Post on 06-Mar-2018
1
National Pressure Ulcer Advisory Panel
Registered Nurse Competency-based Curriculum: Pressure Ulcer Prevention
Barbara Pieper, PhD, RN, CWOCN, ACNS-BC, FAAN
Based on: National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. Prevention and treatment of pressure
ulcers: Clinical practice guideline. Washington DC: National Pressure Ulcer Advisory Panel; 2009.
May 29, 2013
Major
Competencies/Objectives
Examples: Content
Objective(s)
Examples: Content Topic Examples: Teaching
Method
Possible references in
addition to the NPUAP
/EPUAP Prevention and
treatment of pressure
ulcers: Clinical practice
guideline, 2009. Many of
the references match more
than one objective, but are
listed in this document
one time only.
Understands pressure ulcer
incidence and prevalence
Define pressure ulcer
incidence and prevalence.
Participates in data
collection for pressure ulcer
incidence and prevalence.
Prevalence definition and
formula
Incidence definition and
formula
Lecture
Practice with data
collected within the
institution or developed
for practice.
Set up an agency program
to measure pressure ulcer
incidence and prevalence
Case studies
Discussion/analysis of
Dealey C, Chambers T,
Beldon P, Benbow M,
Fletcher J, Fumarola S,
Guy H, Nixon J, Price J,
Purser K, Stubbs N, Way
L, Weafer K; Members of
TVS Pressure Ulcer
Working Group.
Achieving consensus in
pressure ulcer reporting. J
2
articles about incidence
and prevalence.
Discussion/analysis of the
agency’s pressure ulcer
prevalence and incidence.
Develop methods to
decrease pressure ulcer
incidence.
Test: multiple choice,
true/false, etc.
Develop research/data
collection method for
institutional pressure ulcer
prevalence and incidence
studies
Tissue Viability.
2012;21(3):72-83.
He J, Staggs VS,
Bergquist-Beringer S,
Dunton N. Unit-level time
trends and seasonality in
the rate of hospital-
acquired pressure ulcers
in US acute care hospitals.
Res Nurs Health.
2013;36(2):171-80.
Hendrichova I, Castelli
M, Mastroianni C,
Piredda M, Mirabella F,
Surdo L, De Marinis MG,
Heath T, Casale G.
Pressure ulcers in cancer
palliative care patients.
Palliat Med.
2010;24(7):669-73.
Kottner J, Wilborn D,
Dassen T. Frequency of
pressure ulcers in the
paediatric population: a
literature review and new
empirical data. Int J Nurs
Stud. 2010;47(10):1330-
3
40.
Berlowitz D. Prevalence,
incidence, and facility
acquired rates. In Pieper
B. (Ed.) with the National
Pressure Ulcer Advisory
Panel (NPUAP). (2012).
Pressure ulcers:
Prevalence, incidence,
and implications for the
future. Washington, DC:
NPUAP, p 19-24.
Identify etiologic factors
contributing to pressure
ulcer occurrence.
Identify risk factors for
pressure ulcer
development.
Impaired mobility
Impaired activity
Nutritional indicators (
Common geriatric
syndromes impacted by
primary and secondary
nutrition preventions
Characteristics of
undernutrition and
malnutrition, Signs of
vitamin and mineral
deficiencies)
Factors affecting
perfusion and
oxygenation (diabetes;
cardiovascular
instability/norepinephrine
use; low blood pressure;
Lecture
Registered dietitian as
guest lecturer
Independent learning
modules
Case studies
Develop games based on
content
Poster with risk factors
Internet-based educational
programs
Simulation laboratory
patient practice
Patient-centered rounds on
unit
Institution –based
discussion on pressure
ulcer risk factors
Benoit R, Mion L. Risk
factors for pressure ulcer
development in critically
Ill patients: a conceptual
model to guide research.
Res Nurs Health.
2012;35(4):340-62.
