For more than 100 years, authors have written about the evaluation of nursing practice as a process with minimal elements of –

· Setting standards

· Comparing nursing practice to such standards

· Instituting changes to increase the adherence to the standards


The first to write about standards in English language was Florence Nightingale whose notes on nursing what it is and what it is not was first published in England in December 1859. In it she frequently called for change to achieve high standards.

Nightingale developed a multitude of standards of nursing care in the 19th century whether the care was provided by a family member as some one far such service. Notes on nursing have standards regarding.

· Noise and its control around sick.

· Consistency of food and when it should be served.

· Type of bed and mattress to be used, as well as prospects about the bed linens

· Position of the bed in relation to windows so that the patient can look out.

· Cleanliness of the room.

· Personal cleanliness.

Though Nightingale made no comparison between her standards and the existing conditions, within 6 months she reduced the mortality to 2%. In other words a quality assurance as quality control process was used. Much has been done since that time to isolate the concept of setting standards from the larger process of evaluation. Establishing schools of nursing after 1873, was quite an indirect approach in terms of setting standards for practice and meaning improved compliance. Almost two decades after schools of nursing has been established. Efforts were again made to set standards far them. This in turn improved the care of side in the hospitals, because schools of nursing were intimately associated within the hospitals. Eldredge addressed the quality of nursing care in 1932 predominantly in terms of the quality of care given by students in hospitals. She defined quality of nursing care in terms of the quality of care given by students in hospitals. She defined quality of nursing care in terms of outcomes of nursing practice although not in the measurable outcomes used today.

After the World War II the attention was again focused on establishing standards and upgrading nursing care. In the 1950’s as the nursing process emerged, as an identifiable entity with the specific elements evaluation of care was almost always included as a step in nursing process. Orlando identified function, process and principles of professional nursing. She stressed on the evaluation of nursing process. Carrier and Sitzman in 1971 included evaluation as the final point in the six step process of the nursing care plan. In 1973 the ANA legitimized the nursing process. Thus started the era for the evaluation of the nursing profession for better quality care of the patient and quality assurance of the profession itself.

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