Operational Standards of

Nursing Practice
 Outline
Introduction
Objectives
Definition of concepts
Operational standards of nursing care
Summary

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 Session objectives
After completing this session, the trainees will be able to
• Define Nursing and nursing standard
• Describe the operational Standards of Nursing Care Practice

• Explain the purpose and importance of Nursing Care

Standard
• List the twenty three operational nursing care practice
standards under three main categories

• Explain the use of the SOP

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 Definition of concepts
Nursing
 Nursing is the protection, promotion, and optimization of health

and abilities, prevention of illness and injury, facilitation of healing,

alleviation of suffering through the diagnosis and treatment of

human response, and advocacy in the care of individuals, families,

groups, communities, and populations (ANA, 2015)

 Nursing encompasses autonomous and collaborative care of individuals

of all ages, families, groups and communities, sick or well in all settings.

It includes the promotion of health,, the prevention of illness, and the

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care of ill, disabled and dying people (WHO, 2017). 4
 Definition of concepts…
Standard
• Standard is the benchmark of achievement which is based on
a desired level of excellence or

Nursing standard
• nursing standards are professionally developed expressions of
the range of acceptable variations from a norm or criterion.

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 Introduction
• Nursing is a profession that ensures:
– the successful implementation of interventions that-
• welcome and nurture life,
• promotes or restores health,
• enables the means to a-
– peaceful, dignified and pain-free death

Care Coordination is at the

heart of what nurses do best:
Patient-Centered Care! (ANA)

That Sounds Like a Nurse!

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 Introduction…
• Care coordination promotes:
– greater quality,
– safety, and
– efficiency in care,
– resulting in
• improved healthcare outcomes and is consistent with
– nursing’s holistic, patient-centered framework of
care (ANA, 2015)

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Source: Standard Continuum of Care Pathway, Deborah, 2011
 Operational standards for
nursing practice
• The first 10 operational standards are
extracted from EHSTG document, which all
hospitals should fully implement to ensure
proper nursing care.
1. The hospital has established nursing/midwifery
service management structures and job
descriptions that detail the roles and
responsibilities of each nursing and midwifery
professional, including reporting relationships.
2. The hospital has a nursing and midwifery
workforce plan that addresses nurse /midwife
staffing requirements and sets minimum nurse
/midwife to patient ratios in each service area.
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3. The hospital has written policies describing the
responsibilities of nurses and midwives for the
nursing process including the admission
assessment, planning, implementation and
evaluation of nursing/midwifery care.
4. All admitted and emergency patients/clients have
a nursing/midwifery care plan that describes holistic
nursing/midwifery interventions to address their
needs. The plan is regularly reviewed and updated as
required.

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5. All hospital nurses/midwives comply with the
professional code of conduct and ethics
which governs their professional practice.
6. The hospital has established guidelines for
verbal and written communication about
patient/client care that involves nurses/midwives
and their patients/clients, families, other case
team professionals of the disciples, including
verbal orders and timely documentation of
accomplished activities

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7. The hospital has standardized procedures for the
safe and proper administration of
medications by nurses or designated clinical
staff.
8. The hospital has established nursing/midwifery
care practice audit program, including the
documentation of completed audits and resulting
practice improvements.
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9. The hospital implements regular
nursing/midwifery eight hours’ shift, hourly
rounds, and central medication cabinet or
room.
10. The hospital has a centralized nursing/midwifery
station set-up in each ward with adequate space,
equipment and consumables.

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• Additionally, trainers and nurse practitioners should
consider the operational standards below at a
regional/local level when implementing the national
guidelines to enable nurses to fully address the holistic
needs of patients under their care.

11. Hospitals should provide on a regular basis

complete uniforms for all nursing staffs who are
assigned or allowed to work in the facility.

12. Nurses ensure delegation of nursing care to

nursing students and assistants is appropriate, safe
and in the best interests of the person in the care of
a nurse.
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13. Nurses should work with others to protect and
promote the health and wellbeing of those under
their care.
14. Nurses should take part in the ongoing continuing
professional development (CPD) required by
their professional body and maintain a CPD portfolio.

