Integrating the Nursing Process into a Nursing Quality Improvement Program

Abstract

In 1991, the Joint Commission's nursing services standards scoring guidelines went into effect. Nancy Claflin discusses the changes in the nursing process needed to meet these revised standards under the rubrics of assessment, planning, intervention, and evaluation. She then presents an extensive implementation plan for integrating this revised nursing process into a nursing QI program. The focus of this article is both on the principles of quality improvement and the exigencies of aspects of care, standards of nursing practice, and indicators.

Nursing Standards of Patient Care and Standards of Nursing Practice—A Practical Approach

“…Standards should be developed for most of the major patient populations d e h e d in the scope-of-care and practice statements. These standards should include the different types of nursing care delivered to patients, such as assessment, planning for care, intervention, evaluation, discharge planning, and patient education (Claflin, 1992). In addition, patients on different units who have the same nursing care needs have a right to expect comparable levels of nursing care throughout the hospital.…”

“…care be based on the hospital's patient care standards, the admission assessment process was revised to define the use of standards more clearly (JCAHO, 199 1 b). The section of the admission completed by the RN now has the following elements, as shown in Figure 6: (a) an admission assessment by a registered nurse, (b) nursing diagnoses, (c) the acuity level, (d) nursing standards of care and practice, (e) the anticipated length of stay, (f) planned interventions, (g) educational interventions planned with the patient or significant other, and (h) the signature of the registered nurse (Claflin, 1992). To complete this section, the nurse collects data or reviews collected data, assesses the patient, and documents the conclusions in the "admission assessment by R"' section.…”

“…Nursing interventions appropriate to that patient are then selected from the standards of nursing practice. Tlus completes the admission process (Claflin, 1992). The current documentation system requires the nurse to document the reassessment, the nursing diagnosis, the planned interventions, the nursing care provided, and the patient response and/or outcome (Claflin, 1992).…”

“…Tlus completes the admission process (Claflin, 1992). The current documentation system requires the nurse to document the reassessment, the nursing diagnosis, the planned interventions, the nursing care provided, and the patient response and/or outcome (Claflin, 1992). The nurse selects appropriate patient outcomes from the nursing standards of patient care (Kuhn, 1990).…”