1. QUALITY OF CARE , STANDARDS OF
CARE , ETHICAL AND LEGAL ISSUES
IN HEALTH CARE
By : AlJuhara AlMarzoog
Medical-Surgical Master program 2013

2. Outlines
 Introduction
 What is quality ?
 Key components of high quality of care
 Measurement of quality
 Quality indicators
 ANA standards for nursing
 Ethics in nursing

3. Quality
 Joint commission defines Quality as “ the optimal
achievement of therapeutic benefit and avoidance of
risk and minimization of harm “ .
 Institute of Medicine ( IOM ) defines Quality of Care
as “ the degree to which health services for
individuals and populations increase their likelihood
of desired health outcomes and are consistent with
current professional knowledge “

4. The ideal key components of high quality of
health care
1- The system is safe : free from accidental injury for all
patients , in all processes , in all time .
2- Effectiveness of care : care that , wherever possible , is
based on the use of systematically obtained evidence to
make determinations regarding whether a preventive
service , diagnostic test , therapy , or no intervention
would produce the best outcomes .

5. The ideal key components of high quality of
health care
3- Patient – centered : this concept encompasses the
following : respect for patients values , preferences , and
expressed needs ; coordination and integration of care ;
provide education ; physical comfort ; emotional support
; and involve family and friends .
4- Care delivered in timely manner : without long waits that
are wasteful and often anxiety provoking .

6. The ideal key components of high quality of
health care
5- Efficient care : uses resources to obtain the best value
for the money spent .
6- Equitable : care should be based on an individual's
needs , not on personal characteristics such as gender
, race or insurance status .

7. Measuring of quality
 The measurement of health care quality is an “
elusive but achievable goal “ . Health care quality is
not a single product like a car , microwave . It is
made up of unusually diverse components varying
from mammography screening to performing surgery
to counseling for depression .
1- Structure .
2- Process .
3- Outcomes .

8. Quality indicators
 Fall / injury falls rate .
 Hospital acquired pressure ulcer rate .
 Central line associated blood stream
infection rate .
 Catheter associated UTI rate .
 Documentation .
 Staff satisfaction .
 RN education / Certification .

9. Standards of care
 “ Standards are professionally developed
expression of the range of acceptable variations from
a norm or criterion “ Avedis Donabedian .
 Benchmark of achievement which is based on
desired level of excellence .
 Criteria are pre-determined elements against which
aspects of the quality of nursing/medical services

10. Nursing standards
All standers of practice provide a guide to knowledge
, skills , judgment & attitude that are needed to
practice safely .
 They reflect a desired and achievable level of
performance against which performance can be
compared . Their main purpose is to promote , guide
and direct professional on nursing practice .

11. Why are standards
important ?
 Outlines what the profession expects of its members .
 Promotes , guides and directs professional nursing
practice .
 Aids in developing a better understanding and respect
for the various and commentary roles that nurses have
. ( Registered Nurses Association ( 2003 ) & College of
Nurses of Ontario ( 2002 ) .

12. ANA standards of care
 The standard of care are intended to be used in
conjunction with the scope of practice , which
addresses the role and bounders of practice for
nursing .
 The professional practice of the nurses is
characterized by the application of relevant theories
, research , and EBP guidelines to explain human
behavior and related phenomena .

13. ANA standards of care
 Such application also provides a basis for nursing
intervention and evaluation of patient-oriented
outcomes .
 The nursing process is used as the framework and
build upon ANA’s Nursing : Scope and Standard of
Practice .

14. ANA standards of care
1- Assessment .
2- Diagnosis .
3- outcomes identification .
4- Planning .
5- Implementation .
6- Evaluation .

15. ANA standards of professional
performance
 Describes a competent level of behavior in the
professional role , including activities related to
quality of care , performance appraisla , education
, ethics , collegiality , collaboration , research , and
resources utilization .
 Although the standards of professional performance
delineate the expectations of all nurses , membership
in professional organization , certification , CE , and
pursuit of advanced degree are additional methods of
demonstrating professionalism .

16. ANA standards of professional
performance
1- Quality of practice .
2- Professional practice evaluation .
3- Education .
4- Collegiality .
5- Ethics .
6- Collaboration .
7- Research / Clinical inquiry .
8- Resources utilization .
9- leadership .

17. Ethics vs. Morality
 Ethics : is the systematic study of moral conduct
and provides the framework for examining and
studying moral dilemmas .
 Bioethics : also called biomedical ethics or medical
ethics , is the study of moral conducts within the
context of health care .
 Morality : refers to norms about right and wrong

18. Ethics theory
 Utilitarianism , one classical theory in ethics , is
based on the concept of “ the greatest good for the
greatest number “ .
 The choice of action is clear under this theory
, because the action that maximizes good over bad is
the correct one .

19. Approaches to ethics
1-Meta-ethics
 Analysis of the concept
of informed consent .
Nurses are aware that
patient must give
consent before surgery
or any invasive
procedure , but
sometimes a question
arises as to whether a
2-Applied ethics
 Is when a specific
discipline identifies
ethical problem within
that discipline’s practice .

20. Types of ethical problems in
nursing
 The ANA, in Nursing’s Social Policy Statement ( 2003
, p. 6 ) , defines nursing as “ the protection
, promotion , and optimization of health , prevention
of illness and injury , alleviation of suffering through
diagnosis and treatment of human response , and
advocacy in the care of individuals , families
, communities , and populations “ .

21. Types of ethical problems in
nursing
1- Confidentiality .
2- Restraints .
3- Trust issues .
4- Refusing to provide care .
5- End-of-life care .

22. Ethical and legal issues
 Since nurses address complex ethical and human
rights issues on a regular basis , the ANA Board of
Directors and the Congress on Nursing Practice first
initiated Code of Ethics for Nurses in 1985 .
 The code was revised in 2001 to include issues of
advancing nursing science .

23. Code of Ethics for Nurses
 The ANA approved nine provisions that address
ethical practice issues such as compassion and
respect , commitment , patient advocacy
, responsibility and accountability , duties
, participation in the healthcare environment
, advancement of the profession , and collaboration .