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Pressure Injury Prevention – does turning work

It was with great interest that I read the article by Richard White, et al; where they reviewed an Australian study about repositioning aged care residents at risk of pressure ulcer development.

Pressure area prevention is seen as a key role in the application of nursing care. I’ve been a nurse long enough to remember the “back trolley” that housed towels, metal bowls for water, methylated spirits, and talc. We would diligently steer this trolley through the ward and anyone who was confined to bed or immobile had their back washed every couple of hours, then metho applied followed closely by talcum powder! For the poor darlings who were immobile – every two hours, all their boney prominences were rubbed (massaged) with emollient cream and they were turned from side to side. This happened 24/7 – sleep deprivation is a form of torture but we did not see it this way – we woke them every two hours because we thought we were preventing pressure areas and we did not have any other mechanism available to us to relieve pressure.

We continue to “turn” patients at risk of developing pressure ulcers every two hours. Especially in residential aged care facilities where there are a number of strategies employed to gain staff compliance. From a tick sheet to a clock face – the focus is on compliance and consistency, however, there is little evidence to show that second hourly turning works to prevent pressure ulcers.

The paper identifies that waking clients every two hours can lead to problems associated with sleep deprivation – from confusion through to aggressive behaviour. Sleep is the bodies mechanism to reset and restore – waking every two hours does not allow for this to occur.

The conclusion reached is that immobile patients are at risk of developing pressure ulcers and that pressure ulcers can at a minimum cause discomfort and in the worst-case scenario death. Relieving pressure remains at the core of prevention strategies but the practice of turning people every two hours, in the view of the authors, is not effectual and becomes a human rights issue. The recommendation is that all clients are assessed for pressure injury risk and at a minimum, those identified at risk are provided with alternate pressure air mattresses. Best practice scenario would be that all clients in aged care facilities are provided with these mattresses.

Click here to read the article

I’d be interested to hear your thoughts after you’ve read the article.