Pressure Ulcer Risk Research Articles

Dynamic changes in seating pressure gradient in wheelchair users with spinal cord injury

ABSTRACT Pressure ulcer interventions are commonly assessed with measures of seating interface pressure, such as peak pressure gradients (PPGs). Decreases in PPG magnitudes may reduce pressure ulcer risk by decreasing tissue deformation and increasing tissue perfusion of at-risk weight-bearing tissues. Changes in PPG directions, which have previously been overlooked in the seating pressure literature, may provide a transient increase in blood flow to at-risk tissues, even if the PPG magnitude and location remain the same. The purpose of this study was to assess both PPG components in response to combinations of wheelchair tilt and recline angles. Thirteen power wheelchair users were recruited into the study. Six combinations of wheelchair tilt (15°, 25°, and 35°) and recline (10° and 30°) were tested in random order. Each combination was tested with 5-min upright sitting, 5-min tilt and recline, and 5-min maximal pressure relief recovery. Changes in PPG magnitudes and PPG directions under the left ischial tuberosity were computed for the six angle combinations. The findings in this study suggested that when combining wheelchair tilt and recline, the recline function may be particularly useful in reducing PPG magnitudes, while the tilt function may be particularly useful in manipulating PPG directions.

Pressure Ulcer Prevalence, Incidence, Risk, Clinical Features, and Outcomes Among Patients in a Turkish Hospital: A Cross-sectional, Retrospective Study

This study was conducted to assess PU prevalence, incidence, clinical features, nursing care measures, and patient variables and outcomes among inpatients admitted to 13 internal medicine departments at a university hospital in Turkey between 2010 and 2014. Using a cross-sectional, retrospective design, records of all hospitalized patients were reviewed and records from patients with a PU abstracted. Patient demographics, diagnosis, Braden Scale score, and PU information were abstracted from patient files/electronic records. Data were collected to an electronic data collection form between January and December 2015 and analyzed using descriptive statistics, chi-squared, one-way analysis of variance, and Student's t test. From a population of 20 175 patients, the records of 664 patients showed the presence of a PU; the total PU prevalence rate was 3.3% and the overall PU incidence rate for 5 years was 1.8%. Ulcers were most often Stage 1 (326. 49.1%), located at the sacrum (364, 54.8%), and hospital-acquired (370, 55.7%; 175 (56%) of PU patients were oncology patients, followed by dementia/Alzheimer's patients (31, 9.2%). A significant relationship between Braden scores and general diagnoses was found (P <.01). PU incidence was highest in patients with cancer and patients >65 years old, and patients with a diagnosis of dementia/Alzheimer's were at highest risk. Many patients outside of acute care settings have a PU. Risk assessments should be conducted and appropriate nursing interventions should be provided during facility admission and follow-up care. Prospective studies on the prevention of PU development in patients at risk are warranted.

Biomechanical analysis of different dynamic sitting techniques: an exploratory study

Prolonged static sitting in wheelchairs increases the risk of pressure ulcers. This exploratory study proposed three dynamic sitting techniques in order to reduce the risk of developing pressure ulcer during wheelchair sitting, namely lumbar prominent dynamic sitting, femur upward dynamic sitting, and lumbar prominent with femur upward dynamic sitting. The purpose of this study was to analyze the biomechanical effects of these three techniques on interface pressure. 15 able-bodied people were recruited as subjects to compare the aforementioned sitting techniques in a random order. All parameters, including dynamic contact area, dynamic average pressure, and dynamic peak pressure on backrest and seat were measured and compared. In result, when compared with lumbar prominent dynamic sitting, femur upward dynamic sitting and lumbar prominent with femur upward dynamic sitting appeared to yield significantly lower dynamic average and peak pressure on the back part of seat, and significantly higher dynamic average and peak pressure on the front part of seat. This study can serve as a reference point for clinical physicians or wheelchair users to identify a suitable dynamic sitting technique.

