The nursing standard of care is the embodiement of knowledge that refers to the reasonable degree of care expected to be provided to an individual by a nurse (Iyer, 2003). There are sources for determining whether or not the standard of care has been met, which include guidelines and protocols that nurses are expected to follow to prevent, assess, and treat pressure injuries, while documentation of these actions reflect whether or not nurses have met expectations. Established by organizations such as the National Pressure Injury Advisory Panel (NPIAP), the Wound Ostomy and Continence Nurses Society (WOCN), and the Agency for Healthcare Research and Quality (AHRQ), among others, these guidelines are based on scientific evidence and best practices, and are designed to ensure that patients receive high-quality care for the prevention and treatment of pressure injuries.

The nursing standards of performance associated with pressure injuries cover a range of topics, including risk assessment, prevention, assessment, and treatment, while determination of the standard of care resides in a variety of sources, such as scope and standards of practice by American Nurses Organization, and professional nursing organizations such as the Wound Ostomy Continence Nurses Society. The LNC determines what the standard of care is and whether or not it has been maintained or breached.

Nursing professionals are expected to perform regular risk assessments to identify patients who may be at risk for pressure injuries, and to implement preventive measures such as repositioning, pressure redistribution devices, and skin care. When pressure injuries do occur, nursing professionals are expected to assess the severity of the injury and to develop a treatment plan that includes wound care, infection prevention, and pain management. The standard of care depends upon the professional role of the nurse, degree of skill, background, specialty and credentials. For example, with a specialization in skin and wound care, the WOC Nurse is held to a different standard of care than a general bedside nurse.

This leads to the further question of whether or not all pressure injuries are preventable. There is and has been an ongoing debate on the Avoidable versus the Unavoidable Pressure Injury. You might be interested in reading my blog on ‘Avoidable versus Unavoidable’ pressure injuries. The dialogue evolved over time, but began when the NPIAP, then the NPUAP proposed the concept during the 1990’s and brought health care professionals together for an entire consensus conferences on the topic in 2008. Look for my upcoming blog on this topic, to be posted right here in the coming weeks.

In addition to expectations associated with clinical practice, the standards of professional practice associated with pressure injuries also include expectations related to documentation and communication. Nursing professionals are expected to document their assessments, interventions, and outcomes related to pressure injuries, and to communicate openly and effectively with other members of the healthcare team and with patients and their families. Documentation is a form of evidence that standard of care has been met and maintained, or otherwise, breached. An expectation surrounding documentation and communication is that there must be sharing among the interprofessional team, since no effective patient outcomes happen in a silo.

Adherence to the standard of care associated with pressure injuries is critical to ensuring that patients receive the highest quality of care possible. When healthcare professionals fail to follow the standard of care, patients may suffer from preventable injuries, and legal cases may arise as a result. As such, it is essential for healthcare professionals to stay up-to-date on the latest evidence associated with maintenance of skin integrity and prevention of pressure injuries and to incorporate that evidence into their practice. As the science of clinical practice changes, so does the knowledge base and the reasonable expectation of care to be delivered by nurses. The standard of care is a living concept that over time is a reflection of research, innovation and advanced technology.

Iyer, Patricia, ed. Legal Nurse Consulting Principles and Practice. 2nd ed. Washingotn DC: CRC Press, AALNC, 2003.

Cynthia Sylvia, legal nurse consultant, is a Certified Wound Care Nurse with 42 years of clinical expertise. With a Doctorate in Nursing and an MSc in Wound Healing, Cindy is a former VP of Clinical Affairs, an honorary lecturer at Cardiff University and a published author and international speaker.