Standard

Standard is a quantitative or qualitative

measure against which someone or something is judged, compared or used to service as an example. Standards are professionally agreed levels of performance, which are achievable, and measurable

 Standard is an acknowledged measure

of comparison for quantitative or qualitative value, criterion, or norm. A nursing care standard is a descriptive statement of desired quality against which to evaluate nursing care. It is guideline. A guideline is a recommended path to safe conduct, an aid to professional performance.

CHARACTERISTICS OF STANDARDS
Objective, realistic, acceptable, achievable

and flexible. Must be framed by the members of the nursing profession. Should be phrased in positive terms like good, excellent, etc. Must be understandable and unambiguous. Must be based on current knowledge and scientific practice. Must be reviewed and revised periodically

Importance
.Standards give direction and provide

guidelines for performance of nursing staff. Standards provide a baseline for evaluating quality of nursing care Standards help improve quality of nursing care, increase effectiveness of care and improve efficiency. Standards may help to improve documentation of nursing care provided. Standards may help to determine the degree to which standards of nursing care maintained and take necessary corrective action in time.

 Standards help supervisors to guide nursing

staff to improve performance. Standards may help to improve basis for decision-making and devise alternative system for delivering nursing care. Standards may help justify demands for resources association. Standards my help clarify nurses area of accountability. Standards may help nursing to define clearly different levels of care. Major objectives of publishing, circulating and enforcing nursing care standards are to: 1. improve the quality of nursing care, 2. decrease the cost of nursing, and 3. determine the nursing negligence

PURPOSE OF STANDARDS
To evaluate the quality of nursing
practice in any setting. To compare and improve the existing nursing practice. To provide a common base for practitioners to coordinate and unify their efforts in the improvement or practice. To identify the element of independent function of nursing practices

 To provide a basis for planning and

evaluating educational program for practitioners. To inform society of our concern for the improvement of nursing practice. To assist the public in understanding what to expect of nursing practice. To assist employers to understand what to expect of Practitioners. To identify areas for developing core curriculum for practicing nurses. To provide legal protection for nurses

SOURCE OF NURSING CARE STANDARDS

Standards can be developed, established,

reviewed or enforced by: Professional organization like TNAI. Licensing body e.g. INC, statutory bodies. Institutions/Health care agencies. e.g. University Hospitals, Health Centres. Department of institutions e.g. Nursing Department. Patient care unit e.g. specific patients' unit, Medical ICU. Government units at national, state and local government units. Individual e.g. personal standards.

LEVELS OF STANDARD
: MINIMUM VS OPTIMUM Minimum standards are generally
thought to represent a level of acceptability below which they eyes on those judging, lies the unacceptable. The desirable or optimal standards, represent a degree of excellence.

Classification of Standards
There are different types of standards
used to direct and control nursing actions. 1. Normative and Empirical Standards . Normative standards describe practices considered 'good' or 'ideal' by some authoritative group. Empirical standards describe practices actually observed in a large number of patient care settings.

 the normative standards describe a

higher quality of performance than empirical standards. Generally professional organisations (ANA/TNAI) promulgate normative standards where as regulatory bodies (INC/MCI) promulgate empirical standards

2. Ends and Means Standards

The ends standards are patient-oriented;
they describe the change as desired in a patient's physical status or behaviour. The means standards are nursing oriented, they describe the activities and behaviour designed to achieve the ends standards. Ends (or patient outcome) standards require information about the patients. A means standard calls for information about the nurses performance

3. Structure,Process and Outcome Standards

Standards can be classified

and formulated according to frames of references relating to nursing structure, process and outcome,

a. Structure Standard

A structural standard involves

the 'set-up' of the institution. The philosophy, goals and objectives, structure of the organisation, facilities and equipment, and qualifications of employees are some of the components of the structure of the organisation,

 The structure is related to the

framework, that is care providing system and resources that support for actual provision of care. Evaluation of care concerns nursing staff, setting and the care environment. The use of standards based on structure implies that if the structure is adequate, reliable and desirable, standard will be met or quality care will be given.

b. Process Standards
A process standard involves the
activities concerned with delivering patient care. These are nursing oriented and referred to the behavior and actions which a nurse should carryout. Here focus is on nursing standards technique and procedures e.g. planning, implementation, nurses interaction, clients participation, communication and recording.

 Process standards help in assessing the

degree of skills with which the techniques are performed, the degree of client involvement, and interaction between nurse and client. Thus, it implies professional judgment in determining quality of nursing care/skills. Outcome identification etc. Resources. Implementation of actions. Evaluation of the results or effectiveness of nursing actions taken. Professional Performance: Performance appraisal , Education , Ethics, Research .

Nursing actions: Assessment , Diagnosis ,

c.Outcome Standards
These are patient centered or client centered. These are the description statement of result of care
for the patient and can be both qualitative and quantitative. Outcome standards are related to patients health status, such as: Self-care or disability. Morbidity or mortality status. Non-occurrence of complication and restoration of body functions, etc. The results of outcome standards may be positive or negative. If one discovers that outcomes are not according to the expectation, then one needs to scrutinize the structure and process standards e.g. patients developing infections postoperatively, explore the causes and take remedial actions accordingly.

STEPS OF STANDARD FORMULATION

Organize into small groups of nurses who

work in the same field and meet periodically. Decide on the area of nursing practice for which you want to work out standards. Review philosophy, purposes and objectives of institution. Review existing nursing care practices, nursing process and identify your client for nursing service, clients role and strategies for nursing care services. Write the statements considering all the frame of reference giving rationale and criteria i.e. assessment indicators see that standards are relevant.

 Discuss them with nursing service

administrators to get their approval. Devise a method for determining achievement of standards. It may be through the use of criteria checklist for making observation of care given; examining records; self evaluation checklist; patients opinion, etc. Determine validity by giving to the experts. Try out the standards to determine the feasibility. The standards are put into practice and quality care is audited. Updating of standards periodically with continuous renewal

LEVELS OF STANDARD SETTING

There are four levels of standard

setting: National and state level, Community level , Institution level, Department level.

CONCLUSION
The success of standard would depend
on whether they are used in an ongoing process. Set standards should be observable, attainable and measurable. They are to be compared to actual practices. Identify the strengths and weaknesses, take actions to correct deficiencies, review the effectiveness of those actions through an audit protocol derived from the standard.