Path Analysis for Delirium on Patient Prognosis in Intensive Care Units

This study was conducted to investigate relationship between delirium, risk factors on delirium, and patient prognosis based on Donabedian's structure-process-outcome model. This study utilized a path analysis design. We extracted data from the electronic medical records containing delirium screening data. Each five hundred data in a delirium and a non-delirium group were randomly selected from electronic medical records of medical and surgical intensive care patients. Data were analyzed using SPSS 20 and AMOS 24. In the final model, admission via emergency department (B=.06, p=.019), age over 65 years (B=.11, p=.001), unconsciousness (B=.18, p=.001), dependent activities (B=.12, p=.001), abnormal vital signs (B=.12, p=.001), pressure ulcer risk (B=.12, p=.001), enteral nutrition (B=.12, p=.001), and use of restraint (B=.30, p=.001) directly affecting delirium accounted for 56.0% of delirium cases. Delirium had a direct effect on hospital mortality (B=.06, p=.038), hospital length of stay (B=5.06, p=.010), and discharge to another facility (not home) (B=.12, p=.001), also risk factors on delirium indirectly affected patient prognosis through delirium. The use of interventions to reduce delirium may improve patient prognosis. To improve the dependency activities and risk of pressure ulcers that directly affect delirium, early ambulation is encouraged, and treatment and nursing interventions to remove the ventilator and drainage tube quickly must be provided to minimize the application of restraint. Further, delirium can be prevented and patient prognosis improved through continuous intervention to stimulate cognitive awareness and monitoring of the onset of delirium. This study also discussed the effects of delirium intervention on the prognosis of patients with delirium and future research in this area.

Development and Evaluation of Electronic Health Record Data-Driven Predictive Models for Pressure Ulcers

The purpose of this study was to develop predictive models for pressure ulcer incidence using electronic health record (EHR) data and to compare their predictive validity performance indicators with that of the Braden Scale used in the study hospital. A retrospective case-control study was conducted in a tertiary teaching hospital in Korea. Data of 202 pressure ulcer patients and 14,705 non-pressure ulcer patients admitted between January 2015 and May 2016 were extracted from the EHRs. Three predictive models for pressure ulcer incidence were developed using logistic regression, Cox proportional hazards regression, and decision tree modeling. The predictive validity performance indicators of the three models were compared with those of the Braden Scale. The logistic regression model was most efficient with a high area under the receiver operating characteristics curve (AUC) estimate of 0.97, followed by the decision tree model (AUC 0.95), Cox proportional hazards regression model (AUC 0.95), and the Braden Scale (AUC 0.82). Decreased mobility was the most significant factor in the logistic regression and Cox proportional hazards models, and the endotracheal tube was the most important factor in the decision tree model. Predictive validity performance indicators of the Braden Scale were lower than those of the logistic regression, Cox proportional hazards regression, and decision tree models. The models developed in this study can be used to develop a clinical decision support system that automatically assesses risk for pressure ulcers to aid nurses.

Clinical value of curved supine position to prevent pressure ulcer and comfort experience in postoperative fracture patients

Objective To explore the effect of curved supine position to prevent pressure ulcer and comfort experience in postoperative fracture patients. Methods A total of one hundred and seventy-eight leg fracture patients who underwent operating in hospital were randomly divided into study group and control group (89 patients in each group). Conventional prevention and nursing method was given in the control group, based on the control group, curved supine position nursing method was carried out in the study group. The incidence of pressure ulcer, main compressed parts, pressure ulcers risk score and comfort degree in two groups were compared during hospitalization. Results The incidence of pressure ulcer in the study group (1.1%,1/89) was significantly lower than in the control group (7.9%,7/89), the difference was statistically significant between two groups (χ2=4.712, P=0.030). The scores of Kolcaba General Comfort Questionnaire (GCQ) in two groups showed a time-dependent manner, the physical, psycho-spiritual, environmental scores in the study were higher than in the control group at 13:00, 17:00 and 20:00. Meanwhile, the scores of socio-cultural were higher than in the control group at 17:00 and 20:00, the difference was statistically significant between two groups (P<0.05). Conclusion Curved supine position canreduce the incidence of pressure ulcer as well as promote comfort experience in postoperative fracture patients. Key words: Curved supine position; Pressure ulcer; Prevention; Comfort experience

Comparing the Effect of Henna Oil and Olive Oil on Pressure Ulcer Grade One in Intensive Care Units Patients.