White, J. Consensus
Statement: AND and
ASPEN: characteristics
recommended for the
identification and
documentation of adult
malnutrition
(undernutrition.) J Acad
Nutr Diet 2012, 112.5.
4
ankle brachial index;
oxygen use; smoking)
Skin moisture
Advanced age
Shear
Sensory perception
General health status
Persons of color: race
and ethnicity
Test: multiple choice,
true/false, etc.
730-738.
Törmä J, Winblad U, Cederholm T, et al. Does undernutrition still prevail among nursing home residents? Clin Nutr. 2013 Aug; 32(4):562-8.
Kane RL, Talley KM, Shamliyan T. et al. Common Syndromes in Older Adults Related to Primary and Secondary Prevention. Evidence Report/Technology Assessment No. 87. AHRQ Publication No. 11-05157-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; July 2011.
Bernabe KQ. Pressure
ulcers in the pediatric
patient. Curr Opin
Pediatr. 2012;24(3):352-
6.
5
Black JM, Edsberg LE,
Baharestani MM,
Langemo D, Goldberg M,
McNichol L, Cuddigan J;
National Pressure Ulcer
Advisory Panel. Pressure
ulcers: avoidable or
unavoidable? Results of
the National Pressure
Ulcer Advisory Panel
Consensus Conference.
Ostomy Wound Manage.
2011;57(2):24-37.
Black J, Baharestani M,
Black S, Cavazos J,
Conner-Kerr T, Edsberg
L, Peirce B, Rivera E,
Schultz G. An overview
of tissue types in pressure
ulcers: a consensus panel
recommendation. Ostomy
Wound Manage.
2010;56(4):28-44.
Cakmak SK, Gul U, et al.
Risk factors for pressure
ulcers. Adv Skin Wound
Care. 2009;22;412-415.
Doughty D, Junkin J,
6
Kurz P, Selekof J, Gray
M, Fader M, Bliss DZ,
Beeckman D, Logan S.
Incontinence-associated
dermatitis: consensus
statements, evidence-
based guidelines for
prevention and treatment,
and current challenges. J
Wound Ostomy
Continence Nurs.
2012;39(3):303-15; quiz
316-7.
Fogerty MD, Guy J, et al.
African Americans show
increased risk for pressure
ulcers: a retrospective
analysis of acute care
hospitals in America.
Wound Rep Reg.
2009;17:678-684.
Guihan M, Bombardier
CH. Potentially
modifiable risk factors
among veterans with
spinal cord injury
hospitalized for severe
pressure ulcers: a
descriptive study. J Spinal
7
Cord Med.
2012;35(4):240-50.
Hanson D, Langemo DK,
Anderson J, Thompson P,
Hunter S. Friction and
shear considerations in
pressure ulcer
development. Adv Skin
Wound Care.
2010;23(1):21-4.
Masotti P, McColl MA,
Green M. Adverse events
experienced by homecare
patients: a scoping review
of the literature. Int J
Qual Health Care.
2010;22(2):115-25.
Sieggreen M. Pressure
ulcers in persons of color:
race and ethnicity. In
Pieper B. (Ed.) with the
National Pressure Ulcer
Advisory Panel (NPUAP).
(2012). Pressure ulcers:
Prevalence, incidence,
and implications for the
future. Washington, DC:
NPUAP, p 147-150.
8
VanGilder C, Amlung S,
et al. Results of the 2008-
2009 international
pressure ulcer prevalence
survey and a 3-year, acute
care, unit-specific
analysis. Ostomy Wound
Manage. 2009;55:39-45.
Wound Ostomy and
Continence Nurses
Society. Guideline for
prevention and treatment
of pressure ulcers. Mount
Laurel, NJ, 2010.
Conduct a structured risk
assessment on admission,
and repeat as regularly and
as frequently as required
by patient acuity and
setting.
Select a risk assessment
method or tool appropriate
to the population
(e.g., Braden Scale, Braden
Q, & Norton Scale).
