Page 21 - Mobility Management, March/April 2021

The final factor in the Jackson report, Norton said, is access to needed care, services and support. “Sometimes people who are in wheelchairs who have issues with pressure injuries or are at risk of developing them don’t have wheelchair-accessible healthcare. So that also contributes to skin breakdown.”
The Need for Pressure Injury Education
Even among healthcare professionals, pressure injuries aren’t uniformly understood.
Norton said, “Years ago, we tried to do a study on bedrest and whether it was an effective treatment for pressure injuries. We were looking for people who had stage 1 or stage 2 pressure inju- ries, but in the phone calls, people were saying, ‘How big does the hole have to be before it’s considered a pressure injury?’
“So by the time somebody identifies that they have a pressure injury, it’s a 911 complete, ‘We’ve got to do something.’ If we could identify issues much more quickly, right at the development of redness, for example, then we would have more of an opportu- nity to intervene. We also know that it’s much easier to close a pressure injury the less time somebody’s had it, or the smaller or more shallow it is. But we’re not necessarily identifying them.”
Pressure injuries can also be mis-diagnosed. “Sometimes pres- sure injuries get confused with moisture-associated dermatitis or
incontinence-associated dermatitis, which is a different thing,” Norton said. “And the treatments are different.
“The other thing worth making a note of is nutrition. One
of the things that has been associated with closure is people’s nutritional status. It makes sense: If you don’t have the nutrients to use to repair your skin, then it’s going to take longer.” Norton added that a study found that 45 percent of medical and surgical patients admitted to hospitals across Canada were malnourished.
Where Clinical Practice Actually Happens
Ideally, wheelchair users, caregivers and healthcare professionals would quickly identify pressure injuries so patients could heal under optimal circumstances, with all the support they needed.
Then there’s pressure injury care in the real world.
“Donald Schon described medical research and best practices as a high ground, where all the needed resources are available, and the client sample may be limited to those without other compli- cating factors,” Norton said. “Unfortunately, that’s not always the case in clinical practice. Resources may be limited, and the clients may have other factors that could impact their treatment plan.
“That was the whole interesting thing when I started doing my research. I looked at how do healthcare providers identify and address lifestyle factors for their clients with chronic wounds?
MobilityMgmt.com
Untitled-15 1
MOBILITY MANAGEMENT | MARCH-APRIL 2021 19 3/16/21 6:46 PM