Background:One of the most common problems in the intensive care unit (ICU) is the incidence of pressure ulcer or bedsore. This research was conducted with the aim to compare the effect of henna and olive on pressure ulcer grade one in ICU patients hospitalized in the selected hospitals of Isfahan University of Medical Science in 2016.Materials and Methods:This study conducted on 108 ICU patients with pressure ulcer. Patients were randomly divided into three groups. The two intervention groups were treated with olive oil and henna oil, respectively, and the third group was the control group. Data were collected using a demographic information questionnaire, Braden pressure ulcer risk assessment scale, and a table for daily record of the skin temperature before and within 1 week of the study. Data were analyzed in SPSS 22 using independent t-test, repeated-measures ANOVA, and Fisher's exact test.Results:The results showed a significant difference between the two henna and olive groups in the mean score of pressure ulcer measured through the pressure ulcer scale for healing tool (P < 0.05). The mean area of the ulcer on days 4 and 7 in the henna oil group was lower than that in the olive oil and control groups (P < 0.001).Conclusion:The results of this study showed that both henna and olive oils were effective in healing the pressure ulcer. However, henna oil showed better results in reducing the area of pressure ulcers over time.

The Effect of Henna (Lawsonia Inermis) on Preventing the Development of Pressure Ulcer Grade One in Intensive Care Unit Patients.

Background:Detecting pressure ulcer is an important nursing diagnostic and care requirement in patients hospitalized in Intensive Care Unit (ICU). The purpose of this study is to examine the effect of Lawsonia plant on pressure ulcer grade one in ICU patients.Methods:In this clinical trial, 72 patients eligible for hospitalization in hospitals of Isfahan University of Medical Sciences were divided randomly into two control and intervention groups. The standard program of skin care was implemented on both groups; in addition, a mixture of Lawsonia (henna) and distilled water was applied topically in the intervention group. The classification form of the International Pressure Ulcer Advisory Panel was used to identify grade one ulcers. Data were collected on the 1st day through demographic information questionnaire and Braden pressure ulcer risk assessment scale. An infrared thermometer was used to record local temperature of the ulcers on a daily basis. Assessments were made based on Pressure Ulcer Scale for Healing (PUSH), and the pressure ulcer area was examined per square centimeter on the 1st, 4th, and 7th days. The data were analyzed using SPSS 16.Results:The average change in the ulcer area per square centimeter in the control group increased by 29.9 ± 37.93 whereas it decreased by 3.54 ± 33.91 in the intervention group. The mean PUSH score decreased in the intervention group (5.36 ± 3.12) while it increased in the control group (1.91 ± 1.53). The average changes of PUSH score before and after the intervention showed a significant difference in both groups.Conclusions:With regard to the effect of henna on the reduction of ulcer area and the average PUSH score in ICU patients, the application of henna is recommended for healing grade one pressure ulcers.

Pressure Ulcers in Hospitalized Children: Prospective Observational Study and Italian Linguistic and Cultural Validation of the Glamorgan Pediatric Pressure Ulcer Risk Assessment Scale

Pressure Ulcers in Hospitalized Children: Prospective Observational Study and Italian Linguistic and Cultural Validation of the Glamorgan Pediatric Pressure Ulcer Risk Assessment Scale

Braden scale for pressure ulcer risk predicts rehabilitation placement after pancreatic resection

