Nutrition as a nursing prevention strategy in pressure injury care: a structured framework for risk assessment and clinical reasoning

Background Pressure injuries remain a major patient-safety and quality-of-care challenge, particularly among older adults and patients with impaired mobility or chronic disease. Nutritional status has emerged as a relevant factor influencing tissue vulnerability, prevention, and wound healing. Methods A structured narrative review was conducted following SANRA principles. Searches were performed in PubMed/MEDLINE and CINAHL and were complemented by searches in SciELO, Dialnet, and ScienceDirect. Literature published from January 2016 through April 2026 was considered. Evidence was synthesised to develop a nursing prevention-oriented framework integrating nutritional assessment, pressure injury risk evaluation, and nurse-led preventive interventions. Results The reviewed evidence consistently linked malnutrition and inadequate protein-energy intake with increased risk of pressure injuries and impaired healing. Nutritional screening, early risk assessment, repositioning strategies, skin care, and multidisciplinary coordination emerged as central nurse-led prevention domains. The synthesis also highlighted the relevance of wound-reference nurses, defined as nurses with designated expertise in wound prevention and management, in promoting evidence-based prevention practices and continuity of care. Conclusions Integrating nutritional assessment into pressure injury prevention supports a prevention-oriented nursing approach focused on early risk identification, patient safety, and coordinated care. The proposed framework offers a structured model to support nursing clinical reasoning and preventive decision-making across care settings.