Use a structured approach
to risk assessment to
identify individuals at risk
of developing pressure
ulcers.
Calculate an individual’s
pressure ulcer risk
assessment score.
Interpret the significance of
the pressure ulcer risk
Braden Scale
Braden Q Scale
Norton Scale
Lecture
Independent learning
modules
Case studies
DVD showing patient to
rate for pressure ulcer risk.
Discussion of difficulties
in using a risk assessment
tool.
Develop decision tree on
how to respond to risk
assessment tool’s findings
Poster showing risk
assessment tool
Observation and
Baharestani MM, Ratliff
CR. Pressure ulcers in
neonates and children: an
NPUAP White Paper. Adv
Skin Wound Care.
2007;20:2008-220.
Bergquist-Beringer S,
Daley CM. Adapting
pressure ulcer prevention
for use in home health
care. J Wound Ostomy
Continence Nurs.
2011;38(2):145-54.
9
score.
Use professional judgment
in evaluating risk
assessment scores and
individual risk factors in
the context of the
individual’s goals and
needs.
Reassess pressure ulcer risk
as significant changes
occur in a patient’s health
status.
evaluation of clinical use
of risk assessment tool.
Simulation laboratory
experience with risk
assessment.
Bolton L. Which pressure
ulcer risk assessment
scales are valid for use in
clinical settings. J Wound
Ostomy Continence Nurs.
2007;34:368-381.
Denby A, Rowlands A.
Stop them at the door –
should a pressure ulcer
prevention protocol be
implemented in the
emergency department. J
Wound Ostomy
Continence Nurs.
2010;37:35-38.
Gadd MM. Preventing
hospital-acquired pressure
ulcers: improving quality
of outcomes by placing
emphasis on the Braden
subscale scores. J Wound
Ostomy Continence Nurs.
2012;39(3):292-4.
Niederhauser A,
VanDeusen Lukas C,
Parker V, Ayello EA,
Zulkowski K, Berlowitz
D. Comprehensive
10
programs for preventing
pressure ulcers: a review
of the literature. Adv Skin
Wound Care.
2012;25(4):167-88; quiz
189-90.
Ensure that a complete
skin assessment is part of
the risk assessment
screening policy in place
in all health care settings.
Conduct a thorough skin
assessment.
Assess skin on admission
and routinely thereafter.
Inspect skin at bony
prominences and other
areas of exposure to
etiologic factors.
Able to identify blanching
response, localized heat,
edema, and induration.
Identify issues in the skin
assessment of individuals
with darkly pigmented
skin.
Ask individuals to identify
areas of discomfort or pain
that could be attributed to
pressure ulcer damage.
Observe skin for pressure
damage by mechanical
devices.
Know pressure ulcer
stages: Stages I – IV,
unstageable, suspected
Body areas critical for
assessment
Blanching
Edema
Induration
Color and darkly
pigmented skin
Pain tools
Pressure ulcer stages
Documentation of skin
and pressure ulcers
Lecture
Independent learning
modules
Pictures showing pressure
changes on light and
darkly pigmented skin.
DVD of risk assessment
Clinical practice
Pictures showing pressure
damage from mechanical
devices
Role play skin assessment
and documentation
Test: multiple choice,
true/false, etc.
Black J, Baharestani M, et
al. An overview of tissue
types in pressure ulcers: a
consensus panel
recommendation. Ostomy
Wound Manage.
2010;56:28-44.
Black J, Langemo D.
Pressure ulcer
staging/categorization. In
Pieper B. (Ed.) with the
National Pressure Ulcer
Advisory Panel (NPUAP).
(2012). Pressure ulcers:
Prevalence, incidence,
and implications for the
future. Washington, DC:
NPUAP, p. 5-14.
Gorecki C, Closs SJ,
Nixon J, Briggs M.
Patient-reported pressure
ulcer pain: a mixed-
methods systematic
11
deep tissue injury.
