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Two hourly, three hourly turns, what we do just doesn’t work

  • Comments (4)

I have been really interested in your debate about the effectiveness of 30 degree tilts to reduce pressure ulcers.

I have two thoughts, one professional and the other personal.

My first thought is if we know how to prevent skin breakdown, why is pressure ulceration still a major problem?

Several weeks ago, Judy Harker, a tissue viability nurse consultant, talked about the challenges of pressure ulcer prevention and the work underway to improve care. The problem is that although we have guidelines, the supporting evidence is surprisingly poor.

I agree research into essential care can sometimes feel like “teaching your grandmother to suck eggs”. But looking forward we are facing very different challenges of caring for older, sicker and more dependent patients, and this must demand systemic investigation. We need to know more about individual risk factors and how interventions can be used efficiently and effectively.

On a personal note, both my parents died in recent years.

My father died with a grade 4 pressure ulcer and my mother with ulcers on both heels.

I wish the staff had known about 30 degree tilts, turning and mattresses. They both died with infected,  painful wounds which could have been prevented if every nurse involved in their care had thought about their complex health problems and understood their risk factors, hypoxia, neuropathy etc etc..

This shouldn’t happen and any research that improves nurses’ knowledge has to be a step in the right direction.

Judy Harker noted a possible link between the value a nurse places on pressure ulcer prevention and the patient care that they deliver.  Discussing ways to improve care is essential and we have to work together as a nursing community to find solutions.

Looking at your debate about 30 degree tilts, I note one brave contributor who put his hand up and said “I didn’t know that”. 

I am absolutely sure he is not the only one.

  • Comments (4)

Readers' comments (4)

  • michael stone

    ‘The problem is that although we have guidelines, the supporting evidence is surprisingly poor.’Eileen’s comment there is interesting – do people follow guidelines without examining if they are well-founded, or do nurses ‘challenge’ guidance which looks dubious ?
    And this is interesting, as well: ‘Looking at your debate about 30 degree tilts, I note one brave contributor who put his hand up and said “I didn’t know that”. I am absolutely sure he is not the only one.’
    Someone has to be brave enough, to be the first person to ask ‘Is this wrong, or am I being stupid and missing something ?’ and often, once one person has been brave enough to do that, a forest of arms shoot up with ‘me too !.’

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  • eileen shepherd

    Michael my point is that we have very little evidence to support interventions. Guidelines are often based on expert opinion. These guidelines are extremely useful but looking forward we need more research into risk factors for pressure ulceration if we are to meet the challenges of an ageing population.

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  • Anonymous

    Not directly related to your article but I thought this might be of general interest to nurses and your other readers

    in this mornings online Telegraph

    Bedsores: the treatable killer
    Bedsores are caused in the main by neglectful nursing care for the bed-ridden. Why are we allowing it to happen?
    By Max Pemberton7:30AM BST 11 Jul 2011

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