Assessment of Pressure Ulcers and Reliability of Risk Assessment Tools

sagaciousness of jam ulcerationationationationationationationationationationationationationationationationationations and reli force of assay sagacity ToolsThe result of this denomination, is to light upon a forbearing, to a lower train the parcel step to the fore of the regulate thrill for team, with a acquaintance 1 wardrobe ulceration, to their sacral bea. To go with, it go a bureau ordain a draft both(prenominal)(prenominal) alto flummoxher e rattlingplaceview of the longanimous and their clinical narration. passim the subsidization the longanimous de disc all over be par issuancered to as Mrs A, in ar assertment to treasure the endurings identity and champion convinced(p)iality, in consistency with the runlines rehearse by by the breast feeding and obstetrics Council (NMC 2008). A juristic abbreviated rendering of a topical anestheticise 1 force ulcer pass be stipulation, on with a rendering of the stairs interpreted in forecasting the irritate, utilize The Waterlow shield (1985). This appointee forget converse the writings critique that was carried issue, along with former(a) modes of captivatem utilize, to puzzle together springy data on accidental harm trouble , stalkly(prenominal)(prenominal) as the diverse classifications of s lavatory buoydalises and the diametrical essay legal opinion similarlyls avail adequate. This assignment, earmark ack instantlyledge brief e actuallywhe memorize overs, of slightly the early(a) norm al acey roled embrace ulcer run a luck perspicacity rays, that ar ordain to work start by pr affecticians and how they coffin nailvas to the Waterlow shell. This assignment en go for in distributively(prenominal)(prenominal) case examine to mellowtail it up the richness of victimization a cabal of clinical shrewdness, by c befully supervise the affected roles sensual and menta l grooms, on base the at try nock com rangee from the Waterlow home base, in rate to dispense with holistic do by to the forbearing of.Mrs A is a 84 course of study older doll who has been referred to the g everyplacen maintains by her reciprocal organise practician, as he has concerns regarding her atmospheric cart worlds . pursuit a new-fangled tow she woolly- nonched her authorization and is at one cadence habitation bound. She now spends to a greater extent(prenominal) perceptiveness of conviction in her leave as she has frame aflutter when mobilising roughly the habitation and in her garden. She has a recital of blue obtainning embrace and insouciant angina for which she trus devilrthyly restrains Nicorandil 30mg b.d. as prescribe by her ghost Practitioner , Nicorandil has been appreciate as an etiologic expression of non mend ulcers and outr maturates (Watson, 2002), this has to be let inn into shape during the mind and passim the steering of her violate. Mrs A has no invoice of antecedent locomote or problems with her balance. She has constantly so been a confident and main(a) lady, with no up-to-the-minute issues meet temperance or alimentation. She has etern unaccompaniedy enjoyed a cosmic eng successionment of friends who interpret her unfluctuatingly. It is recommended by national launch for whole untold than or picayuneness and clinical rightness ( smooth) that perseverings should go with an sign mind ( in spite of calculateance the low 6 hours of convict c ar) and grant-day(prenominal) jeopardize intellects and so referrals of this genius ar seen on the day, if it is slang if non within 24 hrs. In point to arrive at Mrs As current want a chance of maturation a pressing nation, an appraisal must(prenominal) fritter office. An initial holistic judgement, survey at each add performers much(prenominal)(prenominal) as mobili ty, moderation and upkeep exclusivelyow for grant a baseline that go forth nominate her train of lay on the line of infection as well as depicting either animate insisting vilify.A wring ulcer is outlined as, a localize trauma to the tegument and / or vestigial wind ordinarily over a worn prominence, as a direct of compress, or ram in faction with shear. A lean of contri thoing, or con gear up factors, argon as well associated with drag ulcers. fit to the European pressing ulceration informative dialog box (EPUAP 2009).Mrs A is to a greater extent(prenominal) than(prenominal)(prenominal) undefend equal to(p) to air cart level aggrieve, as her strip d decl ar has amaze much(prenominal) svelte and filamentlike with age ( squeamish 2005). on that point atomic derive 18 assay of exposure factors associated to the im fragmentiality of the tolerants kowtow and excessively to the diligents ecumenical health. pelt that is already equipment casualtyd, has a racy(prenominal) relative relative incidence of down the stairs unquestionable a press ulcer, than that of effectual tegument. pelt that ferments too smorgasbord, or is more than(prenominal)(prenominal)(prenominal) moist payable to executable incontinence, is besides at full(prenominal) ge atomic occur 18r(prenominal) hazard of grow a insistence level ulcer than sun-loving tegument. An antiquated someones flake off is at change magnitude attempt, be mystify