Correlating Nursing Care, Nursing Practice, and
Nu rsing Performance Standards
by Irene Kane, RN, MSN, and Barbara J. Fickley, RN, MSN, CS
All too often nursing standards have been viewed as
a cumbersome paperwork task with little day-to-day
zyx
N u r s i n g standards of practice, care, and performance
have tended to be viewed as a burdensome paperwork
task disproportionate to any practical application. This
imbalance has existed because the various standards have
practical relevance. Using a matrix approach that been developed in isolation from each other and with
zyxwvu
debatable day-today relevance. When standards correlate
incorporates nursing role functions and the nursing with each other, and are integrated into other aspects of
nursing responsibilities, they form a meaningful frame-
process, the authors developed a model that provides work from which to direct the course of patient care.
Developing such integrated standards became the
the basis for job descriptions, pevfomnce appraisals, mission of a small group of nurse administrators, of
which the authors were a member. The group first
peer review, and quality management activities. reviewed the pertinent literature and regulatory require-
ments regarding standards and then brainstormed about
desired client outcomes. The standards of psychiatric
mental health nursing, created by the American Nurses’
Association (1982),were integrated in order to insure ful-
fillment of professional responsibilities.
The goal was to develop standards that would form
the basis for job descriptions, performance appraisals,
peer review, and quality improvement activities.
Another target goal was to get these standards to cor-
relate with nursing role functions and the nursing pro-
cess. Linking these concepts was accomplished
through the development of a functional matrix model,
which also served as a framework for evaluating nurs-
ing care activities.
.
.
zyx
Defining Standards of Practice, Care, and Performance
In order to formulate the functional matrix model it
was necessary to define and distinguished among the
following kinds of standards:
Standards of practice: what the nursing staff must do
to provide patient care
Standards of cure: what patients can expect to
receive from nursing staff
Standards of performance: how nursing staff must
perform to meet expectations established in the
zyxwvutsrqpo
zyxwvutsrq standards of care (Patterson, Kranz, & Brandt,
1986).
Perspectivesin Psychiatric Care Vol. 28, No. 3, July-Sept,1992 27
, ~ ~
Correlating Nursing Care, Nursing Practice, and Nursing Performance Standards zy
zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHG
These definitions provided the horizontal axis of the The resulting functional matrix includes a general
matrix in this model (Table 1). standard, which is an adaptation of the ANA psychi-
The second step was to translate these descriptions of
standards into practical guidelines for nursing care. Role
theory and the nursing process provided a context from
which to carry out ths phase. Nurses function in multi-
ple roles during their course of care with patients,
including: clinical, administrative, research, education,
and consultation (Stuart & Sundeen, 1987). These roles,
or nursing functions, formed the vertical axis of the
matrix of the model (Table 1).
A Framework for Job Descriptions
and Performance Appraisals
zy
atric/mental health nursing practice standards (1982).
Table 2 outlines the expected standard of practice, care,
and performance, and the subsequent rationale.
The standards of performance section of the horizontal
axis form the basis of job description and performance
Table 1. Matrix Model for Correlating Standards
Standard Standard Standard
Nursing Roles of Practice of Care of Performance
Probationary Staff Psychiatric
Nurse Nurse Nurse
1. Clinical
a) Assessment
b) Manning
c) Implementation
d) Evaluation
2. Administration
3. Education
4. Research
5. Consultation
28 zyx
Perspectivesin Psychiatric Care Vol. 28, No. 3, July-Sept,1992
Nu rsing Performance Standards
by Irene Kane, RN, MSN, and Barbara J. Fickley, RN, MSN, CS
All too often nursing standards have been viewed as
a cumbersome paperwork task with little day-to-day
zyx
N u r s i n g standards of practice, care, and performance
have tended to be viewed as a burdensome paperwork
task disproportionate to any practical application. This
imbalance has existed because the various standards have
practical relevance. Using a matrix approach that been developed in isolation from each other and with
zyxwvu
debatable day-today relevance. When standards correlate
incorporates nursing role functions and the nursing with each other, and are integrated into other aspects of
nursing responsibilities, they form a meaningful frame-
process, the authors developed a model that provides work from which to direct the course of patient care.
Developing such integrated standards became the
the basis for job descriptions, pevfomnce appraisals, mission of a small group of nurse administrators, of
which the authors were a member. The group first
peer review, and quality management activities. reviewed the pertinent literature and regulatory require-
ments regarding standards and then brainstormed about
desired client outcomes. The standards of psychiatric
mental health nursing, created by the American Nurses’
Association (1982),were integrated in order to insure ful-
fillment of professional responsibilities.
The goal was to develop standards that would form
the basis for job descriptions, performance appraisals,
peer review, and quality improvement activities.
Another target goal was to get these standards to cor-
relate with nursing role functions and the nursing pro-
cess. Linking these concepts was accomplished
through the development of a functional matrix model,
which also served as a framework for evaluating nurs-
ing care activities.
.
.
zyx
Defining Standards of Practice, Care, and Performance
In order to formulate the functional matrix model it
was necessary to define and distinguished among the
following kinds of standards:
Standards of practice: what the nursing staff must do
to provide patient care
Standards of cure: what patients can expect to
receive from nursing staff
Standards of performance: how nursing staff must
perform to meet expectations established in the
zyxwvutsrqpo
zyxwvutsrq standards of care (Patterson, Kranz, & Brandt,
1986).
Perspectivesin Psychiatric Care Vol. 28, No. 3, July-Sept,1992 27
, ~ ~
Correlating Nursing Care, Nursing Practice, and Nursing Performance Standards zy
zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHG
These definitions provided the horizontal axis of the The resulting functional matrix includes a general
matrix in this model (Table 1). standard, which is an adaptation of the ANA psychi-
The second step was to translate these descriptions of
standards into practical guidelines for nursing care. Role
theory and the nursing process provided a context from
which to carry out ths phase. Nurses function in multi-
ple roles during their course of care with patients,
including: clinical, administrative, research, education,
and consultation (Stuart & Sundeen, 1987). These roles,
or nursing functions, formed the vertical axis of the
matrix of the model (Table 1).
A Framework for Job Descriptions
and Performance Appraisals
zy
atric/mental health nursing practice standards (1982).
Table 2 outlines the expected standard of practice, care,
and performance, and the subsequent rationale.
The standards of performance section of the horizontal
axis form the basis of job description and performance
Table 1. Matrix Model for Correlating Standards
Standard Standard Standard
Nursing Roles of Practice of Care of Performance
Probationary Staff Psychiatric
Nurse Nurse Nurse
1. Clinical
a) Assessment
b) Manning
c) Implementation
d) Evaluation
2. Administration
3. Education
4. Research
5. Consultation
28 zyx
Perspectivesin Psychiatric Care Vol. 28, No. 3, July-Sept,1992
