Page 22 - Mobility Management, March/April 2021

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Pressure Injuries: It’s Not Always the Cushion
I didn’t just focus on pressure ulcers, but people with pressure ulcers are certainly a large proportion of who the clinicians I worked with treated. I spent six years studying this to basi- cally draw the conclusion that there’s no common definition of what lifestyle factors are, there’s no common approach of how to manage them. And so what happens is it’s almost like we’re having two different conversations.”
Norton advocates for creating relationships in which wheel- chair users and caregivers can be honest with seating teams. “The healthcare provider is telling you [the client] what the best practices are. You [as the client] want to be liked, so you’re telling the healthcare provider that’s what you’re doing, and if it turns out you’re not, you’re labeled non-compliant,” she said.
“We really need to be having the conversation ‘This is what best practice is. How do we implement prevention of pressure injuries into what you do day to day? What are the strategies that will work for you in your current settings?’ Even saying, ‘Some clients find it really difficult to follow these recommendations. Is that going to be an issue for you?’ Make it okay to not be perfect.”
Norton ties pressure management to activities clients are already doing. “If the person likes TV, I tie weight shifting to commercials: Every time there’s a commercial, you’re weight shifting. Or for somebody who is a gamer, every time they change a level
or ‘die,’ that’s time for a weight shift.”
These strategies reflect Norton’s view of how to improve
compliance. “The way I explain it in my head comes from a work of Donald Schon. He talks about best practices being this ivory tower on a mountain, but it overlooks a swamp. In the swamp
is where clinical practice actually happens. You don’t have the perfect patient, you don’t have the perfect system like they often do when they’re doing research studies. Because a lot of that stuff is controlled. You have to do the best you can for that patient, applying those best practices, but it’s not necessarily realistic for them to follow all the best practices perfectly.”
Norton’s suggestions include weight-shifting adapted to real life. “Teaching a client to weight shift in different ways is also important,” she said. “It might not always be a full tilt back. Even small, frequent changes in weight shifting make a huge differ- ence. We don’t always teach all the strategies.
“I think that’s where we need to focus, because we’re not living in a perfect system. It’s messy because there are so many contributing factors, and the person still needs to live their life, and that’s something that’s of value.”
For the studies referenced here, access the online version of this story:
mobilitymgmt.com/2103pressure. m
20 MARCH-APRIL 2021 | MOBILITY MANAGEMENT
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