What are the 4 goals of nursing

Standard of care

Standards of care are guidelines / (internal institution) standards that define the goal and quality of care for a precisely limited measure. Care standards usually determine what the caregiver should do in a specific situation, based on the activity. * This distinguishes them from care plans or organizational guidelines. Care standards can support specific care by describing the course of action. However, they replace no schooling in this. As a rule, an individual adjustment of the actions to situational and nursing framework conditions is necessary and is also required by every nursing standard! They are to be distinguished from so-called expert standards, for example at the federal level.

(* Original text - On February 14, 2011, 2:39 pm, the following post was published by Account N3 at pflegewiki.de 1.0 under the free license. In the meantime, the ...)

Goals, expectations

  1. Care standards determine a certain quality level of care through quantitatively measurable criteria. According to the ICN guidelines for standard development, they should convey innovative and intelligent content in order to meet the requirements of an effective instrument for quality development.
  2. Nursing standards define a certain performance area of ​​professional nursing care (process quality with the goal of good result quality.

Different definitions of standards

Care standards describe individual care measures, actions of a professional caregiver on a person to be cared for.

= they are therefore binding instructions in the facility for dealing with recurring care problems and actions. Expandable in the individual needs adjustment, stored in this form in the resident-related care planning.

It is by no means meant to be organizational guidelines or maintenance plans in any form.


"Standards correspond to an achievable and professionally coordinated level of performance. They reflect the ideal of the quality of care against which the actual performance is measured."

Adelheid von Stösser (1994):

"Nursing standards are generally applicable and accepted norms that define the area of ​​responsibility and the quality of care. Nursing standards determine, subject or activity-related, what the caregivers generally want / should do in a specific situation and what this service should look like." (See Stösser- Standards)
  • Criticism: This definition is illogical; one cannot define universally and specifically at the same time.

American Nurses Association (ANA, 19 ??)

  • describes standards and guidelines in terms of standard care plan (practice guidelines)
    • these have different intentions and ranges
    • the approach claims international and interdisciplinary validity for the healthcare system
    • is compatible with definitions from other professional associations

Standards of care

  • are often confused with (medical) guidelines or (action) guidelines
  • can be developed as practical or as expert standards (depending on the objectives of those involved)
    • accordingly have a different level of abstraction
  • are the professional agreement on a verifiable level of performance
  • also reflect professional values ​​and priorities
  • define the responsibilities and tasks of the carers
  • can contain structure, process and result criteria of the quality of care
  • require regular review
  • have a specific structure
  • must be technically justified and recognized within a professional group (capable of reaching a consensus)
  • can be under a motto / statement that describes the topic and objective of the standard
  • should be developed and introduced using station-based or decentralized methods
  • are created by working groups of nursing practitioners (and possibly nursing experts) (do not confuse it with a quality circle for cross-departmental problems)
  • Draft is put up for discussion and checked in practice through tests (consent)

The entire standard development process should be documented for the purpose of traceability.

  • are not there to make every care activity generally measurable, but only to standardize certain, particularly important areas in the sense of an improvement.

Features of standards of care

  • only briefly define important terms
  • contain a list of literature and references or refer to textbooks or manuals.
  • Practice standards:
    • are developed and applied in a specific ward, residential area or facility
    • reflect a feasible level of work for this area
    • are formulated more concretely
    • are mandatory minimum level of care in the facility. Supply (see service instructions)
    • may also have to be expanded within the scope of individual care planning = to be individualized

Quality assurance and standards of care

  • Care standards are an element of quality assurance
  • aims:
    • Standardization of procedures
    • Completeness of the preparations, especially the material
    • Minimum standard binding in the facility
    • Improve care plans and quality

For which areas can care standards be helpful?

  • Emergency situations
  • extensive material provision required
  • Complex disease-related assistance (e.g. with medical diagnostics and therapy)

Nursing standards are in no way a substitute for training or a textbook. They are only reminders for professionals who have already been trained or instructed.

Structure and content of care standards

Structure and shape

aims to provide a quick overview. It is not a legal instruction or insurance for a thousand eventualities

  • in writing, uniform structure (structure)
  • formulated in a way that is easy to understand
  • clear
  • no fine print
  • If possible, no longer than 1 page (material list may be extra)
  • Easily accessible for all caregivers - durable storage

The clear distinction between at least and possibly meaningful extensions is helpful.

Content of care standards

Necessarily available information

  • Problems posed by / by / for the patient
  • Possibly also: care category / level. Personal resources of the patient to be taken into account.

Application in which care situation (e.g. illness-health, diagnoses, therapy program; cooperation with other groups)

Clear definition of the measure - the name should not be an incomprehensible or ambiguous abbreviation. The code number for the documentation does not have to be in today's IT. When an abbreviation is entered, programs use a text module that is understandable and legible.

