qa & nps
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Our Lecture TodayOur Lecture Today
Section 1. Nursing Practice Standard (NPS) in
The Community
Section 2. Quality Assurance (QA) in Community
Health Nursing
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Nursing practice standard inNursing practice standard in
the communitythe community
Section 1
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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.
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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
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1. Definition of NPS1. Definition of NPS
Merupakankomitmenprofesikeperawatandalammelindungimasyarakatterhadappraktik yangdilakukanolehanggotaprofesi (DPP PPNI 1999).
Penegasantentangmutupekerjaanseorangperawat yangdianggapbaik, tepatdanbenar, yangdirumuskandandigunakansebagaipedomandalampemberianpelayanankeperawatansertatolakukurdalampenilaiankerjaseorangperawat
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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
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3. Consideration3. Consideration
Resources quantity and quality
Resources educational background
Social/public/customers expectation
Professionals expectation
Potential resources
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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
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55.. ImplicationImplication
a. Health Service sector
Quality control
Operational procedure (material purpose andmethod)
Basic consideration on supervision and course (aswork profile and performance evaluation)
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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.
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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
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As the final assessment of course purpose achievement.
As a tool to reach the same level of nursing service botheducational and work field.
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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
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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
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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.
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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
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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
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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
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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
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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)
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ContdContd
Nursing intervention as the effort of helping clients in
improving their health statue
Clients improvement to the goal achievement
Continuous nursing assessment.
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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.
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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.
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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
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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
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Standard5
Standard5
--ImplementationImplementation
Sub a-Coordination
Coordinating programs, services, and other
activities which were planned well.
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and Promotionand Promotion
Cooperating as teams through education to promote
and prevent possible disease, and also a convenient
environment
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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
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Standard 6-Evaluation
Evaluating the health statue of community
Standard 7-The Quality Practice
Improving the quality and effectiveness of
nursing
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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.
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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
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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.
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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.
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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
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TheE
nd of Section 1TheE
nd of Section 1
Any Question? ? ?
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Quality Assurance inQuality Assurance in
Community NursingCommunity Nursing
Section 2.
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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
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Opinion:Opinion:What is quality? What is Assurance?
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Then Quality Assurance is?Then Quality Assurance is?
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DefinitionDefinitionQuality:
The entire characteristic of good or service which
represents its ability in satisfying customers need, eitherexplicit or implicit.
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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.
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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.
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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
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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.
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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
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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.
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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.
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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
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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
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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
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Evaluation in Community Health NursingEvaluation in Community Health Nursing
ServiceService
1. Prospective evaluation
2. Retrospective evaluation
3. Congruent evaluation
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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
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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.
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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
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End of Lecture
End of Lecture
Question??
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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.
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