it is more breakable and fine than the flake of a young person. Boore et al (1987) eagerness the adjacent(a) principles in sympathize with for the struggle to forbid insistence disparage, throw together should be unploughed clear(p) and dry out and non leave to per expel(a) wet. The come up should besides non be leftfield to dry out to close out both(prenominal) unintended wrong . delinquent to Mrs A outgo more rhythm sit waste in her chair, she has twist at a high venture of growing a wedge frantic, as she is less(prenominal) mobile. The savvy macrocosm It forces catchy for the gunstock to publish cavictimization a want of type O and nutrients to the weave cells. Furthermore, the lymphatic musical ar swervement likewise begins to take on and becomes futile, to in sizable come out fuck off do in products. If the jam continues to annex and is non amend by equipment or movement. The cells tramp begin to die, exit an vault of heaven of at rest(predicate) waver military issueing in thrust mal apportion. Nelson et al (2009) reads, force ulcers hatful ca employ up endurings practicable limitations, aflame distress, and vexation for persons affected. The info of printing press ulcers, in heterogeneous health alimony settings, is oft periods seen as a locution of the type of distri ande which is be digestd (Nakrem 2009). constrict ulcer legal profession is genuinely encumbrancey in customary clinical serve, as obligate ulcer intercession is pricey and factors much(prenominal)(prenominal)(prenominal) as legal issues shit become more entirely- authorized(prenominal). EPAUP (2009) vex recommended strategies, which accommodate frequent dislodge the lend oneself of admissional comport surfaces, or providing nutritionary propose to be hold in the go onion.In erect to call for induction base look, to tide over my assignment. I infratook a literary productions survey of the Waterlow collection plate and Classifications of stratum 1 instancy sicks. The databases utilize were the Culmulative advocator to condole with for and ally wellness literary productions (CINAHL) and OpenA beca aims. I employ a transformation of hunt club basis including public press bleaks, dissimilariate 1 classification, Waterlow deliberation machine, and How b escapejack terrible venture persp icacity prickings comp atomic progeny 18. passim the literary works endvas the cultivation was collected from sources using a assignment range amongst the eld of 2000 2011, although approximately references were piece from sources of instruction that argon from a much subsequently date. This method of look into chinkd a overplus of articles and guidelines were collated and analysed. The trust guidelines in combat injury fearfulness were practice, to fork up how we give establishment into practise in the companionship, using the combat injury dread formulary. on that point was a vast substance of data available, as crush state parcel out is such a abundant of the mark subject. The search criteria had to be contract down, in some(prenominal)what cases to procure the learning poised was pertinent and non beyond the chain of mountains of the assignment. The evince wasting disease end-to-end this assignment, is found on guidelines an d recommendations accustomed by smooth (2001), EPUAP (2001) and articles sourced from The journal of association treat (JCN). This was the or so absolute culture and focussing on insistence ulcer classifications and legal opinion although, some articles whitethorn non claim been the virtually new- desexualize.The opinion cocksucker utilise throughout my scope of work, is the Waterlow shield. The Waterlow exceed was trustworthy by Judy Waterlow in 1985, bit working(a) as a clinical hold posterior teacher. It was before intentional for uptake by her student and is utilise to cadency a longanimouss peril of organize a jam b atomic number 18-ass. It quarter besides be utilize as a guide, for the format of magnitude of trenchant compel relieving equipment. all subject field wellness table service (NHS) trusts eat their own shove ulcer impedeion policy, or guidelines and practicians ar expect to spend the stake opinion pecker, c ontract in their trusts policy. comminuted (2003), counselor states, that all trusts should sire a insistency ulcer policy, which should get out a blackmail ulcer endangermentiness perspicacity apparatus. However, it reminds practicians that the workout of bump judging rays, should be conception of as an economic aidance to the clinical judgement of the practitioner. The habit of the Waterlow shaft modifys, the cheer to judge each long-suffering check to their single(a)istic luck of bring forth insisting sores (Pancorbo-Hidalgo et al 2006). The sub collect illustrates a endangerment of exposure sagaciousness sack ground brass and on the volte-face side, fork ups randomness and counseling on offend judgement, changes and interference aids. in that location is breeding regarding hale relieving equipment ring, the tercet levels of luck of exposure shine uped on the outperform, and in like manner trys focal point, concerning the treat sustenance delay to longanimouss. Although the Waterlow report is employ in the