Required Requirements for the nursing staff

  • Training, course
  • number
  • possibly required feedback, registration

Preparation (information, personal preparation, material, space, person to be cared for)

Main points the process of implementation (steps, patient involvement, possibly important questions, steps)

Theses and follow-up support

  • Also helpful: Notes on the documentation
  • Forwarding of findings, etc.
  • Reorders
  • An important must: Name possible complications for which one must be prepared.

Time expenditure (time frame, minimum / maximum - no unrealistic time limits)

Put into effect:

  • who when
  • Intended re-examination of this standard of care

Questions about standards

  • which nursing objectives are being pursued?
  • what should care do?
  • who should provide care for whom and why
  • who is authorized to do what?
  • which resources are available
  • which options for checking the quality are available?
  • Care standards that are intended to help develop quality must have different dimensions.
    • Division into structure, process and result standards (but it does not have to be; has proven itself)
  • Usually the level of a standard is set high so that a quality improvement can be achieved with it

Also behind the word Quality standard can hide a standard of care.

Checklist for Analyzing Standards

  • Nursing understanding
  • advantages
  • Nursing objectives
  • Verifiability
  • Alternatives in the scope of action
  • Bibliography
  • Changes in care as a result
  • Differences to textbook opinions (a standard should contain far more than textbook opinions)
  • Representation of reasons in the standard
  • Level of care to be achieved
  • Information about the educational level of exam. Nurses go out
  • Information too banal or too complex?
  • Responsible for standard
  • "Best before" date of the standard
  • who can implement it with whom?
  • is there any further training available, is there a need for further training?

Possible criticism of a standard

  • deal with topics that are self-evident that are part of the basic training of a nurse - the meaning of these standards remains hidden
  • primarily process-oriented
  • Unclear definition of the level of care (no technical expression)
  • Verifiability of the application as a problem
  • missing current nursing knowledge
  • often updating of traditional knowledge or textbook opinions without current review
  • published standards are service instructions with legal liability claims
  • mostly missing (full) name of the author
  • missing references
  • many standards were developed from a retrospective point of view
    • This means that the standardization is inhibited and the professionals conveyed that they need such checklists because they have insufficient training.

These types of standards do more harm than good to the profession. Issue clarification is very important with standards because it helps train skills to prioritize and avoid maintenance errors.

  • Standards treat all residents / patients equally if well-trained staff does not address the personal concerns of the resident / patient

Quality assurance through standards

  • has a significant influence on nursing quality by specifying a minimum standard. The description makes it easier to check.
  • Care according to standards is also noticeable externally
  • Networks are useful for the development of standards and the associated quality review
  • EUROQUAN (European Network for Quality Assurance in Nursing) Coordination by the Osnabrück University of Applied Sciences
  • CBO (in the NL)
  • RCN (in GB)
  • BQS

See also articles about:


(… needs to be updated ) Books:

  • Jasenka Korecic: Care standards for elderly care. (1996, 1999 - 2. A). Springer, Berlin. ISBN 3-540-60265-8. 286 p. (Contains 30 nursing standards, each with a short and a long version with extensive reasons)
  • Simone Schmidt: Expert standards in nursing: practical and efficient. An instruction manual. Springer, Berlin, 2009. 207 pages. ISBN 978-3-642-01322-5 (publisher's website, but partly also on google-books)
  • Adelheid von Stösser: Care standards. Renewal of care by changing the standards. 1992, 1994 2.A, 1997 3. Erw. A: Springer-Verlag, Berlin. 236 pp. ISBN 3-540-58124-3


  • Sachs, Marcel (2006): Successful strategies and methods of implementing nursing standards. A systematic review. In: Pflege 1/2006, pp 33-44
  • Bartholomeyczik, Sabine (2005): It's not about the color of the washcloth. Standards in care. In: Dr. med. Mabuse ,. Issue 154, pp. 20-23.
  • Boelicke, Claus (2001): Definitions of standards, guidelines, and standard care plans. Pflege Aktuell 2/2001 pp. 96-99
  • Marhold D; Bite K (1999): Care Standards - Pros and Cons. Care & Society VOL: 4 (1); Pp. 14-16
  • Bartholomeyczik, Sabine (1999): Reason to think along. About the sense and nonsense of care standards. Care outpatient VOL: 10 (3); Pp. 33-36
  • Funny, Erich (1998): Conceptual Considerations for Working with Care Standards. Care, 11/1998 pp. 199 - 206
  • Trede, I. (1997): Of Babylonian Language Confusions. A literature review on the goals and characteristics of standards of care. Care VOL: 10 (5); Pp. 262-272
  • Janknecht, M. (1997): Care standards - an instrument for professional action? Care Current VOL: 51 (11); Pp. 678-681
  • Bartholomeyczik, Sabine (1995): Care standards viewed critically. The sister / the carer, 10/95 pp. 888 - 892

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