Joyce M Black

University of Nebraska at Omaha | UN Omaha · College of Nursing

Although other patient safety indicators have seen a decline, pressure injury (PI) incidence has continued to rise. In this article, the authors discuss the role of shear stress and shear strain in PI development and describe how accurate assessment and management can reduce PI risk. They provide explanations of shear stress, shear strain, friction...

Background Pressure injury prevention is complex, and rates continue to rise. Checklists reduce human error, improve adherence and standardization with complex processes, focus attention on evidence‐based practices derived from clinical practice guidelines and are arranged in a systematic manner to manage the entirety of a patient's risk for preven...

Objective: The incidence of skin/tissue damage, such as pressure ulcers, remains high in mechanically ventilated patients in the prone position. According to guidelines, critically ill patients with acute respiratory distress syndrome (ARDS) should be prone for at least 12-16 hours to improve oxygenation and decrease mortality. Therefore, educatin...

Background: Pressure injury (PI) development is multifactorial. In patients with dark skin tones, identifying impending PIs by visual skin assessment can be especially challenging. The need for improved skin assessment techniques, especially for persons with dark skin tones, continues to increase. Similarly, greater awareness of the need for inclu...

The International Wound Dressing Technology Expert Panel has provided important work about the history of wound treatment dressing construction, development and testing methods related to clinical performance. As it now stands, these types of dressings require additional rigorous engineering testing to ensure that the indication of a dressing, whet...

p>Although great strides have been made to tackle hospital-acquired pressure ulcers (HAPUs), there is a need for greater recognition of device-related pressure ulcers (DRPUs), including their causes, management and prevention. This consensus statement, an updated second edition, aims to continue raising awareness of these largely preventable injuri...

Background: Data from the Agency for Healthcare Research and Quality indicate that hospital-acquired pressure injuries (HAPIs) and surgical site infections are the only 2 hospital-acquired conditions that have not improved. Consequently, health systems around the nation are struggling to lower HAPI rates and avoid penalties. All patient care areas...

Background Ventilating critically ill patients with acute respiratory distress syndrome in the prone position is a life-saving strategy, but it is associated with adverse consequences such as skin damage. Aim To identify, review and evaluate international proning and skin care guidelines and make an inventory of commonly used equipment and trainin...

COVID-19 has infected millions of patients and impacted healthcare workers worldwide. Personal Protective Equipment (PPE) is a key component of protecting frontline clinicians against infection. The benefits of PPE far outweigh the risks, nonetheless, many clinicians are exhibiting skin injury caused by PPE worn incorrectly. These skin injuries, ra...

Deep tissue pressure injury (DTPI) is a serious form of pressure injuries. The condition remains invisible for up to 48 hours and then progresses rapidly to full-thickness skin and soft tissue loss. Many other conditions that lead to purple skin can be misidentified as DTPI, making the diagnosis difficult at times. A thorough history exploring expo...

An optimal position of the patient during operation may require a compromise between the best position for surgical access and the position a patient and his or her tissues can tolerate without sustaining injury. This scoping review analysed the existing, contemporary evidence regarding surgical positioning‐related tissue damage risks, from both bi...

Catherine Milne and colleagues present the findings of their review, ccna2@juno.com

Black J, Kottner J, Gefen A, Santamaria N, Alves P, (2019) Meeting report: Addressing risk factors with evidence-based technologies for the prevention and treatment of pressure injuries in different healthcare settings. Wounds International 10(3): 76–81

Root cause analysis (RCA) is a systematic process for identifying the causes of an adverse occurrence or combined with an approach for a response designed to prevent recurrences. This method may be used for continuous quality improvement in a facility or health system. Root cause analysis can aid nurses and hospital risk managers to determine how t...

A deep-tissue pressure injury (DTPI) is a serious type of pressure injury that begins in tissue over bony prominences and can lead to the development of hospital-acquired pressure injuries (HAPIs). Using a commercially available thermal imaging system, study authors documented a total of 12 thermal anomalies in 9 of 114 patients at the time of admi...

Most acute care facilities are undergoing a major culture change and transforming into a high reliability organization focused on putting the patient experience first by delivering high quality, safe care. Reducing or eliminating hospital acquired conditions (HAC) fuels many quality improvement (QI) projects and successful reductions are attained w...

PRISMA Systematic review that preceded the currently published 8 year cohort study of the same population

This paper addresses a fundamentally important issue in health care, namely how to make informed decisions on product selection when two products, from different manufacturers, appear to be similar and have medical claims that sound comparable. In such cases, manufacturers of competing products often use each other’s evidence. They argue that the p...