BackgroundPatients undergoing pancreatic resection frequently require rehabilitation facilities after hospital discharge. We evaluated the predictive role of validated markers of frailty on rehabilitation facility placement to identify patients who may require this service. MethodsSingle-center retrospective cohort study of patients who underwent pancreatic resection from 2010 to 2015. 90-day morbidity and mortality were calculated. Postoperative validated markers of frailty (Activities of Daily Living scale, Braden scale [assesses pressure ulcer risk, lower scores = higher risk] and Morse fall scale) were evaluated via multivariate regression to identify predictors of discharge to rehabilitation facility. Results470 patients with complete data were included. Mean age was 62 and 49.2% were male. Postoperative median length of stay (LOS) was 8 (IQR 7–10). 92 (19.66%) patients were discharged to rehabilitation facilities and 138 (29.49%) patients were readmitted within 90 days. On multivariate analysis, age, sex, LOS > 8 days, inpatient Comprehensive Complication Index (CCI) and initial Braden scale were predictive of rehabilitation placement. ConclusionA marker of frailty routinely collected daily by nursing staff, the Braden scale, is available to help surgeons predict the need for postoperative rehabilitation placement after pancreatic resection. Engaging discharge planning services for at-risk patients may help prevent delayed hospital discharge and should be further evaluated.

The reliability and validity of the Chinese version of The Pressure Ulcer Risk Primary or Secondary Evaluation Tool

Objective To translate The Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE-T) into Chinese, and assess its reliability and validity in Chinese hospitalized patients. Methods The original PURPOSE-T was translated into Chinese and back translated and modified for cultural adaptation according to guidelines. The reliability and validity of the Chinese version of PURPOSE-T were tested in 230 hospitalized patients. Results The Chinese version of PURPOSE-T consists of three parts and contains 25 entries. The inter-rater consistency Kappa coefficient was 0.798, the weighted Kappa coefficient was 0.843. The evaluation results were compared with binary variables with a Kappa coefficient of 0.745. The test-retest reliability Kappa coefficient and the weighted Kappa coefficient were 0.863 and 0.892. Two classified assessment Kappa coefficient was 0.857. The item content validity index ranged from 0.83 to 1.00, and the scale content validity index was 0.98. The phi correlation coefficient of PURPOSE-T and Braden scale was 0.781; the phi correlation coefficient of Waterlow Scale evaluation result was 0.777. The correlation coefficient between Chinese PURPOSE-T items and Braden scale items ranged from 0.605 to 0.877 (P<0.01), and the Waterlow Scale items ranged from 0.599 to 0.887 (P<0.01). Conclusions The Chinese version of PURPOSE-T appears to possess adequate validity, test-retest reliability and internal consistency. The newly translated Chinese version of PURPOSE-T may be used to assess the risk of pressure injury in inpatients in China. Key words: Pressure injury; Risk evaluation; Reliability; Validity

Hospital-acquired pressure ulcers: taking steps towards prevention

It may be a fallacy to state that most pressure ulcers are preventable, as research typically fails to recognise that most NHS nurses do not work in a well-staffed and well-equipped work environment 24 hours a day, 7 days a week. This article acknowledges this and proposes disrupting the current workflow with a default intervention that reduces the risk of pressure ulcers forming, without creating more work for under-resourced staff.

The relationship between pressure ulcer risk assessment and preventative interventions: a systematic review.

Hospital-acquired pressure ulcers (PU) continue to occur despite an ongoing focus on prevention. The aim of this review was to identify and evaluate primary research which links pressure ulcer risk assessment with prescription and implementation of preventative interventions for hospitalised adults. A systematic review of the databases EBSCO CINAHL Complete, EBSCO MEDLINE Complete, Scopus and Web of Science was undertaken, using search terms related to pressure ulcers, hospital-acquired, risk, planning, implementation, prevention and outcome. Primary research reports that linked PU risk assessment with prescription and implementation of preventative interventions in some way were included. From 589 potentially eligible publications, 20 primary research reports were included. Of these, seven linked PU risk assessment to preventative intervention implementation and 13 linked it to preventative intervention prescription and implementation in some way. No studies linked PU risk assessment to preventative intervention prescription alone. While the included studies linked these components in some way, there was little focus on the relationship between the three. PU preventative intervention prescription is not well defined, with inconsistencies noted in intervention prescription across studies. Many studies reported inadequate provision of prevention measures for patients at risk of PU. Further research is required to explore the relationship between PU risk assessment and preventative intervention prescription alone, and with implementation.

