8/9/2019 QA & NPS

1/58

8/9/2019 QA & NPS

2/58

Our Lecture TodayOur Lecture Today

Section 1. Nursing Practice Standard (NPS) in

The Community

Section 2. Quality Assurance (QA) in Community

Health Nursing

8/9/2019 QA & NPS

3/58

Nursing practice standard inNursing practice standard in

the communitythe community

Section 1

8/9/2019 QA & NPS

4/58

PrefacePreface

Nursing practical standard became a framework for

nursing practice which has to be achieved by a nurseand well developed to help nurse in validating thequality and developing nursing itself.

A practical standard as one of our professionalcharacteristics, needed as the quality assurance of

nursing care so that the care quality is on optimumlevel.

8/9/2019 QA & NPS

5/58

Giilies (1994): standard is a descriptive statement of appliedappearance level in measuring quality, structure, process andoutput/outcome.

Standard is an ideal or the highest achievement level, used as theminimum 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.

Standard

8/9/2019 QA & NPS

6/58

1. Definition of NPS1. Definition of NPS

Merupakankomitmenprofesikeperawatandalammelindungimasyarakatterhadappraktik yangdilakukanolehanggotaprofesi (DPP PPNI 1999).

Penegasantentangmutupekerjaanseorangperawat yangdianggapbaik, tepatdanbenar, yangdirumuskandandigunakansebagaipedomandalampemberianpelayanankeperawatansertatolakukurdalampenilaiankerjaseorangperawat

8/9/2019 QA & NPS

7/58

2. The Objective2. 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 ofnursing process which may endanger our clients

8/9/2019 QA & NPS

8/58

3. Consideration3. Consideration

Resources quantity and quality

Resources educational background

Social/public/customers expectation

Professionals expectation

Potential resources

8/9/2019 QA & NPS

9/58

4. Nursing care standard4. Nursing care standard

CharacteristicCharacteristic

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

8/9/2019 QA & NPS

10/58

55.. ImplicationImplication

a. Health Service sector

Quality control

Operational procedure (material purpose andmethod)

Basic consideration on supervision and course (aswork profile and performance evaluation)

8/9/2019 QA & NPS

11/58

Evaluation tools

Information media for Administration of nursing process,Job Desc., Staff development

Information media for patient to build a sufficientcommunication with the service (health provider) team

As an effort to enhance social belief and appreciation tonursing.

As the basis in identifying the debility factor which may bethe core for research in order to increase and provide abetter nursing care quality.

8/9/2019 QA & NPS

12/58

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 thecompetency in the work field

8/9/2019 QA & NPS

13/58

As the final assessment of course purpose achievement.

As a tool to reach the same level of nursing service botheducational and work field.

8/9/2019 QA & NPS

14/58

6. Type of Nursing Practice6. Type of Nursing Practice

StandardStandard

a. Standard of Structure

The including of this kind of standard are philosophy,

nursing service goals and scope, and nurses role

Philosophy : As the pointing belief giving the

purpose and direction of a nursing practice

8/9/2019 QA & NPS

15/58

ContdContd

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

8/9/2019 QA & NPS

16/58

Either group or community levelEither group or community level

Group of certain cultural and geo-social background

whom dealing with specific problem,

Nurses role : Due to Lok. Nas. 1983 : Care giver,

manager, care educator and researcher.

8/9/2019 QA & NPS

17/58

bb. Standard of Process. Standard of Process

Visualizing how a nurse work in delivering a comprehensive nursingprocess 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 deliveringnursing process.

d. Provide a therapeutic communication

8/9/2019 QA & NPS

18/58

ContdContd

Maintaining and improving a better quality of therapeuticrelationship

Developing a good cooperation

Delivering a solving problem method approach through nursingprocess

Involving client in delivering care

Coordinating the whole team of health service

8/9/2019 QA & NPS

19/58

ContdContd

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

8/9/2019 QA & NPS

20/58

cc. Outcome Standard. 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. Clients adaptation to the environment

c. The improvement of clients health status, including

physic, and psycho-social.d. Well-prevented wounds and accidents.

e. Case finding

8/9/2019 QA & NPS

21/58

7. 19747. 1974 ANAsANAs Community Nursing PracticalCommunity Nursing Practical

StandardStandard

Collecting a continuous systematic data of clients health

status

Diagnose

Planning: Aims.

The plan should do prior to care delivery

Nursing intervention (Promotive, preventive, and

rehabilitative)

8/9/2019 QA & NPS

22/58

ContdContd

Nursing intervention as the effort of helping clients in

improving their health statue

Clients improvement to the goal achievement

Continuous nursing assessment.

8/9/2019 QA & NPS

23/58

ANA 2004ANA 2004

According to American Nursing Association,

a nursing practice standard is then divided into16 standard, by their separated competencies

for general nurse and community nurse

specialist.

8/9/2019 QA & NPS

24/58

Standard 1Standard 1--The AssessmentThe Assessment

A community nurse assesses the

community by collecting data,identifying resources inside the

community, certain opinion and

professional evaluation.

8/9/2019 QA & NPS

25/58

Standard 2Standard 2--The Community Priority and TheThe Community Priority and The

DiagnosisDiagnosis

The analyzing process of the data in classifying bothpriorities and diagnosis.

The diagnosis is then validated by the superior or

non-formal social organization

8/9/2019 QA & NPS

26/58

ContdContd

Standard 3-Output Identification

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

Standard 4-Planning

Developing the most suitable intervention and plan toidentify strategies and alternatives to achieve the purpose ofcommunity

8/9/2019 QA & NPS

27/58

Standard5

Standard5

--ImplementationImplementation

Sub a-Coordination

Coordinating programs, services, and other

activities which were planned well.