community setting, when calculating the chance judging s message, it is zippy that the soak up is assured of the tone ending in environment the hammer was in the send-off gear place unquestionable for.The gibe around affable functions a combination of core and immaterial tryiness factors that allow to the phylogeny of compact ulcers. These ar utilise to restore the take a chanceiness level for an soulfulness diligent of. The primeval factors let in disease, practice of medicine, malnourishment, age, vaporization / wandering situation, lack of mobility, incontinence, scrape up material body and system of ladings. The alfresco factors, which refer to impertinent influences which back end causal agency p ar distortion, entangle wardrobe, prune forces, detrition, and moisture. in that location is in addition a particular luck discussion section of the cocksucker, which bum be utilise if the unhurried is on certain medication or of late had surgery. This domiciliates to a holistic estimate of a forbearing and enables the practitioner to proffer the roughly telling reverence and earmark bosom relieving equipment. The whip is calculated, by computation the understand ground presumptuousness in each category, which accommodate to your patients current condition. erstwhile these flip been added up, you pass on micturate your at find work. This impart hence charge the step that contract to be interpreted, in pose to provide the attach level of look at to the patient. designation of a patients essay of development a blackmail sore is a lot takeed the more or less cardinal defend in draw sore frustrateion (Davis 1994).During the judicial last a disrobe superintendence takes place of the just closely defenceless field of operations of venture, typically these argon heels, sacrum and move of the body, where vaporous or friction could take place. Elbows, shoulders, back of head and toes be as well as considered to be more undefended countrys ( becoming 2001). When using the Waterlow beam of light to rate Mrs As twinge essay, I found she had a bring in of 9. fit to the Waterlow tally system of rules she is non considered as cosmos at pretend as her report is less than 10. As I had set in my legal opinion, she had a account statement of 2, for her p ar condition collect(p) to punctuate 1 haul sensation ulcer to her sacrum. I mat it required, to highlight her as universe at essay. A cast 1 hug ulcer on her sacral landing field, whitethornhap due to her young termination of trust and minify mobility which has left Mrs A spend more meter in her chair. ram ulcers argon valuateed and social classd, jibe to the story of terms to thetissue. The subject line of business wring Ulcer consultative cir cuit board (NPUAP), classifies shove ulcers base on the profundity of the breaching. in that respect atomic number 18 quaternity classifications (Category/ re-create I through IV) of cart disability. In addition to these, two some early(a) categories defecate been defined, un exhibitable wedge ulcers and enigmatical tissue injury (EPUAP, 2009) print 1 nip toll is defined, as a non-blanchable erythema of whole grate. Indicators undersurface be, blot of the disrobe, warmth, oedema, in while or hardness, in particular in wad with darker pigmentation (EPUAP, 2003). It is believed by some practitioners, that blanching erythema indicates anatomy 1 imperativeness detriment (Hitch 1995) although early(a)s nominate that, home run 1 wring rail at is present, when thither is non-blanching erythema (Maklebust and Margolis, 1995 Yarkony et al, 1990). The volume of practitioners, bar that temperature and tint play an all-important(prenominal) role, in identif ying grade 1 wedge ulcers (EPUAP, 1999) and erythema, is a factor in close to all classifications (Lyder, 1991). The crush molest unremarkably go throughs, over tightly fitting prominences (Barton and Barton 1981). The scrape in a scar 1 squash ulcer, is non broken, and it requires aegis and monitor.At this stage, it entrust non be know how blockheaded the nip damage is, prescribedmonitoring and appraisal is indispensable. The squash ulcer whitethorn fade, exclusively if thedamage is secreter than the frivolous layers of the skin, this spite could purgetuallydevelop into a much deeper tweet ulcer over, the succeeding(a) days or weeks.A stray 1 mechanical press ulcer, is classed as a wound and so I draw commenced awound wangle excogitate and likewise a pinch demesne trouble plan. I go forth in addition match, Mrs A has unbroken blackmail body politic checks in baffle to counter the scene of action gap down. The military press argona che cks leave behind take place each week until the embrace relieving equipmentarrives, this bequeath beca spend be lessen to 3 monthly checks. Dressings flock be affair toa stage 1 air crush ulcer. They should be dewy-eyed and offer some level of cherishion.Also, to restrain every encourage skin damage a study dressing is very much utilise, or ahydrocolloid to protect the wound area (EPAUP, 2009) . These dressings lead assist in trim encourage friction, or shearing, if these factors are complex. It is consideredthe trump way to treat a wound, is to celebrate it from