are perhaps the most useful source of information on
quality of care rendered. The records.

a) Detail of the patient condition.

b) Document all significant interaction between patient and the

nursing personnel.

c) Contain information regarding response to treatment.

d) Have the dates in an easily accessible form.

13.11) Miscellaneous factors:

a) Lack of good supervision.

b) Absence of knowledge about philosophy of nursing care.

c) Lack of policy and administrative manuals.

d) Substandard education and training.

e) Lack of evaluation technique.

f) Lack of written job description and job specifications.

g) Lack of in-service and continuing educational program.

14. ROLE OF NURSE IN QUALITY ASSURANCE

 Nurses are the active participant of interdisciplinary quality

improvement team.

 Develop mechanism for continually monitoring the effectiveness of

nursing care both a collaborative and an individual professional
activity

 Contribute innovations and improvement of patient care

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 Participate in improvement projects and patient safety initiatives

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  Participate in CNE and Inservice educational programs for continuing
professional development.

 Periodic and continuing appraisal and evaluation of health care

situation of the patient.

 Participate research works related to quality assurance

 Identify the area of needed improvement in delivery of care.

15. JOURNAL ABSTRACT

‘Quality Assurance in Nursing Education: A Qualitative Study Involving

Students and Newly Graduated Nurses’

ABSTRACT:

Background: Assuring quality training for future nursing professionals is

essential to preserving population health and socio-economic development.
Quality assurance in the European Higher Education Area places students in a
leading role to transform and improve higher education programs. Therefore, an
innovative way of reviewing strengths and weaknesses of the nursing education
program of a Spanish university has been developed.

Objectives: The aim of this paper was to explore the perceptions and opinions
of nursing students and newly-qualified nurses regarding the contents of the
nursing curriculum in order to improve its quality.

Methods: Descriptive and exploratory qualitative research was carried out

involving 12 newly-qualified nurses and 12 student nurses. Semi-structured
interviews and focus groups were performed.

Results: Based on the thematic analysis, two themes emerged: improving

clinical practices and reviewing the theoretical curriculum.

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 Conclusions: Among the improvements suggested by the participants, the most
relevant ones were establishing a clear structure of learning contents in the
practicum, and redistributing the European Credit Transfer and Accumulation
System ECTS credits in various courses of the study program. However,
additional evidence is needed prior to proceeding with any changes.

Keywords: education, nursing, nursing education research, nurses, qualitative

research, students, nursing

16. THEORY APPLICATION

I have applied General System Theory by Ludwig Von Bertalanffy

(1969), which was explained by Putt AM (1978).

INPUT THROUGHPUT OUTPUT

Assess and analyze: Implement and Health care quality
Collect and organize intervene: Put your improvement, patient
data about the actual or plan into action safety and customer
potential needs for satisfaction with
quality improvement. expertise in infection
Plan and prioritize: control, medication
Formulate your plan. management,
This involves devising accreditation standards
goals and expected compliance, and
outcomes, setting
accreditation systems
priorities, and
identifying interventions development

FEED BACK

Evaluate: Assessyour
outcomes and see how they measure against the goals

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16. SUMMARY

Till now I have discussed about “ QUALITY ASSURANCE IN

NURSING” introduction of quality assurance in nursing, terminologies,
history, definition of quality assurance, purpose, objectives and principles of
quality assurance, approach for a quality assurance program, models of quality
assurance ie 10 model ( system mode, ANA model, Donabedian model,
Wilson’s model, quality outcome mode, quality care model, FOCUS- PDCA
model, joint commission model, maker’s umbrella model, factors affecting the
quality assurance and last the role of nurse in quality assurance.
17. CONCLUSION

I conclude my seminar topic “Quality Assurance in Nursing” that quality

assurance program is an ongoing, systematic process designed to evaluate and
promote excellence in the health care provided to clients. Quality assurance
frequently refers to evaluation of the level on care provided in a health care
agency, but it may be limited to the evaluation of the performance of one nurse
or more broadly involve the evaluation of the quality of the care in an agency,
or even in a country. I hope you all understood this seminar briefly and clearly.

18. BIBILIOGRAPHY

Book reference

 Nisha Clement, “Essentials of Management of Nursing Service

and Education”, Jaypee Publication, 1st Edition, Page no: 380-393.
 Clement, “Management of Nursing Service and Education”, Elsevier
Publication, 2nd Edition, Page no: 281-288.
 Neelam Kumari, “Advance Nursing Practice”, Pre-Vee Publication, 1st
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 ‘Quality Assurance in Nursing Education: A Qualitative Study

Involving Students and Newly Graduated Nurses’, Published online on
29th Dec 2019 in International journal of Environmental Research and
Public Health, Volume: 17, Issue:1, Page no: 240.

Net reference

 http:// www. Slideshare.com/ Quality Assurance in Nursing

 https:// www.researchgate.net

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