Pressure Sore Management: An Educational Gap in Clinical Areas

Nursing
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Pressure sores management is one of the main issues in the clinical setting. This write up will
address pressure sore management as an educational gap in the clinical areas and further discuss
how best to handle it. Pressure sores are injuries to the skin and underlying tissues due to
prolonged pressure on the skin (Edsberg.et.al 2016, pp. 585). These ulcers mostly develop in the
skin that covers bony prominences such as heels, hips, and ankles. They present with unusual
changes in skin color, pain, swelling and pus-like draining (Khan.et.al 2016, pp. 111). Most
pressure sores can heal with treatment but the main thing is to prevent its development. The
management of pressure sore is not really at a level which is satisfactory and this is an
educational gap which has to be look into and rectified.
Despite the implementation of prevention protocols on pressure sores, patients are still
developing pressure ulcers. Hospital-acquired pressure ulcers are mainly caused by constant
pressure on a certain part of the body that can lead to the reduced blood supply to that area
(Black.et.al 2015, pp. 322-327). Decreased blood supply deprives the tissue oxygen and nutrients
and hence necrosis. Friction and shear to the skin are also the most common causes of pressure
ulcers especially when the skin is moist (Garcia-Fernandez.et.al 2014, pp.28-38).
Other contributing factors are cognitive impairment and immobility. People with mobility
problems especially bedridden patients are at high risk. The preventive measures for these
patients are skin care and turning the patient at least after every 30m minutes (Gunningberg.et.al
2017, pp. 53-59). This has been a challenge especially when the nursing staff is few and they
have to attend to many patients. The high nurse to patient ratio is also contributing because the
nurses get so exhausted attending many patients from shift to shift. They therefore end up
attending only the number of patients whom they are capable of only. They at times take long
hours before coming back to the first patient and this has greatly increased the incidence of

occurrence. Lack of enough knowledge and skills especially by the student nurses is also a
contributing factor. The nursing students if not well informed about the preventive factors of
pressure sores, may end up being the cause (Gunningberg.et.al 2015, pp. 462-468). According to
Cox and Roche (2015, pp.501-510), the patients have been found to lack enough knowledge of
pressure sores affecting them. They end up developing them because of not knowing what they
should do for example exercising in bed if they cannot come out of bed or turning regularly.
According to O'grady, Hannigan, and O'connor (2017, pp. iii13-iii59), the proposed educational
tool for pressure sores is the SSKIN (skin, surface, keep moving, incontinence and
nutrition/hydration) bundle. This tool is designed to aid in the assessment and care planning for
people at risk of pressure ulcers. The main aim is to avoid pressure injury occurring and if it
does, to identify problems early in order to prevent deterioration and promote healing (Fleming
2015). The skin should be assessed regularly depending on the risk of the pressure sore
development. Skin tolerance test is used and the pressure sore graded (Campbell 2016, pp.S14-
S26). This will help to realize the risk of developing a pressure sore as early as possible. The
patient can also do the test him/herself. For patients with dark skin, changes in skin temperature,
texture, pain, and discoloration can be observed.
Interventions should then be carried out depending on the stage of the pressure ulcer. Those
patients who are at risk, a repositioning regimen should be put into place. Patient education is
also very important in these patients. Patients, who have already existing pressure sores, should
be repositioned more frequently. Transfer aids should also be used to prevent further shear and
tear. For patients with grade one and grade two pressure sores in the buttocks, they should not be
allowed to sit for more than two hours and those with grade 3 and 4 should not sit at all (Moore
and Cowman 2014). According to Moore and Webster (2018), silicon-based cream to act as a