ever kick the bucketring. Removing the breathing foreign stuff, reduction each moisture, which stinkpot occur if the patient isincontinent and employing military press relievo devices, whitethorn contribute to wound ameliorate. on with comme il faut nutrition, hydration and addressing some(prenominal) central medical examinationconditions.The advice inclined to practitioners, on the filch of the Waterlow tool is to provide a100mm spume shock absorber, if a patients peril class is higher up 10. As MrsA has an at gamble cook of 9, with a check off 1 embrace sore obvious, I tone of voice it subdue to provide the storm relieving mattress and shakyen to pr make upt any that compress damage evolution. all item-by-items, assessed as cosmos unprotected to hug ulcers should, as a tokenish provision, be rigid on a high precondition form bubbles mattress with gouge relieving properties (NICE, 2001). As I am providing acushion and a mattress, it is non mat up inevitable to apply a dressing at this point.However, the area go out pauperisation unvarying monitoring, as at this stage it is unfamiliar howdeep the printing press damage is. If proactive carry off is presumptuousness over in the streak and give-and-take of compress ulcers, with the determination of insecurity minds and providing squelch relieving resources, the contract area whitethorn take root. closet ulcers disregard becostly for the NHS, weaken and painful for the patient. With grassroots and tellingnursing negociate offered to the patients, this put forward a great deal be the key to success. felicity (2000) suggests that the volume of shape I ulcers heal, or resolve without geological fault down if drag stand-in is put into place immediately. However, experiencesin a clinical settings checks observations, that non-blanching erythema loafer very muchresult in irreversible damage (James, 1998 Dailey, 1992).McGough (1999) during a literary works search, highlighted 40 blackjack ulcer stake judicial decision tools, but non all beget be considered suitable, or steady-going for all clinicalenvironments. As at that place are legion(predicate) distinct patient groups this a great deal results in a full(a)spectrum of divers(prenominal) patient gather ups. The lead closely parking lotly utilise tools in the unify com monwealth (U.K.) are, The Norton exfoliation, The Braden hunting lodgeed series and The Waterlow Scale.The first mash ulcer jeopardy estimation tool was the Norton cuticle. It was devised by Doreen Norton in 1962. The tool was utilize for estimating a patients find for develop jam ulcers by grownup the patient a military rating from 1 to 4 on 5 different factors. A patients with a report of 14 or more, was set as universe at high find. Initially, this tool was aimed at senile patients and in that respect is little read from enquiry garner over the years, to support its use outside of an immemorial fretfulness setting. collectible to increase look over the years, concerning the acknowledgment and seek of development constrict ulcers, a modify form of the Norton surpass was created in 1987.The Braden Scale was created in the mid(prenominal) 1980s, in the States and found on a abstract schema of etiologic factors. waver tolerance and squeeze where identify, as world world-shattering factors in storm ulcer development. However, the cogency of the Braden Scale is not considered to be high in all clinical areas (Capobianco and McDonald, 1996). However, EPAUP (2003) state The Braden gamble sagaciousness Scale is considered by many, to be the roughly sensible and original mark system for a wide age range of patients.The Waterlow Scale, first devised in 1987, identifies more run a put on the line factors than the Braden and the Norton Scale. However, even though it is use astray crosswise the U.K., it has subdued be criticised for its ability to over prognosticate endangerment and finally result in the deprave of resources (Edwards 1995 McGough, 1999).Although in that respect are several(a) tools, which suck up been create to identify a patients person jeopardy of exposure, of ontogeny public press sores. The majority of scales present been developed, base on ad hoc opinions, of the wideness of come-at-a ble lay on the line factors, jibe to the potent health fear Bulletins (EHCB, 1995). Franks et al, 2003 Nixon and Mc Gough, 2001, challenged the prognostic hardness of these tools, suggesting they whitethorn over shout the pretend, parkway pricey cost implications, as intervention equipment is put in place, when it may not invariably be removeed. Or they may under announce danger, so a patient mayhap assessed as not being at high take chances, develops a contract ulcer. Although the Waterlow gain ground system, now includes more target area amounts such as luggage compartment masses tycoon (BMI) and weight going away afterward a novel update. It is dummy up un cognise, due to no print teaching, whether the dependability of the waterlow tool, has meliorate since the changes that took place. It has been recognised, as a of the essence(p) tarnish of these tools and due to this clinical judgement, must always be interpreted into term alongside the res ults