Terms of Confusion..

Over the years, I’ve noticed certain terms often misused and misunderstood by nurses which can lead to false assumptions, misinterpretations and yes, confusion.  Here’s some of those terms:

  • Standards of Care
  • Standards of Practice
  • Policies and Procedures
  • Practice Guidelines
  • Protocols

Often I hear these terms used interchangeably. To help clear up the confusion, let’s define these terms.

  • Standard of Care – the consumer of care, the patient, is the focus of standards of care. These are statements of the expected patient care experience or outcome. Organizations are encouraged to develop standards of care addressing patient care throughout their organization or specific to a care unit or specialty area. An example of an infusion specific standard of care is: “Patients with PICC will remain free of hospital acquired blood stream infection”
  • Standards of Practice – focus on the provider of care and clearly state the acceptable levels of practice in patient care delivery. In nursing, standards of practice define nursing accountability and provide a framework for evaluating professional competency in the delivery of patient care services. Professional nursing organizations have researched, developed, and published standards of nursing practice that reflect commitment to quality patient care. Standards of practice can be generic (applies to all nurses) such as the ANA Standards of Nursing Practice or specialty standards applicable to certain areas of practice such as the Infusion Nurses Society Standards of Practice. (2011 edition coming in January 2011)
  • Standards of care vs. standards of practice – published standards of nursing practice define criteria relative to nursing accountability and professional competency so many healthcare organizations adopt these standards. This differs from standards of care, which is developed and individualized by the organization where the care is delivered.
  • Policies and ProceduresPolicies are the established rules that guide the organization in the delivery of care. Policies are not negotiable and not modified unless it undergoes an official review or revision. Procedures contain a series of precise steps that outline the recommended manner in which the  pyschomotor skills should be performed by  healthcare providers.

Example: Policy: Only registered nurses are permitted to start a peripheral IV.

Example: Procedure:  Performance of venipuncture

  • Practice guidelines –  are used by organizations to help make clinical care decisions based on the current state of knowledge about a specific disease state or therapy.  Nursing practice guidelines are based on the nursing process and can assist with decision making in the delivery of nursing service.

Example: Practice Guidelines on venipuncture suggest that based on the patient’s age and condition. an intradermal local anesthetic is recommended prior to venipuncture.

  • Protocols – complement procedures and practice guidelines because protocols provide a basis for clinical decision making in specific patient care issues.

Example: Protocol for intradermal local anesthetic: Lidocaine 1% 0.2mL inject intradermally

Yes, these terms may be confusing but one thing is so clear, and that is..  the nurse is responsible and accountable for the quality of nursing care given to patients. The single most important protective strategy for the nurse is to be a knowledgeable individual, to follow the standards of  nursing practice and to meet the standards of care with all patients.

Reference: Alexander M et al. (2009) Infusion Nursing: An Evidence based approach. 3rd edition; St. Louis, MO; Saunders.

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