Pressure injury prevention patient and carer

SectionRecommendation Grading
1. Patients, families and careers are informed of the risks, prevention strategies and management of pressure injuries. Development of the pressure injury management plan is to occur in partnership with the patient, family and carers if appropriate. Standard 8
The evidence review for these recommendations was current to December 2012. Clinicians are advised to check the literature as research may have been published that changes these recommendations.

A pressure injury has a substantial impact on all aspects of a patient’s life. There is little data describing the specific impact on patients recovering from critical illness however a systematic review focusing on the impact on the quality of life for the elderly is instructive (2). A pressure injury causes significant physical symptoms, especially pain, with the consequences of restriction on mobility and insomnia (3). Rehabilitation from the primary illness, as well as treatment for other conditions, may be delayed further restricting recovery. Once discharged from hospital, patients may experience social isolation as they withdraw from pre-illness activities, further complicated by ongoing management of the pressure injury. In particular the odour from an exudating wound is of particular concern. Patients also experience a loss of control and independence. To promote an understanding of pressure injury prevention practices patients and families should be provided with clear information.

Table 1 Health-related quality of life impact on the elderly

Health-related quality of life theme

Elements

Physical impact and limitations (11 studies)

  • Restricted activities of daily life (ADLs)
  • Lifestyle change: incorporation of skin care and pressure injury treatment
  • Need for environmental changes
  • Loss of appetite and interest in physical activities, insomnia and reduction of engagement in life

Social life (10 studies)

  • Restriction in social activity
  • Social isolation
  • Problems in interpersonal relationships

Psychological impact (12 studies)

  • Alteration in body image and self-concept
  • Struggle for control
  • Loss of independence
  • Negative emotions including mood, anger, frustration, anxiety and depression

Impact of pressure injury symptoms (15 studies)

  • Pain impacting on all areas of life
  • Interference with ADLs

Impact on general health and consequences (12 studies)

  • Extended hospital stay
  • Re-admission
  • Delays rehabilitation process
  • Restriction on treatment options for other medical problems

Compiled from Gorecki (2, 4).

HRQL health-related quality of life

References

  1. Care ACoSaQiH. National Safety and Quality Health Service Standards. Commonwealth of Australia; 2011.
  2. Gorecki C, Brown JM, Nelson EA, Briggs M, Schoonhoven L, Dealey C, et al. Impact of pressure ulcers on quality of life in older patients: a systematic review. Journal of the American Geriatrics Society. 2009;57(7):1175-83.
  3. Hopkins A, Dealey C, Bale S, Defloor T, Worboys F. Patient stories of living with a pressure ulcer. Journal of advanced nursing. 2006;56(4):345-53.
  4. Elliott R, McKinley S, Fox V. Quality improvement program to reduce the prevalence of pressure ulcers in an intensive care unit. Am J Crit Care. 2008;17(4):328-34.

Disclaimer

The information on this page is general in nature and cannot reflect individual patient variation. It reflects Australian intensive care practice, which may differ from that in other countries. It is intended as a supplement to the more specific information provided by the doctors and nurses caring for your loved one. ICNSW attests to the accuracy of the information contained here but takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.