Chronic and complex wounds of the lower extremity frequently recur. It is difficult to determine the precise recurrence rate across patients with different lower extremity wound types, including diabetic foot ulcers, arterial ulcers, pressure injuries, and venous ulcers. However, we know that...
Holly M. Hovan MSN, RN-BC, APRN.ACNS-BC, CWOCN-AP
Often when we hear the words "pressure injury," our brains are trained to think about staging the wound, considering treatment options, and obtaining a provider's order for care. Ideally, when we hear the words "pressure injury," we should think prevention! As Benjamin Franklin once said, "an ounce of prevention is worth a pound of cure." This is a very true statement and speaks volumes to our goals of care and education format when developing pressure injury prevention curriculum for our facilities.
The nursing assistant (NA) or bedside caregiver (unlicensed personnel) usually has the initial and final contact of the day with our patients and their skin. They are the ones giving bed baths, assisting with perineal care, turning and repositioning, assisting with feedings, recording intake and output, noticing if or when someone is incontinent, and functioning as the eyes and ears of the nurse by reporting abnormal findings or changes. With that being said, we need to be able to trust our "eyes and ears" and be sure that they have the tools and education needed to best perform their job.
Nursing Assistants and Pressure Injury Prevention
The role of the NA is huge when it comes to skin and noticing subtle changes. The NA is often the first person to notice the smallest changes in the patient, especially when consistent assignments are implemented. The learning needs of licensed and unlicensed staff are somewhat different, and it is important that we incorporate unique education for our unlicensed caregivers, specifically related to:
- Knowing and understanding the Braden Scale for Predicting Pressure Sore Risk® score: if it is ≤18, the patient is at risk for developing a pressure injury. A brief overview or definition of the scale is helpful for unlicensed caregivers to understand the evidence-based rationale behind the interventions they are implementing.
- Knowing which categories of the Braden Scale the patient is lacking in and paying more attention to those deficits when implementing the plan of care or interventions (e.g., more frequent incontinence care if resident is incontinent of bowel or bladder).
- Understanding the rationale and importance of assisting at-risk patients with turning and repositioning every two hours while they are in bed.
- Understanding and implementing hospital-specific interventions when appropriate – heel offloading boots, barrier cream, breathable under pads, etc.
- Good communication: feeling comfortable reporting changes to the licensed caregiver and NOT feeling dismissed or brushed off. This is important! If the unlicensed caregiver does not feel like they have a voice, they are less likely to speak up.
As previously mentioned, NAs are our eyes and ears and sometimes even the voice of our patients who cannot speak for themselves. They know these patients, observe their habits, and see their skin regularly. It is important that they are equipped with the knowledge and hands-on skill set to provide evidence-based care and pressure injury prevention measures to our patient population. One-on-one education, interactive games, or routine in-services are some of the ways to involve unlicensed staff in a pressure injury prevention program. Additionally, staff recognition and appreciation are important; badge backers, pins, or even stickers are some of the ways we can recognize our skin champion leaders. The more involved our staff members are, and then more engaged they are, the higher the likelihood that they will be involved in pressure injury prevention measures.
In closing, some specific ways to encourage unlicensed staff to be involved are:
- Participate in in-services and educational opportunities related to pressure injury prevention, and share the information with your co-workers.
- Talk to the Charge Nurse, Assistant Nurse Manager, or Nurse Manager if you ever have a suggestion about something you think may work for specific patients or for the unit in general.
- Share what you learn and know with other staff members.
- If you see something wrong (e.g., an incontinent patient without an order for barrier cream), don't be afraid to speak up and fix it!
- With YOUR help and a team approach, pressure injuries, the pain that they cause, and the overall decrease in quality of life that comes along with them CAN be prevented!
About the Author
Holly is a board certified gerontological nurse and advanced practice wound, ostomy, and continence nurse coordinator at The Department of Veterans Affairs Medical Center in Cleveland, Ohio. She has a passion for education, teaching, and our veterans. Holly has been practicing in WOC nursing for approximately six years. She has much experience with the long-term care population and chronic wounds as well as pressure injuries, diabetic ulcers, venous and arterial wounds, surgical wounds, radiation dermatitis, and wounds requiring advanced wound therapy for healing. Holly enjoys teaching new nurses about wound care and, most importantly, pressure injury prevention. She enjoys working with each patient to come up with an individualized plan of care based on their needs and overall medical situation. She values the importance of taking an interprofessional approach with wound care and prevention overall, and involves each member of the health care team as much as possible. She also values the significance of the support of leadership within her facility and the overall impact of great teamwork for positive outcomes.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.