Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury - 28

PRESSURE ULCER PREVENTION AND TREATMENT FOLLOWING SPINAL CORD INJURY

Education-Health Care
Professionals, Persons with SCI,
Family, Caregivers
10. Provide individuals with SCI, their family,
significant others, and health-care
professionals with specific information on
effective strategies for the prevention and
treatment of pressure ulcers. This should
include the following:

Pressure ulcer etiology

Reducing pressure ulcer risk

Skin cleansing and care techniques

Management of incontinence

Frequency and techniques of skin
inspection

Frequency, duration, and techniques
of recommended position changes

Frequency, duration, and techniques of
recommended pressure redistribution

Nutrition as it relates to maintaining
skin integrity

Use and maintenance of support
surfaces (mattresses and cushions)

Skin changes to be reported to the
health-care team

(Scientific evidence-II, III, IV V; Grade of
,
recommendation-B; Strength of panel opinion-Strong)

Education of the patient, caregivers, and
family members is critical for pressure ulcer
prevention and management. Persons with SCI
have a lifetime need for education regarding skin
care and prevention and treatment of pressure
ulcers. It is essential that individuals be provided
with the basic knowledge necessary to return
them to home and community (Fowler and
Pelfrey, 1993). Learning styles should be
identified and appropriate teaching strategies
to include appropriate content material, time
of dissemination, and recurrent education
when needed should be implemented for the
individual with SCI as well as family and personal
care assistants.
Hospital-based education programs,
especially during initial rehabilitation following a
SCI, are inadequate to effect implementation of
preventive practices once the person has
returned to his home and community. Rarely is
formal or informamal education programs
assessed for their effectiveness in reducing ulcers
(Garber et al., 1996). Information about the
complex management of SCI cannot be absorbed

during the short hospital stays. Individuals are
leaving the hospital with less information about
self-care and there are very few opportunities for
reinforcement of the information presented
during hospitalization. Patients may return home
with reams of papers instructing them on
everything from maintaining nutrition to
managing bowel and bladder. Usually, it is only
after the appearance of the first skin breakdown
that attention is turned to addressing the
pressure ulcer problem. Often, the person does
not even know whom to contact and delays
treatment (Garber et al., 1996).
In a study by Schubart et al. (2008),
investigators identified several educational needs
of persons with SCI:
(1) an awareness of lifelong risks for developing
pressure ulcers, including the ability to assess
risk factors and how risk changes over time;
(2) an ability to take charge of skin care regimen
and to partner with health-care providers;
(3) an adoption of prevention strategies
consistently that fit level of functioning and
activity and an ability to update practices as
risk changes; and
(4) an ability to coordinate social supports.
Patient education for SCI patients is a shared
responsibility of all professionals caring for the
patient. All educational programs should provide
current evidence-based information for the
patient and family. Educational materials for
patients must be at an appropriate reading level,
and should also target family members. Garber et
al. (2002) reported that 4 hours of structured
individualized education on the prevention of
pressure ulcers during hospitalization for surgical
repair of a pressure ulcer and up to 24 months
after discharge was effective in improving a
patient's pressure ulcer knowledge. Computeraided instruction was found to be more effective
as compared to traditional educational methods
in increasing the initiation and performance or
pressure-relieving techniques for individuals with
SCI in one study (Pellerito, 2003). Hoffman et al.
(2011) compared in-person education forums for
persons with SCI to Internet versions of the
forums for a one-year period and participants
reported learning new information from the
online format 88% of the time as compared to
96% for the in-person format; 91% reported that
video was more effective than text for presenting
educational information.
One of the most frequently taught preventive
behaviors in the acute care, rehabilitation, home,
and long-term care settings is daily visual and

Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury

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