15. Nurses should find solutions to conflicts caused

by deep moral, ethical and other beliefs arising from
a request for nursing service through dialogue with
patients /employer and or professional body

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16. All nurses should be in full uniform as designated
by hospital guidelines

17. Nurses should be open and honest, act with

integrity and uphold the reputation of their
profession.

18. Nurses should care for all patients equally and

without prejudice to age, gender, and economic,
social, political, ethnicity, religious or other status
and irrespective of their personal circumstance.

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19. Nurses should not disclose confidential
information relating to their patients and /or
about their matters and conditions unless in line
with the Ethiopian law and / as required by their
professional body /employing hospital.

20. Nurses should seek verbal or written informed

consent from their patients or their relatives/next
of kin (for incompetent patients) before any
procedure.

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21. Nurses adhere to and provide information on
infection prevention practices to patients,
clients, family members and other caregivers, as
appropriate.
22. Nurses may not receive gifts, favors or
hospitality of any kind from patients, caregivers,
or visitors at any time including prior to or after the
provision of care.

23. Hospitals have appropriate arrangements to

ensure nurses access clinical supervision and
support and participate in regular clinical audit and
reviews of clinical services
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 Exercise 1.2: Group work: 10 Minutes

Which standards relate to which of the following 3

categories:
What nurses should expect from any
hospital 10

What hospitals should expect from any

nurse 6

What patients should expect from any

hospital nurse 7

= 23

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 Implementation guideline
What is managerial structure?
Managerial structure is
• Provide an effective work system,

• A network of communications, and

• Identity to individuals and the organization and should

consequently foster job satisfaction.

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 Types of organizational structures

• The formal organizational structure:

• It describes positions, tasks, responsibilities and

relationships among people in their positions in the
different departments in the organization, and presented
in diagrammatic form called organizational chart.

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 Informal organizational structure
• It describes the personal and social relationships that do
not appear on the organizational chart.

• It helps members to meet their personal objectives

and provides social satisfaction.

• It also has its own channels of communication,

• is important to manage thus, the supervisor should be

aware of its existence

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 Organizational chart
• a diagram shows the different positions and departments,
and the relationships among them.
• It is used to show:
– The formal organizational relationships.
– Areas of responsibility.
– Persons to whom one is accountable.
– Channels of communication.

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 Advantages of an organizational chart

• provides a quick visual illustration of the organizational

structure.
• provides help in organizational planning.

• shows lines of formal authority

• facilitates management development and training.

• evaluate strengths and weakness of current structure.

• provides starting points for planning organizational
changes.
• describes channels of communication.
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 Hospital Board

Chief Executive Director

Nursing Director

Associate Associate
Associate
Outpatient Emergency
Inpatient ND
ND ND
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d d d d d d
Nurs Nurs Nurs Nurs Nurs Nurs
eShi
A eShiB eShi
A eShi
B eShi
B eShi
B
ft ft ft ft ft ft
Lea lea Lea Lea Lea Lea
St
der St
der St
der St
der St
der St
der
af
A af
A af
A af
A af
A af
A
f f f f f f
N N N N N N
ur ur ur ur ur ur
se se se se se se

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Nursing service managerial structure, Adama 2017 18
 Job description
• The hospital has established management structures and
job descriptions that detail the roles and responsibilities
of each nursing professional, including reporting
relationships

• Job descriptions clarify what an employee is responsible for

and what is expected of them.
• Elements of a functional Job Descriptions
– Position summary
– Typical Duties
– Machines and Equipment Used
– Requirements

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 Work force
• should have in place a nursing workforce plan that addresses
nurse staffing requirements and in accordance with nationally
set nurse-to-patient ratios
• Expected to consider caregiver Hours per Patient Day
– Reflects the nursing care hours required in 24
hours for each patient
– Includes nurses and health assistants
– Includes only productive or worked time
– Is stable never changing despite more or less
patients
– Can be compared across units and hospitals

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 Nursing Process
• should provide written policies describing the responsibilities
of nurses for the nursing process and accessible physical
resources for the admission assessment, planning,
implementation and evaluation of nursing care

Communication

– has established guidelines for verbal and written

communication about patient care that involves nurses,
including verbal orders

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 Medication

– The hospital has standardised procedures for the safe and proper
administration of medications by nurses or designated clinical
staff

Clinical Supervision

– The hospital have appropriate arrangements to ensure nurses

access clinical supervision and support and participate in
regular clinical audit and reviews of clinical services

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 Exercise 1.3: Group work for 10 minutes

• What are the model and characteristics of clinical

supervision?

