Practical Standard and Quality Assurance

in Community Health Nursing

Setho Hadisuyatmana, S.Kep. Ns.

Community and Mental Health Nursing Department

University of Airlangga
Faculty Of Nursing
March – April 2010
 Our Lecture Today

Section 1. Nursing Practice Standard (NPS) in The

Community
Section 2. Quality Assurance (QA) in Community
Health Nursing
Nursing practice standard in the
community

Section 1
Preface
 Nursing practical standard became a framework for
nursing practice which has to be achieved by a nurse and
well developed to help nurse in validating the quality and
developing nursing itself.
 A practical standard as one of our professional
characteristics, needed as the quality assurance of nursing
care so that the care quality is on optimum level.
 Standard
 Giilies (1994): standard is a descriptive statement of applied appearance
level in measuring quality, structure, process and output/outcome.
 Standard is an ideal or the highest achievement level, used as the
minimum limit of acceptance level (Clinical Practice Guideline., 1990).
 While in Steven (1983) standard has 2 definitions :

1. Outcome Criteria

2. Basis in sizing phenomena or behavior.

1. Definition of NPS
 Merupakan komitmen profesi keperawatan dalam melindungi
masyarakat terhadap praktik yang dilakukan oleh anggota
profesi (DPP PPNI 1999).

 Penegasan tentang mutu pekerjaan seorang perawat yang

dianggap baik, tepat dan benar, yang dirumuskan dan digunakan
sebagai pedoman dalam pemberian pelayanan keperawatan serta
tolak ukur dalam penilaian kerja seorang perawat
2. The Objective

 Improving the nursing care quality by focusing the effort and

nurses’ motivation in achieving any purpose
 Cost efficiency by means of lessen the unnecessary activity.

 As the fundamental basis in defining nurses’ negligence as

anticipation of the un-standard relevant outcome, and
initializing nurses’ failure in fulfilling the standard of nursing
process which may endanger our clients
3. Consideration

 Resources’ quantity and quality

 Resources’ educational background

 Social/public/customer’s expectation

 Professionals’ expectation

 Potential resources
4. Nursing care standard Characteristic

 Distinctive, understandable
 Legitimate, based on fact and health believe
 Meet the social expectation as the end user of our service
 According the professional expectation due to the
principal and professions’ philosophy
 Realistic and Implementable
 Measurable, as an evaluation
5. Implication

a. Health Service sector

 Quality control

 Operational procedure (material purpose and method)

 Basic consideration on supervision and course (as

work profile and performance evaluation)
 Evaluation tools
 Information media for Administration of nursing process, Job
Desc., Staff development
 Information media for patient to build a sufficient
communication with the service (health provider) team
 As an effort to enhance social belief and appreciation to nursing.
 As the basis in identifying the debility factor which may be the
core for research in order to increase and provide a better nursing
care quality.
b. Education sector
 The consideration in curriculum development

 Basic and guidance in formulating the study purpose,

material, and method
 As a guidance of beneficial role of graduate for teacher and
the student
 As the outcome evaluation direction in practicing the
competency in the work field
 As the final assessment of course purpose achievement.

 As a tool to reach the same level of nursing service both

educational and work field.
6. Type of Nursing Practice Standard

a. Standard of Structure

The including of this kind of standard are philosophy,

nursing service goals and scope, and nurse’s role
 Philosophy : As the pointing belief giving the
purpose and direction of a nursing practice
 Cont’d
 Goal : improving both individual health status, family,
goup and community.
 Scope:

Individual level:
 Hospitalized client
 Client of public health service and outpatient
 Client at home whom dealing with health problems
 Either group or community level

Group of certain cultural and geo-social background

whom dealing with specific problem,
 Nurse’s role : Due to Lok. Nas. 1983 : Care giver,
manager, care educator and researcher.
b. Standard of Process
Visualizing how a nurse work in delivering a comprehensive nursing
process to individual client, family and community level in:

a. Caring his/her role and function

b. Understanding his/her authority and responsibility

c. Treating clients as human being and active partner in delivering

nursing process.

d. Provide a therapeutic communication

 Cont’d

 Maintaining and improving a better quality of therapeutic relationship

 Developing a good cooperation

 Delivering a solving problem method approach through nursing

process
 Involving client in delivering care

 Coordinating the whole team of health service

 Cont’d

 Providing a good documentation of the process and the

outcome of the service.
 Applying the nursing ethics

 Using concept and basic principals to educate and direct

others
c. Outcome Standard

A congruity between the outcome/output and the plan in all

phase of the process.
Which are in general:
a. Maintenance of healthy and therapeutic environment
b. Client’s adaptation to the environment
c. The improvement of client’s health status, including
physic, and psycho-social.
d. Well-prevented wounds and accidents.
e. Case finding
7. 1974 ANA’s Community Nursing Practical Standard

 Collecting a continuous systematic data of client’s health

status
 Diagnose
 Planning: Aims.
 The plan should do prior to care delivery
 Nursing intervention (Promotive, preventive, and
rehabilitative)
 Cont’d

 Nursing intervention as the effort of helping clients in

improving their health statue
 Client’s improvement to the goal achievement
 Continuous nursing assessment.
 ANA 2004
According to American Nursing Association, a
nursing practice standard is then divided into 16
standard, by their separated competencies for
general nurse and community nurse specialist.
 Standard 1-The Assessment

A community nurse assesses the

community by collecting data,
identifying resources inside the
community, certain opinion and
professional evaluation.
 Standard 2-The Community Priority and The
Diagnosis

The analyzing process of the data in classifying both

priorities and diagnosis.
The diagnosis is then validated by the superior or non-
formal social organization
 Cont’d

Standard 3-Output Identification

 The identifying process of a purposed goal in order to plan the
intervention according to the priority

Standard 4-Planning
 Developing the most suitable intervention and plan to identify
strategies and alternatives to achieve the purpose of community
 Standard 5-Implementation

Sub a-Coordination

 Coordinating programs, services, and other

activities which were planned well.

