India is one country which is
growing in the medical world and patients from different parts of the world are
coming to India for treatment. Apollo group of hospitals, Fortis, National
Institute of Mental Health and Neuro Sciences, Christian Medical College are
some of the good hospitals. In the past few years, there has been great
pressure to improve the quality of nursing care in India. Because nurses are
integral part of the hospital and play a pivotal role in patient care, a need
is always felt to make improvements in nursing practice.
The purpose of nursing
profession is to provide safe, competent and ethical nursing with compassion,
comfort, collaboration and knowledge. For this a nurse needs to have clinical
judgement, right attitude, good communication skills, and knowledge regarding
care.
The standards are the pre
requisites to promote good nursing care and they act as a catalyst for self
regulation and improvement also. So guidelines are laid down for evaluating the
nursing services and they are applicable to all the health care organizations.
In this context India has also tried to improve its standards in the field of
healthcare, so that “Tourism Healthcare Industry” could boom. In America Magnet
status hospitals are considered as the standard hospitals with best nursing
care and an inspiration is sought from this.
Aim of nursing services: To
provide comprehensive nursing care in terms of health promotion, prevention of
diseases and therapeutic nursing care to the patients in a HCO as well as to the
community.
Objective of the nursing
professional: To provide safe, competent and ethical nursing
care with compassion, comfort and collaboration with the patients, the family,
the community and the clinical care team.
Role of a Nurse: Nurses
are - The key caregivers in hospitals, Integral to hospitalized patients’ care,
Pivotal in hospital efforts to improve quality, Cornerstone of any quality
related programme, Making all the difference in the ultimate delivery of health
care.
The 1st edition of nursing
excellence standards is divided into 07 chapters, focusing on various
professional, administrative and governance aspects of nursing. Seven chapters
are further divided into 48 standards. Put together there are 216 objective
elements incorporated within these standards. Objective elements are required
to be complied with in order to meet the requirement of a particular standard.
Similarly, standards are required to be complied with, in order to meet the
requirement of a particular chapter. Finally all chapters are deciding factor
to say whether a hospital is meeting the requirements of the certification
program. In the beginning of each chapter, intent is given to highlight the
summary of the chapter. For most of the objective elements, interpretation is
provided just to further elaborate on how that objective element can be met.
Benefits for Patients:
- Patients are the biggest beneficiary among all the stakeholders
- The patients are serviced by credential nursing staff which results in high quality of care and patient safety
Benefits for Hospitals:
- This certification programme stimulates continuous improvement.
- It enables Hospital in demonstrating commitment to quality care.
- It raises community confidence in the services provided by the hospital
- It also provides opportunity to
- Healthcare unit to benchmark with the best.
Benefits for Nursing Staff:
- An environment that recognizes and rewards competence
- Professional growth and development by educational opportunities and support
- A structure that encourages decision making at the bedside over clinical issues
- High job satisfaction
- Low turnover and more stability
- Focus on professional autonomy
- Enhanced Interdisciplinary collaboration
- Professional growth opportunities
- Leadership opportunities
- Opportunity to practice professional nursing with strong interdisciplinary teamwork that support autonomous practice of nursing
- A culture that supports you to be the best
Chapters of NABH Standards for
Nursing Excellence:
Chapter:1 Nursing Resource
Management (NRM)
Chapter:2 Nursing Care of
Patient (NCP)
Chapter:3 Management of
Medication (MOM)
Chapter:4 Education,
Communication and Guidance (ECG)
Chapter:5 Infection Control
Practices (ICP)
Chapter:6 Empowerment and
Governance (EG)
Chapter:7 Nursing Quality
Indicators (NQI)
Chapter:1 Nursing Resource
Management (NRM):
Nursing staff is the most
important resource of a hospital and healthcare system. The goal of nursing
resource management is to acquire, provide, retain and maintain competent staff
nurse in right numbers to meet the needs of the patients and community served
by the organization.
Training and development of
the nursing staff must be in consonance with the expected performance in the
present and future anticipated jobs. The nursing professionals shall be
provided with opportunities for professional advancement. The organization
shall lay down the job description and procedures for credentialing and
privileging of the nursing staff.
Chapter:2 Nursing Care of
Patient (NCP):
The standard aims to guide and
encourage patient safety and quality care as the overall principle for
providing nursing care to patients.
