Reflective accounts

Pressure ulcers

My nursing experience is in acute care. Acute medical nurses are well placed to assess skin integrity, identify patients at risk of pressure ulcer development, and commence appropriate interventions to prevent or treat pressure ulcers.

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The article on pressure ulcer prevention, discussed the intrinsic and extrinsic factors that can cause pressure ulcers in older people. Intrinsic factors include reduced mobility, incontinence and inadequate nutrition, whereas extrinsic factors include pressure, shearing force and friction. I am now well aware that the decrease in sebum secretion in older adults’ skin can increase the risk of developing a pressure ulcer.

I was interested to read that most pressure ulcers experienced by older adults are preventable. The acute medical environments where I have worked have used the SSKIN (Surface, Skin inspection, Keep your patients moving, Incontinence/moisture, Nutrition/hydration) care bundle to provide standardised care to prevent pressure ulcers in at-risk individuals. The SSKIN care bundle emphasises the need to assess and review an at-risk patient’s skin integrity regularly. For example, a brief skin assessment may be performed whenever a patient is repositioned.

The table within the article outlining the classification system for pressure ulcers reaffirmed my knowledge of these stages. It would be useful for members of the multidisciplinary team to use this table to identify and classify pressure ulcers.

Previously, I had experienced confusion in determining the difference between moisture lesions and pressure ulcers. Since reading the article, I was involved in the care of a patient who had broken skin on the buttock, which had initially been described as a pressure ulcer. However, I recognised this as a moisture lesion.

One of the most effective ways of preventing pressure ulcers is regular repositioning of the patient. Pressure relief is also an important component of prevention and treatment, and can be provided using appropriate support surfaces. These can include foam mattresses, cushions and heel elevators, which should be allocated according to the patient’s needs.

Patient education

An important aspect of nursing is offering education to patients and others involved in their care. Advising patients, their families and healthcare staff on measures to prevent pressure ulcers can promote self-care and improve patients’ quality of life.

This article has prompted re-evaluation of my knowledge of pressure ulcers and improved my understanding of their causes and treatment, particularly in older people. Most importantly, I am now aware that the majority of pressure ulcers are preventable, which will inform my nursing practice.

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