Pressure ulcers: e-learning to improve classification by nurses and nursing students


  • Dimitri Beeckman MA, RN,

  • Lisette Schoonhoven PhD, RN,

  • Hilde Boucqué MA, RN,

  • Georges Van Maele,

  • Tom Defloor PhD, RN

Dimitri Beeckman
Nursing Science Ghent University U.Z. Block A 2nd floor De Pintelaan 185 B-9000 Ghent Belgium
Telephone: +32 9 332 36 19


Aims and objectives.  To detect problems when classifying pressure ulcers and to examine whether an e-learning program is able to increase the classification skills of qualified nurses and nursing students.

Background.  Both the distinction between pressure ulcer grades and the differentiation between moisture lesions is difficult. Misclassification and incorrect identification of the lesions results in inadequate preventive and therapeutic measures. Education and training are important for spreading evidence-based insights about this topic.

Design.  Repeated measure design, consisting of one pretest and three posttests.

Methods.  The experimental intervention consisted of a one-hour session during which the participants independently went over an e-learning program. The control intervention consisted of a one-hour lecture. Both interventions had the same learning contents. A convenience sample of 212 qualified nurses and 214 final-year nursing students was randomly assigned to an experimental-and a control group.

Results.  In the pretest, the classification skills were low. After the intervention, these skills improved significantly in both groups. The nursing students achieved better results when using the e-learning program. Among the qualified nurses, there was no difference between the learning methods. Although the classification skills decreased in the posttests, they did not drop under the level of the pretest.

Conclusion.  The actual classification system does not provide the necessary information about the severity of a pressure ulcer. The differential diagnosis between a moisture lesion was complicated. The classification skills of the qualified nurses and nursing students increased by both learning methods. Repetition remains, however, necessary.

Relevance to clinical practice.  Both instruction methods are adequate to acquire the knowledge about the differences between moisture lesions and pressure ulcers. E-learning allows studying in one's own time and place, and could therefore be very suitable for repetition of the training. How to organise this training could be a subject for further research.