The organization supports
nursing service to provide systematic method of nursing care with specific
emphasis on Assessment, Planning, Implementation and Evaluation. Nursing care
is preventive, promotive, curative and rehabilitative in nature. Patient-centred
care supports active involvement of patients and their families in the design
of new care models and in decision-making about individual options for
treatment.
The registered nurse, in
collaboration with the patient, family and other team members assesses, makes
decisions, plans, implements, evaluates, and documents nursing care based on
reflection, current knowledge, and best practices.
Policies and procedures in
concurrence with the laws and regulation guide the nursing services in all
functional units applicable in the organization.
Chapter:3 Management of
Medication (MOM):
Designated nursing personnel
shall be consulted during policy formulation pertaining to pharmacy and
management of medication. The nursing staff will ensure availability, safe
storage, administration of medications and monitoring the effects of
medication.
The nursing personnel should
have an oversight of all medications stocked in the ward and other clinical
areas and should ensure good inventory control practices including correct
storage (as regards to temperature, look-alike, sound-alike etc.), monitoring
expiry dates and maintenance of documentation in the clinical areas.
The availability of emergency
medication is stressed upon.
Every high-risk medication
order should be verified by an appropriate person so as to ensure accuracy of
the dose, frequency and route of administration.
Chapter:4 Education,
Communication and Guidance (ECG):
The organization shall ensure
that nursing professionals are trained in communication skills.
Patients are
informed of their rights and educated about their responsibilities at the time
of admission. They are informed about the disease, the possible outcomes and
are involved in decision making. The patients are educated about the mechanisms
available for addressing grievances.
Patient and families have a
right to information and education about their healthcare needs in a language
and manner that is understood by them and proper timely guidance shall be given
by the nursing staff.
Chapter:5 Infection Control
Practices (ICP):
The standards guide the
provision of an effective infection control programme in the organization.
There shall be a designated Infection control nurse.
The organization provides
proper facilities and adequate resources to support the Infection Control
Practices.
The practices includes an
action plan to minimize hospital acquired infections, control outbreaks,
disinfection/ sterilization activities and their monitoring, biomedical waste
(BMW) management, employee health and training of nursing staff.
Chapter:6 Empowerment and
Governance (EG):
The standards encourage the
governance of the organization in a professional and ethical manner. The
responsibilities of all the Nursing professionals performing management
functions are defined.
The Nursing Service is led by
qualified professionals with desired experience. Nursing professionals are
involved in decision making processes. They are encouraged to participate in
organization decision making groups and committees. There is a commitment to
support and reward nursing staff from time to time.
Nursing professionals at the
bedside are empowered to take decision to meet the needs of patients in
collaboration with the care provider team. Nursing professionals at the bed
side participate in plan of treatment and discharge plan by the medical team.
Leaders ensure that
patient-safety and risk-management issues are an integral part of patient care
and hospital management.
Chapter:7 Nursing Quality
Indicators (NQI):
Nursing care quality improvement
programme should be documented and involve all areas of the organization and
all essential nursing staff members. The organization should collect data on
structures, processes and outcomes, in nursing care areas. The collected data
should be collated, analysed and used for further improvements. The
improvements should be sustained.
Excellent nursing practice is
a reflection of sound ethical standards. The registered nurse systematically
enhances the quality and effectiveness of nursing practice by demonstrating
quality, by documenting the application of the nursing process in a
responsible, accountable and ethical manner and by using quality improvement
activities to initiate changes in nursing practice and health care delivery
system.
A system for monitoring and
measurement of nursing quality parameters shall be established by the
organization. Statistical review and analyses of trends shall be reviewed by
the Organization in order to use these as tools to aim for excellence in
nursing care delivery and satisfaction with nursing care amongst patients,
thereby contributing to overall improvement in quality of care that every
patient receives.
Written by:
Dr. Praveen Bajpai
Director of Ingenious Healthcare Consultants Pvt. Ltd.
Founder of Skill Sathi
MBA in Hospital administration, PG Diploma in Quality Accreditation, PG Diploma in Medico Legal System, M. Phil in Hospital Mgmt. from BITS Pilani, P.hD in Management, Certified NABH Auditor, Certified NABL Auditor, Certified Auditor for Clinical Audits, Green Belt in Six Sigma, Certified in Hospital Infection Control Practices, Certified trainer for International Patient Safety Goals, Certified Auditor for JCI 7th Edition Standards
www.skillsathi.in
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