8/9/2019 QA & NPS

28/58

and Promotionand Promotion

Cooperating as teams through education to promote

and prevent possible disease, and also a convenient

environment

8/9/2019 QA & NPS

29/58

SubSub cc--ConsultationConsultation

Providing consultation to multi-group in the community

Sub d-Controlling Activity

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

rule, and policy

8/9/2019 QA & NPS

30/58

Standard 6-Evaluation

Evaluating the health statue of community

Standard 7-The Quality Practice

Improving the quality and effectiveness of

nursing

8/9/2019 QA & NPS

31/58

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 thestandard and professional guidance, rules and

regulations.

8/9/2019 QA & NPS

32/58

Standard 10-Interpersonal relationship and other healthprofessionals

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 healthprofessionals in providing and promoting health

8/9/2019 QA & NPS

33/58

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 considerationin practice improvement.

8/9/2019 QA & NPS

34/58

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.

8/9/2019 QA & NPS

35/58

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 ofcommunity

8/9/2019 QA & NPS

36/58

TheE

nd of Section 1TheE

nd of Section 1

Any Question? ? ?

8/9/2019 QA & NPS

37/58

Quality Assurance inQuality Assurance in

Community NursingCommunity Nursing

Section 2.

8/9/2019 QA & NPS

38/58

PrefacePreface

QA in community nursing becomes one of theimportant and basic approaching method in deliveringthe service to clients.

QA approach is as valuable tool to those who manageor organizing the service

A qualified service always try to satisfy clients andaccentuate the outcome

8/9/2019 QA & NPS

39/58

8/9/2019 QA & NPS

40/58

Opinion:Opinion:What is quality? What is Assurance?

8/9/2019 QA & NPS

41/58

Then Quality Assurance is?Then Quality Assurance is?

8/9/2019 QA & NPS

42/58

DefinitionDefinitionQuality:

The entire characteristic of good or service which

represents its ability in satisfying customers need, eitherexplicit or implicit.

8/9/2019 QA & NPS

43/58

The Dimension of Quality in HealthThe Dimension of Quality in Health

ServiceService

Technical Competency Dimension

Related to how the health service provider obey thehealth service standard, including obedience, accuracy,

trust, and consistency.

Accessibility

It has to be accessible for all user, including geo-social,

economic, organisation, and language.

8/9/2019 QA & NPS

44/58

ContdContd

Effectiveness

Ability to cure, reduce symptom, prevent illness, andoutbreak possibility.

Efficient

Due to the limited resources, the efficiency is thenbecoming important element in health service.

8/9/2019 QA & NPS

45/58

ContdContdContinuity

It means that the client should be served well,

including reference when needed, without anyrepeating 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

8/9/2019 QA & NPS

46/58

ContdContdInformation

A qualified health service should provide

understandable infos about what, when, where, andhowthe 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.

8/9/2019 QA & NPS

47/58

UrgencyUrgency1. 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

8/9/2019 QA & NPS

48/58

Total Quality ManagementTotal Quality Management--TQMTQM

ParadigmParadigm

TQM as an effort to maximize the organisations

competiveness through the continuous improvement

of goods and services and manpower and

organisationalenvi.

8/9/2019 QA & NPS

49/58

TQM elements (1)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.

8/9/2019 QA & NPS

50/58

TQM elements (2)TQM elements (2)

Lifelong commitment

Team workpartnership is needed to be well developed andcontinuous between the internal and the community

Continuity ofSystem improvement

Training and education work as the fundamental factors

8/9/2019 QA & NPS

51/58

Quality AssuranceQuality Assurance

ProgramProgram--QAPQAPa. QA framework

Identify Q problem and the reason according to theappointed standard

Pointing and implementing solving problem appropriately

Evaluate the output/outcome

Planning the up-coming to improve the quality

8/9/2019 QA & NPS

52/58

bb. QAP Objective. QAP Objective Midst objective the purpose of Quality improvement, as the

basis of benchmarking

Final objective the improvement of end-products andservices quality

c. QAP Processes and steps

8/9/2019 QA & NPS

53/58

Evaluation in Community Health NursingEvaluation in Community Health Nursing

ServiceService

1. Prospective evaluation

2. Retrospective evaluation

3. Congruent evaluation

8/9/2019 QA & NPS

54/58

1. Prospective evaluation1. Prospective evaluationa. 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 healthattorney

e. Accreditation

8/9/2019 QA & NPS

55/58

2. Retrospective evaluation2. Retrospective evaluation

As the evaluation of the service result

Usually composed of documents, such as nursingrecords, interview data, questionnaires, and evaluative

meetings.

8/9/2019 QA & NPS

56/58

3. Congruent evaluation3. 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 clients family

8/9/2019 QA & NPS

57/58

End of Lecture

End of Lecture

Question??

8/9/2019 QA & NPS

58/58

referencesreferencesEffendi &Makhfudli (2008). KeperawatanKesehatanKomunitas;

TeoridanPraktikdalamKeperawatan. Jakarta:

SalembaMedika.Muninjaya, A.A.G. 2004.ManajemenKesehatan. Jakarta: EGC.

Pohan, Imbalo (2004). JaminanMutuLayananKesehatan; Dasar-dasarPengertiandanPenerapan. Jakarta: EGC.

Tjiptono. 1997. Total Quality Service. Jogjakarta: PenerbitAndi.