A new pressure ulcer conceptual framework

Authors

  • Susanne Coleman BSc (Hons) RGN,

    PURPOSE Programme Manager and Project Lead, Corresponding author
    1. Leeds Institute of Clinical Trials Research, University of Leeds, UK
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  • Jane Nixon PhD RN,

    Professor of Tissue Viability
    1. Leeds Institute of Clinical Trials Research, University of Leeds, UK
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  • Justin Keen MSc PhD,

    Professor of Health Politics
    1. Leeds Institute of Health Sciences, University of Leeds, UK
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  • Lyn Wilson MA RGN,

    PURPOSE Programme Manager
    1. Leeds Institute of Clinical Trials Research, University of Leeds, UK
    2. RM&G officer Mid Yorkshire Hospital NHS Trust, UK
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  • Elizabeth McGinnis MSc PhD RGN,

    Nurse Consultant – Tissue Viability
    1. Leeds Teaching Hospitals NHS Trust, UK
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  • Carol Dealey PhD RGN,

    Honorary Professor in Tissue Viability
    1. School of Health & Population Sciences, University of Birmingham, UK
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  • Nikki Stubbs MSc RGN,

    Clinical Lead
    1. Wound Prevention and Management Service, Leeds Community Healthcare NHS Trust, UK
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  • Amanda Farrin MSc,

    Professor of Clinical Trials and Evaluation of Complex Interventions
    1. Leeds Institute of Clinical Trials Research, University of Leeds, UK
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  • Dawn Dowding PhD RN,

    VNSNY Professor of Nursing
    1. Columbia University School of Nursing, Columbia University, New York, New York, USA
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  • Jos M.G.A. Schols MD PhD,

    Professor of Old Age Medicine
    1. Department of Family Medicine and Department of Health Services Research, Caphri – School for Public Health and Primary Care, Maastricht University, the Netherlands
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  • Janet Cuddigan PhD RN FAAN,

    Associate Professor, Chair, Interim Chair
    1. Adult Health and Illness Department, College of Nursing – Omaha Division, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA
    2. Community Based Health Department, College of Nursing – Omaha Division, University of Nebraska Medical Center (UNMC), Omaha, Nebraska, USA
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  • Dan Berlowitz MD MPH,

    Co-Director/Professor
    1. Center for Healthcare Organization and Implementation Research, Bedford VA Hospital, Massachusetts, USA
    2. Boston University School of Public Health, Massachusetts, USA
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  • Edward Jude MD MRCP,

    Consultant Physician, Diabetologist and Endocrinologist/Reader
    1. Department of Medicine, Tameside Hospital NHS Foundation Trust/University of Manchester, UK
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  • Peter Vowden MD FRCS,

    Consultant Vascular Surgeon/Visiting Honorary Professor/Clinical Director
    1. Bradford Teaching Hospitals NHS Foundation Trust/University of Bradford/NIHR Wound Prevention and Treatment Healthcare Technology Co-operative, UK
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  • Lisette Schoonhoven PhD RN,

    Senior Research Fellow/Reader
    1. IQ Healthcare, Radboud University Nijmegen Medical Centre, the Netherlands
    2. Faculty of Health Sciences, University of Southampton, UK
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  • Dan L. Bader PhD DSc,

    Professor/Part-Time Professor
    1. Faculty of Health Sciences, University of Southampton, UK
    2. Biomedical Engineering Faculty, Eindhoven University of Technology, the Netherlands
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  • Amit Gefen PhD,

    Professor
    1. Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Israel
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  • Cees W.J. Oomens PhD,

    Associate Professor
    1. Biomedical Engineering Department, Biomedical Engineering Faculty, Eindhoven University of Technology, the Netherlands
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  • E. Andrea Nelson PhD RGN

    Head of School and Professor of Wound Healing
    1. School of Healthcare, University of Leeds, UK
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Abstract

Aim

This paper discusses the critical determinants of pressure ulcer development and proposes a new pressure ulcer conceptual framework.

Background

Recent work to develop and validate a new evidence-based pressure ulcer risk assessment framework was undertaken. This formed part of a Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056), funded by the National Institute for Health Research. The foundation for the risk assessment component incorporated a systematic review and a consensus study that highlighted the need to propose a new conceptual framework.

Design

Discussion Paper.

Data Sources

The new conceptual framework links evidence from biomechanical, physiological and epidemiological evidence, through use of data from a systematic review (search conducted March 2010), a consensus study (conducted December 2010–2011) and an international expert group meeting (conducted December 2011).

Implications for Nursing

A new pressure ulcer conceptual framework incorporating key physiological and biomechanical components and their impact on internal strains, stresses and damage thresholds is proposed. Direct and key indirect causal factors suggested in a theoretical causal pathway are mapped to the physiological and biomechanical components of the framework. The new proposed conceptual framework provides the basis for understanding the critical determinants of pressure ulcer development and has the potential to influence risk assessment guidance and practice. It could also be used to underpin future research to explore the role of individual risk factors conceptually and operationally.

Conclusion

By integrating existing knowledge from epidemiological, physiological and biomechanical evidence, a theoretical causal pathway and new conceptual framework are proposed with potential implications for practice and research.

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