Reflective accounts

Pressure ulcers

A CPD article improved Pamela Madlakama’s understanding of the prevention of these skin and tissue injuries in frail older people. 

A CPD article improved Pamela Madlakama’s understanding of the prevention of these skin and tissue injuries in frail older people


Picture: SPL

What was the nature of the CPD activity, practice-related feedback and/or event and/or experience in your practice?

The article discussed how the incidence and severity of preventable pressure ulcers can be used as an indicator of quality of care. It established that nurses have an essential role in managing and preventing pressure ulcers in frail older people and emphasised the importance of patient education and teamwork.

What did you learn from the CPD activity, feedback and/or event and/or experience in your practice?

The article explained that, as an individual ages, their epidermal cells become thinner, the sensitivity of their immune system is reduced, and sebum secretion decreases. As a result, frail older people are at increased risk of developing pressure ulcers through friction and shear.

I learned that preventing pressure ulcers should begin with the completion of a risk assessment, which examines factors such as immobility, skin condition, previous pressure ulceration, and suboptimal tissue perfusion. Similarly, older people who have an inadequate dietary intake can become malnourished, which can increase their risk of developing pressure ulcers. Therefore, it is important for nurses to be familiar with the Malnutrition Universal Screening Tool, which should form part of the assessment.

How did you change or improve your practice?

I will consider using the SSKIN care bundle to assist in the prevention of pressure ulcers in frail older people, which focuses on five areas of care: surface, skin inspection, keep moving, incontinence and nutrition.

‘Surface’ is concerned with ensuring that any pressure-relieving equipment, such as support mattresses and cushions, are appropriate for the older person, while ‘skin inspection’ ensures that the nurse inspects the older person’s skin daily, paying particular attention to areas vulnerable to pressure ulcers, such as the buttocks, elbows, sacrum and hips. 

‘Keep moving’ ensures that individuals who are still mobile are encouraged to walk short distances under supervision to relieve pressure on the skin, while ‘incontinence’ ensures that continence pads, barrier creams and toileting regimens are used to reduce the effects of moisture-associated dermatitis. 

‘Nutrition’ ensures that an individual’s diet is appropriate, which will promote the maintenance of skin integrity.

How is this relevant to the Code? Select one or more themes: Prioritise people, Practise effectively, Preserve safety, Promote professionalism and trust

This article was relevant to the theme of practising effectively since it emphasised the importance of effective teamwork in identifying the risk of pressure ulcers in frail older people, for example involving dietitians in a nutritional assessment.

It also encouraged nurses to regularly update their knowledge, particularly in relation to technological developments in pressure-relieving equipment.

Pamela Madlakama is a staff nurse at Connect House Care Home, Nottingham


This reflective account is based on NS824 Barry M, Nugent L (2015) Pressure ulcer prevention in frail older people. Nursing Standard. 30, 16-18, 50-58

Write your own reflective account

You can gain a certificate of learning by reading a Nursing Standard CPD article and writing a reflective account. To write a reflective account for Nursing Standard, use the NMC reflective accounts form. Complete the four questions about a CPD article you have read, writing about 700 words in total.

The authors of reflective accounts that are published in Nursing Standard receive a £50 book token. Details of how to submit your reflective account for publication are available here.

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