Compliance with international best practice guidelines can effectively prevent most hospital‐acquired pressure injuries (HAPIs).(Black 2011, National Pressure Ulcer Advisory Panel 2010, Padula et al. 2016) These guidelines include several nursing interventions that first were introduced in 1992 by the U.S. Agency for Healthcare Research & Quality (...

Pressure ulcers are caused by sustained mechanical loading and deformation of the skin and subcutaneous layers between internal stiff anatomical structures and external surfaces or devices. In addition, the skin microclimate (temperature, humidity and airflow next to the skin surface) is an indirect pressure ulcer risk factor. Temperature and humid...

Evidence indicates that chances for a successful patient mobility program, prevention of pressure injury and falls, and safe patient handling are enhanced when an organization possesses an appropriate culture for safety. Frequently, these improvement initiatives are managed within silos often creating a solution for one and a problem for the others...

Objective: Health systems are grappling with improving the quality and safety of health care. By setting clear expectations, there is an opportunity to configure care models to decrease the risk of adverse events and promote the quality of care. The US Centers for Medicare and Medicaid Services have used Patient Safety Indicator 90 (PSI90), a comp...

Accurate assessment and clear documentation are important aspects of wound care; they provide a basis for appropriate patient care decisions and reimbursement. A descriptive, qualitative study was conducted to develop and provide preliminary evidence of the validity of a new tool to measure wound healing (the Healing Progression Rate [HPR]), a modi...

Management of chronic wounds remains challenging in terms of prevalence and complexity. Considerable progress has been made in understanding the science of wound healing during the past decade, sparking volumes of publications and the development of hundreds of dressing and therapy options. There is a need for a simpli ed overview of evidence-based...

Our understanding of pressure injury etiology and development has grown in recent years through research, clinical expertise, and global interdisciplinary expert collaboration. Therefore, the National Pressure Ulcer Advisory Panel (NPUAP) has revised the definition and stages of pressure injury. The revision was undertaken to incorporate the curren...

Há indicações em publicações específicas que a implementação de estratégias de prevenção da lesão por pressão (LP) pode resultar em redução da ocorrência da lesão por pressão em cenários agudos e de longo prazo3-8. Entretanto, as lesões por pressão continuam ocorrendo e resultando em considerável morbidade e mortalidade e encargos sociais e económi...

Joyce M Black,1 Peggy Kalowes2 1Adult Health and Illness Department, College of Nursing, University of Nebraska Medical Center, Omaha, NE, 2Nursing Research and Innovation, Long Beach Memorial Miller Children’s & Women’s Hospital, Long Beach, CA, USA Abstract: Pressure ulcers from medical devices are common and can cause significant morbidity in pa...

The elderly remain one of the highest at–risk groups for pressure ulcers. Pressure ulcers form due to the intensity and duration of pressure; high intensity leads to deep tissue injury (DTI). DTI pressure necrosis appears as purple or maroon tissue in tissue subjected to pressure and therefore is not always on a bony prominence. Prevention is focus...

Deep tissue injury (DTI) can be difficult to diagnose because many other skin and wound problems can appear as purple skin or rapidly appearing eschar. The diagnosis of DTI begins with a thorough history to account for times of exposure to pressure, such as 'time down' at the scene or time during which the patient was flat and could not respond. Pa...

This executive summary reports outcomes of an interprofessional collaboration between experts in pressure ulcer prevention, bedside clinicians, regulatory agencies, quality improvement, informatics experts, and professional nursing organizations. The goal of the collaboration was to develop a framework to assist facilities to operationalize best pr...

The ACP guidance reflects that risk assessment tools for pressure ulcers are imperfect predictors of risk. Pressure ulcers typically develop in patients with limited ability to participate in their own care. Therefore, application of the principles that are used to predict risk for other conditions, such as cancer, is problematic. First, patients w...

The formulation of recommendations on the use of wound dressings in pressure ulcer prevention was undertaken by a group of experts in pressure ulcer prevention and treatment from Australia, Portugal, UK and USA. After review of literature, they concluded that there is adequate evidence to recommend the use of five-layer silicone bordered dressings...

This systematic review considers the evidence supporting the use of prophylactic dressings for the prevention of pressure ulcer. Electronic database searches were conducted on 25 July 2013. The searches found 3026 titles and after removal of duplicate records 2819 titles were scanned against the inclusion and exclusion criteria. Of these, 2777 were...

Recent clinical research has generated interest in the use of sacral wound dressings as preventive devices for patients at risk of ulceration. This study was conducted to identify the modes of action through which dressings can add to pressure ulcer prevention, for example, shear and friction force redistribution and pressure distribution. Bench te...