The effect of gel foam mattress use during total hip replacement surgeries on the development of pressure ulcers in the recovery unit: a quasi-experimental study

Objective: This study was conducted on patients undergoing total hip replacements in order to examine the effect of the use of a gel foam mattress during surgery on preventing the development of pressure ulcers. Material and Method: A quasi-experimental design, with a pretest-posttest control group, was used for this study, which was carried out in the Orthopedics and Traumatology Clinic of the Adnan Menderes University Research and Treatment Hospital between July 2015 with 80 patients who were to undergo total hip replacement surgery (40 in the experimental group and 40 in the control group who were to undergo total hip replacement surgery and April 2016. Results: According to the research results, 30% of the patients in the experimental group and 60% of the patients in the experimental group developed pressure ulcers in the recovery unit (p=0.013). It was further observed, according to the results of Braden Pressure Ulcer Risk Assessment Scale (BPURAS), that the type of pressure ulcers in the patients who developed them was stage 1 and located in the gluteal region. Conclusion: Our results have been shown that the development of pressure ulcers in patients from both the experimental group and the control group in the recovery unit was related to age, operating time (min), anesthesia type, while height, weight, gender, diagnosis, temperature of operating theater. However, movement restrictions before surgery have not an impact on the development of pressure ulcers.

The impact of a national quality register in the analysis of risks and adverse events among older adults in nursing homes and hospital wards\u2014a Swedish Senior Alert survey

BackgroundThe proportion of elderly in the population in Sweden is increasing. Older adults are more vulnerable to disease and disability which in turn increases the prevalence of negative events as pressure ulcers, malnutrition, falls, and oral health problems.MethodsBy using Senior Alert (SA), a quality registry for care prevention, analyze data concerning risks and adverse events and show the potential of the register for quality improvement and research in nursing homes and hospitals.ResultsThere are differences in the prevalence of pressure ulcers and weight loss in nursing homes compared to hospitals, explained by different risk scores in the assessment tools used as well as differences in the populations with regard to age and days to follow-up. Falls are more prevalent in nursing homes. Fall prevalence decreases more with higher pressure ulcer risk due to factors such as degree of mobility; the fall prevalence decreases for even higher pressure ulcer risk.ConclusionsThe team around the older person needs a more inter-professional profile including healthcare such as physiotherapists, occupational therapists, dietitians, and dental health professionals.Trial registrationThe study is an observational retrospective register-based study, using data from SA during 2015.

A prediction tool for hospital-acquired pressure ulcers among surgical patients: Surgical pressure ulcer risk score.

Surgical patients are prone to developing hospital-acquired pressure ulcers (HAPU). Therefore, a better prediction tool is needed to predict risk using preoperative data. This study aimed to determine, from previously published HAPU risk factors, which factors are significant among our surgical population and to develop a prediction tool that identifies pressure ulcer risk before the operation. A literature review was first performed to elicit all the published HAPU risk factors before conducting a retrospective case-control study using medical records. The known HAPU risks were compared between patients with HAPU and without HAPU who underwent operations during the same period (July 2015-December 2016). A total of 80 HAPU cases and 189 controls were analysed. Multivariate logistic regression analyses identified eight significant risk factors: age ≥ 75 years, female gender, American Society of Anaesthesiologists ≥ 3, body mass index < 23, preoperative Braden score ≤ 14, anaemia, respiratory disease, and hypertension. The model had bootstrap-corrected c-statistic 0.78 indicating good discrimination. A cut-off score of ≥6 is strongly predictive, with a positive predictive value of 73.2% (confidence interval [CI]: 59.7%-84.2%) and a negative predictive value of 80.7% (CI: 74.3%-86.1%). SPURS contributes to the preoperative identification of pressure ulcer risk that could help nurses implement preventive measures earlier.