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 Model of Clinical Supervision
The Interactive Model of Supervision*
Task
3 functions for clinical supervision:
Supportive  To counsel
•This aims to support and enable nurses to understand and
To consult
•manage the emotional stress of clinical practice.

•To set up learning relationship

Educative 
•This approach aims to develop the skills and evidence based
To teach
practice of the nurse/s.

Managerial  To monitor
•This focusesadministrative
on performanceaspects
monitoring of the nurse/s
To monitor professional
•professional and ethical
and operational issues
practice. It aims to promote
To evaluate
•nursing compliance with policies, protocols, procedures and
standards and nursing contribution to clinical audit.

*developed by Proctor (1986)

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 Characteristics of Clinical Supervisors:
Expertise: • Either informal or formal through skills and experience in
one’s clinical role.
• Informal recognition may come primarily from peers
• Formal recognition occurs through status and training, and
possible senior or advance practitioner positions held
within the hospital.

Experience: • Having a breadth and depth of experience in his/her field

of expertise

Acceptability • Acceptable to those he/she supervises.

Training: • All clinical supervisors receive appropriate training

• With the theories and models underpinning the principles
of clinical supervision, the use of documentation, to
practice experience at facilitating clinical supervision
• Give opportunities for reflection on their own skills and
areas for development.

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 Team Work
The Nurse should work with others to protect and promote the
health and wellbeing of those under their care.
In working with colleagues and hospital management, the nurse
must:
• Collaborate with the patient and their caregivers,

• Work with colleagues in formulation of overall goals, plans and

decisions related to patients,
• Work with other members of the multidisciplinary team in caring
for patients,
• Consult with other health care providers on patient care, as
appropriate,

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 Code of conduct and Ethics
• The Nurse must abide by published code of professional practice
relevant to their professional role.

CPD
• The Nurse should take part in the ongoing continuing professional
development (CPD) required by their professional body and
maintain a CPD portfolio

Confidentiality
• The Nurse Should not disclose confidential information relating to
their patients and /or about their matters and conditions unless in line
with the Ethiopian law and / as required by their professional
body/employing hospital.

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 Patient Expectation from Nurse
• Practically Nurses should:
– have a nursing care plan for all admitted patients
– adhere to and provide information on infection prevention
practices to patients, clients, family members and other
caregivers, as appropriate

• Ethically Nurses:
– may not receive gifts, favors or hospitality of any kind
– should be open and honest, act with integrity and uphold the
reputation of their profession
– should find solutions to conflicts

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 Standard Operational Procedure (SOP)
• SOP is a procedure specific to your operation that describes
the activities necessary to complete tasks in accordance with
health service regulations
• It can create:
– Efficiencies and therefore profitability
– Consistency and reliability in service delivery
– Fewer errors in all service areas
– A way to resolve conflicts between service provider and
client
– A healthy and safe environment
– Protection of employers in areas of potential liability and
personnel matters

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 Steps in developing SOP
• Designate a responsible person/persons
• Research the evidence
- Literature
- Ask other hospitals
• Write the SOP in standard format
• Publish in a SOP Manual
• Educate

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 SOP standard format
• Policy/Purpose: statement that defines what the policy
is about and the reason for it
• Equipment: list necessary equipment to do the
procedure
• Procedure: Outlines and describes each step
• Documentation: Defines how, where and how often the
procedure should be documented.
• Sources: List of references
• Approval: Usually Matron or Policy and Procedure
Committee

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 Summary
• Operational Standards of Nursing Care Practice -
Describe
• Explain the purpose and importance of nursing care
standard
• List the twenty operational nursing care practice
standards under three main categories
• Explain the use of the tools for implementation of
operational standards

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