 Sub b-Health Education and
Promotion

 Cooperating as teams through education to promote and

prevent possible disease, and also a convenient

environment
 Sub c-Consultation

 Providing consultation to multi-group in the community

Sub d-Controlling Activity

 Identify, interpret, and implement the law of public health,

rule, and policy

Standard 6-Evaluation
 Evaluating the health statue of community

Standard 7-The Quality Practice

 Improving the quality and effectiveness of
nursing
Standard 8-The Education
 The community nurse has his/her acknowledgement and
competency which describe the latest community practice

Standard 9-Professional Practice Evaluation

 The Nurse evaluates his/her practice, according to the
standard and professional guidance, rules and regulations.
Standard 10-Interpersonal relationship and other health
professionals
 A community nurse should develop a conducive team-working
with the community, organization and group, professional
service, and contribute the improvement of workgroup

Standard 11-Collaboration
 With comm. representatives, organization, and other health
professionals in providing and promoting health
Standard 12-Ethics
 A Community nurse should integrate ethical values
into whole aspects of practical area.

Standard 13-Research
 The result of research is needed as a consideration in
practice improvement.
Standard 14-The use of resources
 A community nurse should consider factors
related to safety, effectiveness, cost, and
the practice impact to community in
planning and delivering the service and
program.
Standard 15-Leadership
 Leadership principal in nursing and community health should
be applied

Standard 16-Advocacy
 Advocacy and strong will is definite needs in order to protect
the health and the safety and the right of community
The End of Section 1

Any Question? ? ?
Quality Assurance in Community
Nursing

Section 2.
Preface

 QA in community nursing becomes one of the important and

basic approaching method in delivering the service to clients.
 QA approach is as valuable tool to those who manage or
organizing the service
 A qualified service always try to satisfy clients and
accentuate the outcome
 Opinion:
What is quality? What is Assurance?

Then Quality Assurance is?
 Definition
Quality:

The entire characteristic of good or service which represents

its ability in satisfying customers need, either explicit or
implicit.
 The Dimension of Quality in Health
Service

Technical Competency Dimension

 Related to how the health service provider obey the health
service standard, including obedience, accuracy, trust, and
consistency.

Accessibility
 It has to be accessible for all user, including geo-social,
economic, organisation, and language.
 Cont’d

Effectiveness
 Ability to cure, reduce symptom, prevent illness, and
outbreak possibility.

Efficient
 Due to the limited resources, the efficiency is then
becoming important element in health service.
 Cont’d
Continuity
 It means that the client should be served well, including
reference when needed, without any repeating of
diagnostic procedure.
Safe
 Both to clients and to health professionals
Convenience
 It is needed to satisfy clients, so that they will see us
when they having a health problem in the future
 Cont’d
Information
 A qualified health service should provide understandable
info’s about what, when, where, and how the service will
be hold
Time
 The service should do in the right way and time
Human Relationship
 Trust between the provider and client is considerable,
among staffs and managers, local authority and social.
 Urgency

1. As a guarantee that the client will be given a qualified service

2. As a continuous effort of efficient service

3. In order to reach a distinguished position

4. As the important concern of service outcome

5. Developing the working satisfaction, and commitment

Total Quality Management-TQM
Paradigm

 TQM as an effort to maximize the organisations

competiveness through the continuous improvement of
goods and services and manpower and organisational
envi.
TQM elements (1)

 Customer oriented external and internal customer.

external : goods and service quality

internal : human, process, and envi.

 Quality obsession int & ext. cust. As the final QC

 Scientific approach designing the work and the process

of policy making and problem solving.
 TQM elements (2)

 Lifelong commitment

 Team work partnership is needed to be well developed

and continuous between the internal and the community
 Continuity of System improvement

 Training and education work as the fundamental factors

 Quality Assurance Program-
QAP
a. QA framework
 Identify Q problem and the reason according to the
appointed standard
 Pointing and implementing solving problem appropriately

 Evaluate the output/outcome

 Planning the up-coming to improve the quality

b. QAP Objective
 Midst objective the purpose of Quality improvement, as the
basis of benchmarking
 Final objective the improvement of end-product’s and service’s
quality

c. QAP Processes and steps

Evaluation in Community Health Nursing
Service

1. Prospective evaluation

2. Retrospective evaluation

3. Congruent evaluation
1. Prospective evaluation
a. Professional education in preparing the qualified behavioral aspects
of the manpower

b. License as the recognition or legal aspect of the practicians

c. Standardization of facility and system

d. Certification from professional organisation or local health attorney

e. Accreditation
2. Retrospective evaluation

 As the evaluation of the service result

 Usually composed of documents, such as nursing records,

interview data, questionnaires, and evaluative meetings.
3. Congruent evaluation

 As the evaluation of the ongoing service

 Through direct observation

 Frequently it also requires inspection to

records/documents, interview and meeting with the staffs
and clients and client’s family
End of Lecture

Question??
references

Effendi & Makhfudli (2008). Keperawatan Kesehatan Komunitas;

Teori dan Praktik dalam Keperawatan. Jakarta: Salemba
Medika.

Muninjaya, A.A.G. 2004. Manajemen Kesehatan. Jakarta: EGC.

Pohan, Imbalo (2004). Jaminan Mutu Layanan Kesehatan; Dasar-

dasar Pengertian dan Penerapan. Jakarta: EGC.

Tjiptono. 1997. Total Quality Service. Jogjakarta: Penerbit Andi.