Document all skin
assessment.
review. J Pain Symptom
Manage. 2011;42(3):443-
59.
Patton RM. Is diagnosis
of pressure ulcers within
an RN’s scope of
practice? Am Nurse
Today. 2010;5:20.
Develop and implement an
individualized program of
skin care.
Discuss “do not turn” the
individual onto a body
surface that is still
reddened from a previous
episode of pressure
loading.
Discuss “do not use
massage” for pressure ulcer
prevention.
Discuss “do not vigorously
rub” skin that is at risk for
pressure ulceration.
Use skin emollients to
hydrate dry skin in order to
reduce risk of skin damage.
Identify individualized
schedule of skin cleansing.
Identify protection of the
skin from exposure to
excessive moisture with a
barrier product to reduce
the risk of pressure
Repositioning/turning
Massage
Skin emollients
Barrier products
Incontinence care
protocols
End of life care
Skin care for the patient
with obesity
Skin care for the
child/neonate
Skin care for patient in
long term care,
rehabilitation, and/or
home.
Lecture
Independent learning
modules
Internet-based educational
modules
DVD/video showing skin
care
Observation and
evaluation of clinical
practice within a
facility/unit.
Evaluation of medical
record notations (paper
and electronic).
Product posters, forms,
demonstrations, etc. of
available skin care
products in the institution
Decision tree tools as to
skin hydration and damage
and products to use.
Teaching materials about a
Baharestani MM. Pressure
ulcers in pediatric
populations. In Pieper B.
(Ed.) with the National
Pressure Ulcer Advisory
Panel (NPUAP). (2012).
Pressure ulcers:
Prevalence, incidence,
and implications for the
future. Washington, DC:
NPUAP, p.151-172.
Ganos D, Siddiqui A.
Operating room. In Pieper
B. (Ed.) with the National
Pressure Ulcer Advisory
Panel (NPUAP). (2012).
Pressure ulcers:
Prevalence, incidence,
and implications for the
future. Washington, DC:
NPUAP, p. 57-64.
12
damage.
For the individual with
incontinence, consider
frequency and methods of
cleaning, skin protection
(barriers, products), and
management
strategies/evaluation for
incontinence.
Consider end of life care as
it affects the skin care
protocol.
Consider the plan of care
for the patient with
excessive weight
(bariatric).
Consider plan of care for
the neonate and child.
Consider the plan of care
for the patient undergoing
surgery.
Consider the plan of care
for the patient in long term
care, rehabilitation
facilities, and home care.
skin care program for
patients/ families
Develop/use transfer form
with skin assessment and
care to home, long term
care, rehabilitation, etc.
Mentoring novice nurse
Develop research about
pressure ulcer prevention
programs
Garcia AD. Home care. In
Pieper B. (Ed.) with the
National Pressure Ulcer
Advisory Panel (NPUAP).
(2012). Pressure ulcers:
Prevalence, incidence,
and implications for the
future. Washington, DC:
NPUAP, p. 97-104.
Langemo D. General
principles and approaches
to wound prevention and
care at end of life: an
overview. Ostomy Wound
Manage. 2012;58(5):24-6,
28, 30 passim.
Langemo DK, Black J;
National Pressure Ulcer
Advisory Panel. Pressure
ulcers in individuals
receiving palliative care: a
National Pressure Ulcer
Advisory Panel white
paper. Adv Skin Wound
Care. 2010;23(2):59-72.
Levine SM, Sinno S,
Levine JP, Saadeh PB.
13
Current thoughts for the
prevention and treatment
of pressure ulcers: using
the evidence to determine
fact or fiction. Ann Surg.
2013;257(4):603-8.
McCaskey MS, Kirk L,
Gerdes C. Preventing skin
breakdown in the
immobile child in the
home care setting. Home
Healthc Nurse.
2011;29(4):248-55; quiz
256-7.
Nenna M. Pressure ulcers
at end of life: an overview
for home care and hospice
clinicians. Home Healthc
Nurse. 2011;29(6):350-
65; quiz 366-7.