Sequential Organ Failure Assessment (SOFA) to Predict Pressure Ulcer Risk in Intensive Care Patients: A Retrospective Cohort Study

The authors assessed the performance of the Sequential Organ Failure Assessment (SOFA) scale and its subcategories in predicting the development of PUs. A retrospective cohort study was conducted of all adult patients admitted to the mixed medical-surgical ICU of a Finnish tertiary referral hospital between January 2010 and December 2012. Data (diagnoses, demographics, clinical information, treatments, and instrument scores) were retrieved from the ICU database. Wilcoxon and chi-squared tests were used to examine patient subgroup (medical or surgical ICU and intensive care or high-dependency care patients), length of ICU stay (LOS), modified Jackson/Cubbin (mJ/C) scores and SOFA subcategory variables, and first-day SOFA scores. PU association was determined by logistical regression. Among the 4899 patients in the study population, the overall PU incidence of acquired PUs was 8.1%. Medical patients had significantly more PUs (145/1281; 11.3%) than surgical patients (212/3468; 6.1%) (P <.0001). In all subgroups, significantly more patients with PUs had higher SOFA scores (mean 8.24) than patients without PUs (mean 6.74) (P =.001). The difference persisted when patients with LOS ≥3 days in the ICU were considered. Among the SOFA subcategories, the Glasgow Coma score, renal and respiratory disorders, and hypotension were significantly (P <.0001) linked to PU development. First-day total SOFA score and its cardiovascular and respiratory subcategory scores were the most important predictors of PUs. The total SOFA score provides an additional tool to assess PU risk in ICUs and should be used together with the Braden or the mJ/C Scale.

Assessing and managing malnutrition in adults in hospital.

The term malnutrition refers to both undernutrition and overnutrition. In healthcare, it most often refers to undernutrition, in particular disease-related malnutrition, which can be a result or a cause of an illness. The reasons for malnutrition are multifactorial, and its consequences may include an increased risk of pressure ulcers, reduced mobility and psychological effects such as depression. It is essential that nurses prioritise the nutritional care of all patients and identify those at risk of malnutrition using accurate and reliable nutrition screening tools. If there is a risk of malnutrition, further assessment and nutrition action planning can reduce the risk to the patient and improve their nutritional status. This article discusses the effects of disease-related malnutrition and outlines the role of screening tools and assessment in identifying patients who are malnourished or at risk of becoming malnourished. It also describes the nursing care that should be provided to patients with disease-related malnutrition, and emphasises the importance of using a multidisciplinary team approach involving speech and language therapists, dieticians, occupational therapists and physiotherapists.

Post-discharge follow-up assessments of frail older people in their home environment: Is it feasible?

Objectives: The aims of this study were to (1) assess the recruitment rate, drop-out, time to complete and acceptability of the test battery and evaluate the feasibility of follow-ups in the home environment and (2) describe the population in terms of sex, comorbidity, disability and frailty.Methods: Participants were recruited from 3 geriatric departments and were assessed before discharge and in their homes at 1 and 3 months. The assessments consisted of: medical diagnoses; medications; risk of pressure ulcers, falls, malnutrition, depression and frailty; physical function, physical activity and health-related quality of life. Data on re-admission and home service were retrieved from the county council and the participating municipalities. Feasibility was evaluated by describing the recruitment process including inclusion/exclusion criteria, the participation rate and the number of and reasons for drop-out, the acceptance of the test battery, time taken and the feasibility of performing the tests in the participants’ homes.Results: Thirty-five of 89 eligible patients agreed to participate (21 men/14 women). It took on average 70 minutes to complete the test battery at baseline and 124 minutes (including travel) at the home visits. The participants accepted the test battery. Mean age was 84 years and the women were significantly older than the men. The greatest number of the participants were regarded as frail, all had comorbidity and 77% had disability (n=27).Conclusions: It was feasible to conduct the test battery at the ward and in the participant’s home. Frailty, comorbidity and disability were present simultaneously in almost half of the participants.

