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A hands-on teaching aid for pressure ulcer prevention

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Using a toy doll to teach staff about pressure ulcer prevention helped tissue viability nurses in one trust to raise awareness of pressure ulcers

Citation: Reece R (2016) A hands-on teaching aid for pressure ulcer prevention. Nursing Times; 112: 1/2, 15.

Author: Rachel Reece is tissue viability nurse at University Hospitals Coventry and Warwickshire Trust.


Finding new, exciting and innovative ways to teach pressure ulcer prevention is a constant challenge for tissue viability nurses.We decided to purchase a toy doll to use as a teaching aid at our trust to educate staff in a “hands-on”, practical way and to raise awareness of pressure ulcer prevention. We named the doll Sally Sore (Fig 1, attached).

Clinical areas

The tissue viability team visit all clinical areas and provide short training sessions using Sally Sore to provide practical demonstrations, including:

  • 30-degree tilt;
  • Use of slide sheets;
  • Skin assessment;
  • Intentional rounding.

The teaching aid promotes discussion around pressure ulcer prevention and the presence of the team in clinical areas gives staff the opportunity to ask questions.

30-degree tilt

The 30-degree tilt is a repositioning technique that can be achieved by rolling patients slightly onto either side using pillows for support.

The traditional 90-degree lateral rotation of patients is no longer advocated as it can result in complete anoxia to weight-bearing areas and may contribute to pressure ulcer development. This position was also very restrictive – patients were often unable to reach drinks and social interaction could be limited when they were positioned away from other patients.

Sally Sore toured clinical areas on a mock bed and, with the help of specially made appropriately sized pillows, allowed staff to practise the technique with the support and supervision of the tissue viability team.

Slide sheet

Sally Sore wears a T-shirt with a poem to highlight the importance of using two slide sheets when repositioning patients. Miniature slide sheets are used to demonstrate the correct repositioning technique: two sheets should be rolled out beneath the patient from head to heels and the top sheet used to slide the patient up the bed. This education supports the mandatory moving and handling training provided by the trust.

Skin assessment and intentional rounding

Policy at our trust is that skin assessments should be carried out:

  • Within six hours of hospital admission;
  • On transfer;
  • At least daily thereafter for patients with a pressure ulcer risk score of ≥10.

Using Sally Sore, the tissue viability team is able to identify “at-risk” areas and demonstrate methods of pressure ulcer prevention such as heel elevation and regular repositioning.

An intentional rounding chart is completed for all inpatients, which incorporates the ASKIN tool. Sally Sore is used to reiterate the importance of documenting actions carried out in relation to all sections of the ASKIN tool.


In conjunction with link worker days, annual moving and handling training, and biannual pressure ulcer prevention training, Sally Sore on Tour has helped further raise awareness of pressure ulcer prevention in an enjoyable, interactive way. Her appeal is wide reaching and spans many disciplines. She has enthused new healthcare support workers, registered nurses, matrons, therapists and medical staff to consider their role in pressure ulcer prevention.

Although it is difficult to measure the effectiveness of Sally Sore as a tool for promoting pressure ulcer prevention, the reaction has been positive. This teaching aid has given us the opportunity to raise awareness, provide practical demonstrations and discuss the importance of clear, concise and accurate record keeping. Sally has become an integral part of our ongoing campaign to eliminate avoidable pressure ulcers in the trust.

  • Sally Sore has her own Twitter page – @SallySore – to promote her activities, and over 140 followers who are equally passionate about pressure ulcer prevention
  • 1 Comment

Readers' comments (1)

  • 30 deg tilt:
    "The traditional 90-degree lateral rotation of patients is no longer advocated as it can result in complete anoxia to weight-bearing areas and may contribute to pressure ulcer development."
    The 30 deg tilt has been around almost 30 years (28 to be exact), so why is 90 deg lateral rotation still regarded as 'traditional', I wonder.
    Ref:Preston K (1988) Positioning for comfort and pressure relief: The
    30º alternative. Care Sci Practice 4(6): 116–9

    Unsuitable or offensive? Report this comment

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