Pieper B. Long term
care/nursing home. In
Pieper B. (Ed.) with the
National Pressure Ulcer
Advisory Panel (NPUAP).
(2012). Pressure ulcers:
Prevalence, incidence,
and implications for the
14
future. Washington, DC:
NPUAP, p. 65-88.
Pieper B. Rehabilitation
facilities. In Pieper B.
(Ed.) with the National
Pressure Ulcer Advisory
Panel (NPUAP). (2012).
Pressure ulcers:
Prevalence, incidence,
and implications for the
future. Washington, DC:
NPUAP, p. 89-96.
Schubart J. An e-learning
program to prevent
pressure ulcers in adults
with spinal cord injury: a
pre- and post- pilot test
among rehabilitation
patients following
discharge to home.
Ostomy Wound Manage.
2012;58(10):38-49.
Sibbald RG, Krasner DL,
et al. SCALE: skin
changes at life’s end: final
consensus statement:
October 1, 2009. Adv Skin
Wound Care.
15
2010;23:225-235.
Sieggreen M. Pressure
ulcers in morbidly obese
patients. In Pieper B.
(Ed.) with the National
Pressure Ulcer Advisory
Panel (NPUAP). (2012).
Pressure ulcers:
Prevalence, incidence,
and implications for the
future. Washington, DC:
NPUAP, p. 147-150.
White-Chu EF, Flock P,
Struck B, Aronson L.
Pressure ulcers in long-
term care. Clin Geriatr
Med. 2011;27(2):241-58.
Demonstrate proper
positioning/repositioning
for pressure ulcer
prevention/treatment.
Consider the use of
repositioning in all at-risk
individuals.
Understand repositioning
frequency will be
determined by the
individual’s tissue
tolerance, level of activity
and mobility, general
medical condition, overall
treatment objectives, and
assessment of the skin.
Repositioning techniques
and schedules
Positioning techniques
and timing
Documentation
Lecture
Independent learning
modules
DVD/video showing
positioning/repositioning
Practice in a simulation
laboratory proper
positioning
Demonstration/return
demonstration of
positioning techniques by
physical therapists
Burk RS, Grap MJ.
Backrest position in
prevention of pressure
ulcers and ventilator-
associated pneumonia:
conflicting
recommendations. Heart
Lung. 2012;41(6):536-45.
Lyder CH. Preventing
heel pressure ulcers:
economic and legal
16
Practice proper positioning
to off set load (e.g. sitting,
lying, height of bed).
Use transfer aids to reduce
friction and shear.
Understand and
demonstrate repositioning
should be undertaken using
the 30-degree tilted side-
lying position, back, and
prone as tolerated.
Know to avoid, if possible,
head-of-the bed elevation
and a slouched position that
places pressure and shear
on the sacrum and coccyx.
Understand the limit the
time an individual spends
seated in a chair without
pressure relief.
Demonstrate appropriate
recording of repositioning
regimes.
Observation and
evaluation of clinical
practice
Evaluation of medical
record notations
Product posters, forms,
demonstrations, etc. of
repositioning products
available in the institution
Teaching materials about
repositioning for
patients/families
Test: multiple choice,
true/false, etc.
Develop research about
pressure ulcer prevention
techniques and/or
treatment
implications. Nurs
Manage. 2011;42(11):16-
9.
Moore ZE, Cowman S.
Repositioning for treating
pressure ulcers. Cochrane
Database Syst Rev. 2012
Sep 12;9:CD006898.
Salcido R, Lee A, Ahn C.
Heel pressure ulcers:
purple heel and deep
tissue injury. Adv Skin
Wound Care.
2011;24(8):374-80; quiz
381-2.
Still MD, Cross LC,
Dunlap M, Rencher R,
Larkins ER, Carpenter
DL, Buchman TG,
Coopersmith CM. The
turn team: a novel strategy
for reducing pressure
ulcers in the surgical
intensive care unit. J Am
Coll Surg.