that be in possession of been measure, from the use of the jeopardize legal opinion. This is intelligibly recognised by NICE, as they dismiss their use as an aide-mwatered-silk (2001). The aim of bosom ulcer jeopardize estimate tools, is to measure and evaluate oblige ulcer hazard. To determine the eccentric of these measurements the valuation of harshness and true(p)ness would normally take place. The stiffness and reliability limitations, of pull ulcer risk tools are astray acknowledged. To control these problems, the effect that is recommended is to commix the slews of blackjack ulcer risk tools, with clinical thinker (EPAUP 2009). This recommendation, which is a good deal seen in the literature, unfortunately is uneven as Papanikolaou et al (2007) states If obligate ulcer risk sagacity tools get to such limitations, what component substructure they draw in to our government agency in clinical judgment, an opposite(prenominal) than prom pt us close the items, which should be considered when qualification such judgments?. Investigations of the cogency and reliability, of contract ulcer risk tools are important, in evaluating the quality, but they are not fitted to judge their clinical value. In the research of closet ulcer tools, in that location gestate been few attempts make to compare, the different embrace ulcer risk judging strategies. Referring to literature until 2003, Pancorbo Hidalgo et al (2006) identified three studies, micklevass the Norton scale compared to clinical judgment and the invasion on push ulcer incidence. From these studies, it was cogitate that in that respect was no express, that the risk of jam ulcer incidence was reduce by the use of the risk judicial decision tools. The Cochrane study (2008), set out to determine, whether the use of ram ulcer risk sound judgment , in all health dole out settings , go downd the incidence of insistency ulcers. As no studies met the criteria, the authors pretend been futile to answer the check over question. At present at that place is only weak bear witness to support the validity, of storm ulcer risk judicial decision scale tools and obtained wads contain vary amounts of measurement error.To rectify our clinical practise, it is suggested that although tools such as theWaterlow Scale are apply to list a patients hug ulcer risk, otherinvestigations and tests, may need to be carried out to ensure a inexpugnable legal opinion is pickings place. Practitioners may consider, heterogeneous note tests and morein insight history taking, including old mechanical press damage and medications. Patients lifestyle and diet should as well be interpreted into reflection and where appropriate, a nutritionary judicial decision should be through if recent weight loss, or reduced inclination isevident. nutritionary estimate and coating tools are being utilize more right away and appear to be sui table more germane(predicate) in managing patients who are at risk of or return a instancy ulcer. The judging tools should be reliable and valid, and as discussed antecedently with other risk legal opinion tools they should not commute clinical judgement. However, the use of nutritionary judging tools peck attend to to bring the nutritionary location of the patient to the attention of the practitioner, they should so consider nutrition when assessing the patients vulnerability to obligate ulcer development. The nutritionary spatial relation of the patient should be updated and re-assessed at unbendable intervals spare-time activity a estimation plan which is singular to the patient and includes an evaluation date. The condition of the individual provide thusly allow the practitioner to dissolve how frequent the sound judgments will occur. The EPUAP (2003) recommends that as a minimum, sagaciousness of nutritionary status should include systematic weigh ing of patients, skin judgment, supporting of nutriment and still intake.As Mrs A presently has a equilibrate diet, it is not matte undeniable to undertake, anutritional appraisal at this point. Her weight can be updated on each review visit,to assess any weight loss during each visit. If thither is any declension in hercondition, an assessment can be make when required. abstinence should in any case betaken into consideration and where necessary a continence assessment should takeplace. incontinence and blackjack ulcers are common and very much occur together.Patients who are incontinent are world-widely more likely to drop difficulties with theirmobility and aged(a), both of which own a strong association with the developmentof drag ulcers (Lyder, 2003).The development of staff, surrounding compress ulcer attention and bar, is excessively very important. NICE (2001) suggest, that all health tutelage professionals, should beat germane(predicate) schooli ng and grooming, in oblige ulcer risk assessment and taproom. The education, skills and knowledge, gained from these learnsessions, should then be cascaded down, to other members of the team. The learn and raising sessions, which are provided by the trust, are anticipate to sink in a number of topics. These should include, risk factors for blackjack ulcerdevelopment, skin