Medical device related pressure ulcers (MDR PUs) are defined as pressure injuries associated with the use of devices applied for diagnostic or therapeutic purposes wherein the PU that develops has the same configuration as the device. Many institutions have reduced the incidence of traditional PUs (sacral, buttock and heel) and therefore the signif...

Although this article is a stand-alone article, it sets the scene for later articles in this issue. Pressure ulcers are considered to be a largely preventable problem, and yet despite extensive training and the expenditure of a large amount of resources, they persist. This article reviews the current understanding of pressure ulcer aetiology: press...

This study examined the effect of practice with a high-fidelity infant simulator on anxiety in undergraduate student nurses before the first head-to-toe assessment of a hospitalized child. Students were assigned to experimental (N = 27) and attention intervention (N = 25) groups. The experimental group provided postoperative assessments using the S...

The primary objective of this study was to compare facility-acquired pressure ulcer incidence and progression of pressure ulcers present on admission in critically ill patients, using 2 different support surfaces. We completed a comparison cohort study in a surgical intensive care unit (ICU). The study setting was a 12-bed cardiovascular ICU in a u...

Moisture-associated skin damage (MASD) occurs when excessive moisture in urine, stool, and wound exudate leads to inflammation of the skin, with or without erosion or secondary cutaneous infection. This article, produced by a panel of clinical experts who met to discuss moisture as an etiologic factor in skin damage, focuses on peristomal moisture-...

A consensus panel was convened to review current knowledge of moisture-associated skin damage (MASD) and to provide recommendations for prevention and management. This article provides a summary of the discussion and the recommendations in regards to 2 types of MASD: incontinence-associated dermatitis (IAD) and intertriginous dermatitis (ITD). A fo...

Moisture-associated skin damage (MASD) is caused by prolonged exposure to various sources of moisture, including urine or stool, perspiration, wound exudate, mucus, saliva, and their contents. MASD is characterized by inflammation of the skin, occurring with or without erosion or secondary cutaneous infection. Multiple conditions may result in MASD...

Although pressure ulcer (PrU) development is now generally considered an indicator for quality of care, questions and concerns about situations in which they are unavoidable remain. Considering the importance of this issue and the lack of available research data, in 2010 the National Pressure Ulcer Advisory Panel (NPUAP) hosted a multi...

Most pressure ulcers occur over bony prominences such as heels and the sacrum. However, the National Pressure Ulcer Advisory Panel recognises that pressure ulcers can also occur on any tissue under pressure and thereby can develop beneath medical devices. This article reports on results from a secondary analysis of existing data collected by The Ne...

Pressure ulcer assessment is usually performed at the bedside by a clinician with minimal training in wound assessment. A multidisciplinary panel of United States' wound experts was assembled to provide anatomically accurate and practical terms associated with pressure ulcer assessment, healing, and nonhealing in order to help clinicians identify a...

Pressure ulcer prevalence and incidence data are increasingly being used as indicators of quality of care and the efficacy of pressure ulcer prevention protocols. In some health care systems, the occurrence of pressure ulcers is also being linked to reimbursement. The wider use of these epidemiological analyses necessitates that all those involved...

The National Pressure Ulcer Advisory Panel has updated the definition of a pressure ulcer and the stages of pressure ulcers based on current research and expert opinion solicited from hundreds of clinicians, educators, and researchers across the country. The amount of anatomical tissue loss described with each stage has not changed. New definitions...

To identify how current pressure ulcer staging systems and experts describe pressure-related deep tissue injury under intact skin in the published research literature. A systematic review of published English-language literature as of November 2002 with the words decubitus or pressure ulcer(s) in the title. Additional relevant articles were identif...

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Several categories of patients may be receiving anticoagulation therapy and require surgery. Many patients take cardioprotective aspirin or warfarin for atrial fibrillation, the presence of a mechanical heart valve, prior thromboembolism, a documented left ventricular thrombus, or a history of venous thromboembolism with or without a pulmonary embo...

Diabetes mellitus is known to retard wound healing. This study of 35 subjects with pressure ulcers found that carbon dioxide levels were negatively correlated to healing rates. Transcutaneous oxygen levels of peri ulcer was not statistically significantly related to healing rates.

Pressure ulcer repair with skin or muscle flaps may appear to close the wound, but elderly patients need extra precautions before and after surgery to improve the outcome. Nursing care of these patients include monitoring nutrition, removing devitalized tissue from the wound bed, providing proper pressure relief, administering proper patient positi...

Surgical alternatives in wound care are a primary consideration for the treatment of nonhealing and traumatic wounds. Using the Reconstructive Ladder as an outline, this article provides an overview of preoperative wound care and the indications for surgical options in wound care. An overview of nursing care is highlighted as each option is reviewe...