2013;216(3):373-9.
Wanless S, Aldridge M.
17
Continuous lateral
rotation therapy - a
review. Nurs Crit Care.
2012;17(1):28-35.
Choose appropriate
support surface for a
patient based on risk and
the patient’s attributes.
Select support surfaces
based on level of pressure
ulcer risk, pressure ulcer
stage, level of mobility,
comfort, and place and
circumstances of care
provision.
Know uses/attributes of
various support surfaces.
Demonstrate protection of
heels with elevation of the
heels off the surface.
Understand use of support
surfaces to prevent pressure
ulcers while seated.
Understand to avoid use of
synthetic sheepskin pads;
cutout, ring, or donut-type
devices; and water filled
gloves.
Consider use of pressure
redistribution products in
the operating room.
Understand safe application
and maintenance of support
surfaces.
Support surfaces for bed
and chair
Heel elevation and
products
Support surfaces in
multiple inpatient
departments such as
emergency and operating
room.
Lecture
DVD/video showing
support surface types,
attributes, uses, etc.
Include
physical/occupational
therapist in teaching
content
Product posters, forms,
demonstrations, etc. of
support surfaces available
in the institution
Decision tree tool as to
how to select a support
surface
Teaching materials about
support surfaces for
patients/families
Include representatives
from Emergency
Department and Operating
Room in selection of
pressure redistribution
surfaces.
Test: multiple choice,
true/false, etc.
Mentoring novice nurse
Junkin J, Gray M. Are
pressure redistribution
surfaces or heel protection
devices effective for
preventing heel pressure
ulcers? J Wound Ostomy
Continence Nurs.
2009;36:602-608.
Lyman V. Successful heel
pressure ulcer prevention
program in a long-term
care setting. J Wound
Ostomy Continence Nurs.
2009;36:616-621.
McInnes E, Jammali-Blasi
A, Bell-Syer S, Dumville
J, Cullum N. Preventing
pressure ulcers--Are
pressure-redistributing
support surfaces
effective? A Cochrane
systematic review and
meta-analysis. Int J Nurs
Stud. 2012;49(3):345-59.
18
Develop research
study/quality assurance
study about support
surfaces for the agency
McGinnis E, Stubbs N.
Pressure-relieving devices
for treating heel pressure
ulcers. Cochrane
Database Syst Rev. 2011
Sep 7;(9):CD005485.
McInnes E, Dumville JC,
Jammali-Blasi A, Bell-
Syer SE. Support surfaces
for treating pressure
ulcers. Cochrane
Database Syst Rev. 2011
Dec 7;(12):CD009490.
McInnes E, Jammali-Blasi
A, Bell-Syer SE,
Dumville JC, Cullum N.
Support surfaces for
pressure ulcer prevention.
Cochrane Database Syst
Rev. 2011 Apr
13;(4):CD001735.
Morton N. Preventing and
managing heel pressure
ulceration: an overview.
Br J Community Nurs.
2012;Suppl:S18, S20-2
Pham B, Teague L,
19
Mahoney J, Goodman L,
Paulden M, Poss J, Li J,
Sikich NJ, Lourenco R,
Ieraci L, Carcone S,
Krahn M. Support
surfaces for intraoperative
prevention of pressure
ulcers in patients
undergoing surgery: a
cost-effectiveness
analysis. Surgery.
2011;150(1):122-32.
Shoham N, Gefen A.
Deformations, mechanical
strains and stresses across
the different hierarchical
scales in weight-bearing
soft tissues. J Tissue
Viability. 2012;21(2):39-
46.
Sprigle S, Sonenblum S.
Assessing evidence
supporting redistribution
of pressure for pressure
ulcer prevention: a
review. J Rehabil Res
Dev. 2011;48(3):203-13.
Turnage-Carrier C,
20
McLane KM et al.