Conversation Map™: strumento per l’educazione del caregiver sulla prevenzione delle lesioni da pressione/Conversation Map™: a tool for the education of the caregiver on the prevention of pressure ulcers

Lo sviluppo di Lesioni da Pressione (LdP) rappresenta un evento molto frequente ma potenzialmente prevenibile; tuttavia, avere una fotografia reale del fenomeno è molto difficile. Le stime variano in rapporto al setting assistenziale considerato: nei reparti per acuti l’incidenza varia dallo 0,4 al 38%, nelle residenze sanitarie assistenziali dal 2,2 al 23,9%, mentre nell’ambito domiciliare dallo 0 al 17%. Si valuta che negli USA sia una condizione che colpisce circa 1,5-3 milioni di persone, comportando una spesa sanitaria annua di circa 5 miliardi di dollari, da 1.4 a 2.1 miliardi di sterline nel Regno Unito e 1 miliardo di euro in Italia, pari al 4% dei costi totali del Sistema Sanitario Nazionale. Partendo dai dati epidemiologici si è voluto indagare se i caregivers delle persone assistite a rischio di LdP conoscano le strategie idonee a prevenire questo tipo di lesioni cutanee. Quindi, con la somministrazione di un questionario di 23 domande a 60 caregivers si è voluto valutare il bisogno o meno di una conoscenza sulla prevenzione delle lesioni da pressione. Lo studio ha rivelato che 83,3% degli intervistati non ha ricevuto informazioni né su cosa siano le LdP né su come si sviluppano; di poco inferiore la percentuale riguardante le informazioni sulla prevenzione di LdP. Si è voluto trovare, quindi, una risposta a questo bisogno di informazione, sviluppando una Conversation Map™, da proporre come strumento per l’educazione dei caregivers alla prevenzione delle LdP. La Conversation Map™, creata da Healthy Interactions Inc., è uno strumento didattico unico e speciale, perché favorisce la partecipazione della persona assistita o dei caregivers in un momento didattico sia verbale che visivo. Nella mappa, che ha il setting di un campo d’atletica, vengono toccati i punti principali della prevenzione delle lesioni: cura della cute, cambi di postura, presidi antidecubito, alimentazione e le medicazioni come prevenzione. Vengono spiegate le definizioni di LdP e di LdP di 1° stadio oltre che i principali fattori che concorrono alla formazione delle LdP, la scala di Braden e l’indice di Norton.&#x0D; The development of Pressure Ulcers (PU) is a very frequent, but potentially preventable, event; however having a real time picture of the phenomenon is very difficult. The estimates vary depending on the considered care setting: in the acute care wards the incidence varies between 0,4 and 38%, in the Extended Care Unit between 2,2 and 23,9%, while in the home-care setting between 0 and 17%. It is estimated that in the US it’s a condition that affects around 1,5-3 million of persons, involving a healthcare expenditures of around 5 billion of dollars per year, between 1.4 and 2.1 billion of pounds in the UK and 1 billion euros in Italy; equal to the 4% of the total costs of the National Health System. Starting from epidemiological data, it has been investigated if the caregivers of the assisted persons with PU risk know the appropriate strategies to prevent this type of skin lesions. Therefore, in order to evaluate the need of knowledge on the prevention of Pressure Ulcers, a questionnaire with 23 questions was administered to 60 caregivers. The study revealed that 83,3% of those interviewed haven’t received any information on what the PU are or on how they develop, slightly less the percentage about the information on the PU prevention. The aim was to find an answer to this need of information by developing a Conversation Map™, to propose as a tool for the education of the caregivers on the prevention of PU. The Conversation Map™, created by Healthy Interactions Inc., is a unique and special teaching tool: it encourages the participation of the assisted person or the caregivers in an educational moment that is both verbal and visual. In the map, that has the setting of a track and field stadium, the main points of the Pressure Ulcers prevention are covered: skin care, posture changes, anti-bedsores surfaces, nutrition and dressing as prevention. The definitions of PU and 1st stage PU are explained, in addition to the main factors that concur to the PU development, the Braden scale and the Norton index.