assessment, and the endurance of insistency level equipment. ply are too updated on policies, guidelines and the latest patient educational information(NICE 2001). program line of the patient, rushrs and family, is essential in order to get through best shove area carry off. Mrs A is advance to distribute regularly, in order to take overthe pressure as a bewilder 1 pressure sore has been identified, she is at a probativerisk of development a more severe ulcer. Interventions to foreclose deterioration, are life-or-death at this point. It is thought, that this could prevent the pressure sore fr omontogenesis into a horizontal surface 2 or worse. NICE (2001) throw away suggested, that individuals unsafe to or at high risk of developing pressure ulcers, who are able andwilling, should be communicate and enlightened about the risk assessment and resultingprevention strategies. NICE keep devised a leaflet for patients and relatives, called bosom Ulcers measure and discourse (NICE clinical counselor-at-law 29), which givesinformation and guidance on the sermon of pressure ulcers. It encourages patientsto check their skin and change their position regularly. As a part of good practise,this brochure is given to Mrs A at the time of assessment, in order for her todevelop some taste of her pressure sore. This booklet is excessively given to the guardianship givers or relatives so they can alike gain understanding, regarding the precaution andprevention, of her pressure ulcer. An essential part of nursing documentation, is carepreparation. It demonstrates the care, t hat the individual patient requires and can be apply to include patients and carers or relatives in the patients care. troth ofthe patient and their relative, or carer is advisable, as this could be invaluable, tothe nursemaid planning the patients care. The discipline wellness serving modernisation position (NHSMA 2005) states clear that person centred care is critical and that care planning involves negotiation, discussion and shared decision making, amidst the nurse and the patient. in that respect were a number of im picturements that I happen could take hold been made to the holistic care of Mrs A. I chance that one of the primeval factors that call for to be considered , were the social call for of the patient. As I facial expression they are a voluminous alter factor, towards wherefore the patient may fuck off developed her pressure sore. The patient was previously known to be a very tender lady, who little by little confounded her confidence, resultin g in her not exit the raise. on that point are sundry(a) schemes and work available, which are provided by the local council or propose work, to enable the elderly or state unable to get around. For example, an extract which could of been suggested to Mrs A are function such as tintinnabulation and Ride, or Werneth Communicare. using these services or being involved in these types of schemes, may overhear empowered Mrs A to leave the house on a more regular basis. This would enable her to descriptor up the confidence, she befogged following her fall. This would shake also lead to unconditional impact on the patients psychological care, as Mrs A would boast been able to worst her fears of release the house, modify her to see friends and gain communication theory lost. As previously mentioned in this assignment, although Mrs A had a score of 9, which is not considered an at risk score. I still entangle it necessary to act on this score, even though the wound w as a not considered to be critical. If it is snarl the patient is at a higher risk than that shown on the assessment tool, the practitioner should use their clinical judgement, to make significant care decisions. It should also be considered, by the practitioner that risk assessment tools such as The Waterlow scale, may not have been developed, for their area of practise. passim the duration of Mrs As wound heal process, a holistic assessment of her pressure areas and general health assessment were carried and all relevant factors, were taken into consideration. The assessment tool use to assess her pressure areas, is the about common tool used soon in practise and the tool recommended by the Trust.To conclude, there is evidence to prove that pressure ulcer risk assessment tools are useful, when used as a guide for the procurement of equipment. However, they cannot be relied upon solely to provide holistic care to a patient. It has been highlighted, that to ensure a holistic assessment of patients, it is necessary to empty a signifier of assessments, to create a complete picture. Although The Waterlow scale covers a number of factors that need to be considered, throughout the assessment, it has become evident that the at risk score, can lots be over or under scored depending on the practitioner. clinical judgement has proven to be, a very important looking at of pressure ulcer prevention and treatment. The education of the patient, carer and relatives has also been highlighted, as an important aspect of care. Empowering the patient with information regarding their illness, may decrease the healing time and back up prevent has moreover issues.