Interface pressure
comparison of healthy
premature infants with
various neonatal bed
surfaces. Adv Neonatal
Care. 2008;8:176-184.
VanGilder C,
Lachenbruch CA. Air-
fluidized therapy: physical
properties and clinical
uses. Ann Plast Surg.
2010;65(3):364-70.
Implement nutritional
interventions as
appropriate to prevent
pressure ulcers.
Using a valid/reliable tool,
screen the nutritional status
of every individual at risk
of pressure ulcers.
Refer individuals with
nutritional risk to a
registered dietitian and/or
nutritional team for a
comprehensive nutrition
assessment.
Describe the importance of
nutrition, hydration,
vitamins and minerals.
Describe the role of
inflammation as a
contributor to declining
Nutrition screening using
a validated tool to
determine under-nutrition
and/or malnutrition
Factors to consider when
implementing a nutrition
plan designed by the
registered
dietitian/nutrition team
which may include
supplementation
(calories, protein, fluids,
vitamins, minerals per
registered dietitian’s
assessment), mor
frequent meals or
Lectures include dietitian
Validated nutrition
screening tools such as
Mini-Nutritional
Assessment (MNA) Short
Form, Malnutrition
Universal Screening Tool,
Short Nutritional
Assessment Questionnaire
Nutrient fact sheets
Decision tree as to when to
consult dietitian
Case studies
Develop games based on
nutrition information
Pictures/posters showing
Cereda E, Klersy C,
Rondanelli M,
Caccialanza R. Energy
balance in patients with
pressure ulcers: a
systematic review and
meta-analysis of
observational studies. J
Am Diet Assoc.
2011;111(12):1868-76.
Collins N. Nutrition
PEARLS: the latest
nutrition hot topics.
Ostomy Wound Manage.
2010;56:14-18.
21
nutritional status
Describe the rationale for
ordering oral nutrition
supplements, protein
supplements or other food
fortifiers
Describe feeding methods
(i.e., oral, enteral,
parenteral)
Recognize the clinical signs
of under-nutrition (e.g.,
unintended weight loss,
physical signs, laboratory
data etc.).
State the goals of nutrition
therapy for an individual.
nutrient dense snackls
between meals.
Feeding strategies.
Nutrition-related
laboratory values
Referral criteria to
registered dietitian,
speech language
pathologist, and/or
occupational therapist.
clinical signs/symptoms of
nutritional deficiencies
Internet-based programs
on nutrition.
Simulation laboratory
experiences with nutrition
assessment.
Discussion of laboratory
and other data in terms of
nutrition assessment and
inflammatory stress.
Teaching materials for the
patient/family in terms of
nutrition for prevention
and treatment of pressure
ulcers.
Test: multiple choice,
true/false, etc.
Dorner B, Posthauer ME, et
al. The role of nutrition in
pressure ulcer prevention
and treatment: National
Pressure Ulcer Advisory
Panel white paper. Adv Skin
Wound Care. 2009;22:212-
221.
Jensen GL , Mirtallo J ,
Compher C , et al. Adult
starvation and disease-
related malnutrition: A
rational approach for
etiology-based diagnosis in
the clinical practice setting
from the International
Consensus Guideline
Committee . JPEN 2010,
34.2. 156–159.
Friedman,A, Fadem, S. Reassessment of Albumin as a Nutritional Marker in Kidney Disease. J Am Soc Nephrol 21: 223–230, 2010
Johnson , AM, Merlini,G. Clinical indications for plasma protein assays: transthyretin (prealbumin) in
22
inflammation and malnutrition. Clin Chem Lab Med 2007;45(3):419-426
Litchford, MD, Dorner, B,
Posthauer, ME.
Malnutrition as a
precursor of pressure
ulcers. Advances in
Wound Care, in press.
Little MO. Nutrition and
skin ulcers. Curr Opin
Clin Nutr Metab Care.
2013;16(1):39-49.
