INTRODUCTION:

Quality assurance provides the mechanisms to effectively monitor patient care provided by health care professionals using cost-effective resources. Quality assurance system motivates nurses to strive for excellence in delivering quality care. Nursing Programmes of quality assurance are concerned with the quantitative assessment of nursing care as measured by proven standards of nursing practice.

DEFINE QUALITY ASSURANCE:

Quality Assurance is the maintenance of a desired level of quality in a service or education or product, especially by means of attention to every stage of the process of delivery or production.

Quality Assurance is a systematic review of educational programs to ensure that acceptable standards of education, scholarship and infrastructure are being maintained.

OBJECTIVES OF QUALITY ASSURANCE:

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

· To Ensure the delivery of Quality client care

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

Other specific objectives are:

· Formulate plan of care

· Attend the patients physical and non-physical needs

· Evaluate achievement of nursing care

· Support delivery of nursing care with administrative and managerial services

APPROACHES OF QUALITY ASSURANCE:

Two major categories of approaches exist in quality assurance they are

· General

· Specific

General Approach:

Credentialing:

Credentialing process has four functional components

· To produce a quality product

· To confer a unique identity

· To protect provider and public

· To control the profession

Licensure:

The licensing process requires that regulations be written to define the scopes and limits of the professional’s practice.

Accreditation:

· ISO

· JCI

· NABH

· Accreditation Canada

· NAAC

Certification:

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.

Specific approaches:

1. Peer review ANA Standard as a device for quality assurance

1) Audit as a tool for quality assurance

The ANA standard for practice include

Standard 1: The collection of data about health status of the patient is systematic and continuous. The data are

accessible, communicative and recorded.

Standard 2: Nursing diagnosis are derived from health status data.

Standard3: The plan of nursing care includes goals derived from the nursing diagnoses.

Standard4: The plan of nursing care includes priorities and the prescribed nursing approaches or measures to

achieve the goals derived from the nursing diagnoses.

Standard 5: Nursing actions provide for patient participation in health promotion, maintenance, and restoration.

Standard 6: Nursing actions assist the patient to maximize his health capabilities.

Standard 7: The patient’s progress or lack of progress towards goal achievement is determined by the patient and the nurse.

Standard 8: The patient’s progress or lack of progress towards goal achievement directs re-assessment, re-ordering of priorities, new goal setting, and a revision of the plan of nursing care.

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 performance by comparing it with accepted standards.

MODELS OF QUALITY ASSURANCE:

SYSTEM MODEL:

The basic components of the system are

1. Input

2. Throughput

3. Output

4. Feedback

The input can be compared to the present state of systems, the throughput to the developmental process and output to the finished product. The feedback is the essential component of the system because it maintains and nourishes the growth.

aNA Quality Assurance Model:

FIGURE: 1

QUALITY ASSURANCE PROCESS:

· Establishment of standards or criteria

· Identify the information relevant to criteria

· Determine ways to collect information

· Collect and analyze the information

· Compare collected information with established criteria

· Make a judgment about quality

· Provide information and if necessary, take corrective action regarding findings of appropriate sources

· Determine ways to collect the information

FACTORS AFFECTING QUALITY ASSURANCE IN NURSING CARE:

· Lack of Resources.

· Personnel problems

· Improper maintenance

· Absence of accreditation laws

· Lack of incident review procedures

· Lack of good and hospital information system

· Lack of nursing care records

· Lack of good supervision

· Absence of knowledge about philosophy of nursing care

· Lack of policy and administrative manuals.

· Substandard education and training

· Lack of evaluation technique

· Lack of written job description and job specifications

· Lack of in-service and continuing educational program

IMPACT OF ISO IN A LOCAL HOSPITAL:

Positive impacts:

· Nurses are accountable for their actions and, professionally we have responsibility to evaluate the effectiveness of our care

· Nurses can deliver a high standard of care, and being empowered to identify and resolve problems can add to personal satisfaction with work

· Documents state clearly how the health service should perform and what the patient can expect

· Guaranteeing standards of care to the public must be a duty of all those who work within the health service

· Nurses are actively involved in audit, service reviews, standard-setting and customer relations

· Improves the overall quality of nursing care

· Improves all types of documentation and communication

· Helps in professional growth

Negative Impacts:

· Lack of adequate resources

· Lack of trained, skilled and motivated employees, staff indiscipline affects the quality of care.

· ISO activities may overburden the nursing personnel.

· Nurses will not get adequate time to spent with the patient, most of the time may be spending for recording and reporting

· The hospital will be restricted only to ISO standards

· Hospital has to provide special training for all the staffs those who are involved in ISO inspection

· All types of services will be under the control of ISO

IMPACT OF ISO IN A LOCAL NURSING EDUCATIONAL INSTITUTIONS:

Positive impacts:

· Improves the quality of nursing education

· improves the quality of nursing practice

· Helps to maintain international standard

· Helps to compare the standard with another institution

· Helps in personnel development of teachers

· Helps to maintain all the records in time

· Avoids malpractice and bias

· Encourages extra-curricular activities also

· Act as a control for all the activities

· Improves professional growth

Negative impacts:

· Gives more importance to documentation

· Over-burden for the teachers

· Teachers need to take special training in maintaining the standards

· Not observing the actual practice

· Organizational philosophy and policies has to be modified according to the ISO standards

NURSES ROLE IN QUALITY ASSURANCE:

FIGURE: 2

CONCLUSION:

The Nurses Participate continuing educational programs and in- service educational programs for continuing professional development .The Periodic and continuing appraisal and evaluation of health care situation of the patient is essential and also Participate in research works related to quality assurance. Develop mechanism for continually monitoring the effectiveness of nursing care both a collaborative and an individual professional activity. Quality assurance programme will helps to improve the quality of nursing care and professional development.

ACKNOWLEDGEMENT:

The Authors Are Grateful to the authorities of Dr M.B.Sharma Nursing College, Ratlam, M.P.

CONFLICT OF INTEREST:

The Author Declare No Conflict of Interest

REFERENCES:

1. Hareesh Sasidharan (2013) objectives, models of quality assurance and quality assurance process (Internet) available from DOI NO:https: //www. slideshare.net/HareeshSasidharan/quality-assurance-2635428

2. Karen P, Corrigan P. (2011) Impact of ISO in hospital andeducational institution (Internet) available Nursing Management open access articles on nursing managementfrom: http:// currentnursing .com /nursing _management /total _quality _management _health_care.html

3. Margaretm.m.1992 ) Approches of Quality Assurance and factors affecting Quality Assurance ( Internet) Available Nursing Management open access articles on nursing management From: http:// currentnursing .com /nursing_ management /total_ quality_management_health_care.html

4. Shyamala. D. Manivannan (2016) Definition of Quality Assurance, Nursing Education and Quality Assurance In Nursing Colleges, Jaypee Brothers Medical Publishers, First Edition, Page No:248

Received on 21.08.2017 Modified on 18.09.2017

Int. J. Nur. Edu. and Research. 2018; 6(1): 57-60.

DOI: 10.5958/2454-2660.2018.00014.5