Accurately document
results of risk assessment,
skin assessment, and
prevention
strategies.
Know documentation
needed for risk assessment,
skin assessment,
interventions, and
prevention strategies.
Interprets/records the
individual’s response to
interventions.
Practices the agency’s
frequency/method of
documentation including
initial and periodic
reevaluation.
Documentation
Lecture
Guest speakers: attorney;
insurance regulator
Practice with risk
assessment tool and
recording findings
Mock/practice charting
sessions
Electronic medical record
Case reports
Peer review of charting
Mentoring of novice
nurses
Ayello EA, Capitulo KL,
et al. Legal issues in the
care of pressure ulcer
patients: key concepts for
healthcare providers. A
consensus paper from the
International Expert
Wound Care Advisory
Panel. J WCETN.
2009;29:8-22.
Farren M, Martelly-
Kebreau Y. OASIS-C
importance of accurate
23
pressure ulcer assessment
and management in home
healthcare: part II. Home
Healthc Nurse.
2011;29(10):599-609.
O'Meara SM, Bland JM,
Dumville JC, Cullum NA.
A systematic review of
the performance of
instruments designed to
measure the dimensions
of pressure ulcers. Wound
Repair Regen.
2012;20(3):263-76.
Wound Ostomy and
Continence Society
Position Paper. Avoidable
versus unavoidable
pressure ulcers. J Wound
Ostomy Continence Nurs.
2009;36:378-381.
Apply critical thinking
skills to clinical decision
making regarding the
impact of changes in the
individual’s condition on
pressure ulcer risk.
Demonstrate critical
thinking in pressure ulcer
risk assessment.
Demonstrates critical
thinking by accurately
interpreting changes in
patient’s status and its
influence on plan of care to
Critical thinking Case studies to
demonstrate mastery of
content about pressure
ulcer risk, change in
patient’s status, etc.
Peer review of practice
and charting
Journal club critical
24
prevent pressure ulcers.
Identification of patient
triggers that require
changes in plan of care.
review of publication
Peer coaching/mentoring
Ethics and pressure ulcers
Make referrals to other
health care professionals
based on client
assessment.
Knows role of health team
members in pressure ulcer
prevention/treatment.
Knows how to initiate
home care referral
properly.
Role of nurse, physician,
dietitian, physical
therapist, etc. in pressure
ulcer prevention
Lecture
Panel discussion presented
by various pressure ulcer
prevention/treatment team
members
Interdisciplinary patient
rounds on patients at risk
for pressure ulcers or who
have pressure ulcers
Interagency discussions on
the best procedures to
facilitate patient transfer.
Peer coaching/mentoring
Butler M, Collins R,
Drennan J, Halligan P,
O'Mathúna DP, Schultz
TJ, Sheridan A, Vilis E.
Hospital nurse staffing
models and patient and
staff-related outcomes.
Cochrane Database Syst
Rev. 2011
6;(7):CD007019.
Choi J, Bergquist-
Beringer S, Staggs VS.
Linking RN workgroup
job satisfaction to
pressure ulcers among
older adults on acute care
hospital units. Res Nurs
Health. 2013;36(2):181-
90
Soban LM, Hempel S,
Munjas BA, Miles J,
Rubenstein LV.
Preventing pressure ulcers
in hospitals: A systematic
review of nurse-focused
25
quality improvement
interventions. Jt Comm J
Qual Patient Saf.
2011;37(6):245-52.
Sullivan N, Schoelles
KM. Preventing in-facility
pressure ulcers as a
patient safety strategy: a
systematic review. Ann
Intern Med. 2013 5;158(5
Pt 2):410-6.
Walker Sewill DK, Van
Sell S, Kindred C.
Pressure ulcer prevention:
utilizing unlicensed
assistive personnel. Crit
Care Nurs Q.
2010;33(4):348-55.
Revision of the 2010 Registered Nurse Competency-based Curriculum: Pressure Ulcer Prevention