3805NRS Assessment 2
Poster & Written Justification
Pressure Injury Prevention
Word Count: 1,504 words (Poster & Justification combined)
Preventing Pressure Injuries
Sara Sefat (s5082166)
Risk factors for Australians over 65 years hospitalized
Pressure injuries are a result of
prolonged pressure to the skin
covering bony prominences
Waterlow Risk Assessment
|Pain preventing repositioning
Hospitalized patients suffering
from pain are at a high risk of
developing pressure injuries
as unmanaged pain can
repositioning and mobilisation
(Latimer, Chaboyer &
Lack of mobility can result in
increased pressure exerted
over bony prominences
causing reduced blood flow to
the tissue and eventually cause
tissue damage (Menzel, 2014).
Reduced human and
equipment resource provision
can increase risks (Latimer,
Chaboyer & Gillespie, 2015)
Neuropathy and inability to
respond to pain or
discomfort can make an
individual more susceptible
to pressure injury (Jaul,
Barron, Rosenzweig &
|Impaired cognition &
Elderly suffering from
impaired cognition and
dementia are at high risk of
developing pressure injuries
as they find it difficult to move
or reposition (Jaul & Meiron,
2017). Unconscious patients
undergoing a surgery are
vulnerable to pressure injuries
(Primiano et al., 2011).
|Malnutrition and dehydration
Malnutrition causes impaired
collagen synthesis, reduced
fibroblastic cellular activity,
and reduces immune function.
Dehydration damages skin
integrity and reduces blood
flow causing pressure injuries
(Mahmoodpoor et al., 2018)
|Incontinence & moisture
Incontinence and moisture
increases the vulnerability
of skin integrity, making it
more susceptible to
pressure injuries. Over
exposure to moisture can
also cause skin erosion
Emmons & VanGilder,
DID YOU KNOW that in Australia
4,313 pressure injuries occurring in
Australian public-hospitals in 2015-
2016 (Australian Commission on
Safety and Quality, 2018).
Risk Assessments &
Reduce moisture on skin –
dry patients thoroughly
Encourage diet and fluids –
fluid balance & nutritional
assessment where necessary
frequently and encourage
Maintain skin integrity –
avoid hot water and harsh
soaps when showering
Rational for health risk:
Older people make a significant portion of Australia’s population as reported in 2017, over 1 in 7 people were Australians aged 65 and over
(Australian Institute of Health and Welfare [AIHW], 2018). Additionally, in 2016- 2017, 90% of care that people aged 65 and over received were categorised
as acute care such as medical or surgical care in hospitals (AIHW, 2018). Therefore, it is crucial to align health systems to the needs of older population, as
problems that matter to them such as pressure injuries (PI) are overlooked by healthcare professionals in hospitals (World Health Organisation [WHO], 2017).
In 2015-2016 there were 4,313 PI occurring within Australian public hospitals (Australian Commission on Safety and Quality, 2018a). A PI is a result of
prolonged pressure to the skin covering bony prominences (Menzel, 2014). PI are one of the most common types of hospital-acquired complications
(Australian Commission on Safety and Quality in Health Care, 2018b).
Hospital-acquired PI are significant burden to healthcare costs due to extended length of hospitalisation and more complex care requirements
(Australian Commission on Safety and Quality in Health Care, 2018b). PI can have several serious complications for elderly such as reduced quality of life,
changed body image, cellulitis, osteomyelitis and sepsis (Joyce, Moore & Christie, 2018). Additionally, there are many contributing factors that put people
aged 65 and over at risk of developing PI in hospital settings (Australian Commission on Safety and Quality, 2018). Risks factors for developing PI include
immobility, impaired sensation, incontinence and prolonged exposure to moisture, malnutrition and dehydration, pain preventing repositioning and impaired
cognition and consciousness (Menzel, 2014). This poster focused on PI as a health risk for older people due to the continuous increase in life-expectancy of
Australian population, increased hospital admissions, increased multifactorial risks and comorbidities.
Rational for audience:
Registered nurses are responsible for maintaining skin integrity and implementing PI prevention (Lawrence, Fulbrook & Miles, 2015). This is
because nurses spend the most amount of time with patients compared to other healthcare professionals (Butler et al., 2018). Consequently, it is essential for
registered nurses to recognize elderly patients at risk of developing PI promptly, as time plays a huge role in PI prevention care pathway (Ebi, Hirko &
Mijena, 2019). The earlier a nurse identifies risk factors, the earlier they can organise for preventative measures to be placed, therefore resulting in improved
patient safety and healthcare quality (Ebi et al., 2019). A cross-sectional survey study by Lawrence et al. (2015), suggested that Australian nurses lack
sufficient knowledge on PI prevention and have poor compliance with evolving best-practice guidelines. Additionally, research demonstrates that using
posters as a healthcare educational tool within hospital settings can successfully increase practitioner’s knowledge, change attitudes and behaviours, thus
Australian nursing staff can benefit from PI prevention posters (Ilic & Rowe, 2013).
Nursing staff are required to assess and assist people aged 65 and over with their Activities of Daily Living (ADLs) depending on their
functional ability (Jaul, Barron, Rosenzweig & Menczel, 2018). While caring for elderly, nurses are regularly involved assisting with their ADLs including
personal hygiene, continence management, dressing, feeding, ambulating, repositioning and changing linen (Jaul et al., 2018). As such, the audience of this
poster is targeted towards nursing staff in specific registered nurses in hospital settings. Nurses are involved in managing patient’s nutrition and hydration
when feeding thus, fluid balance and nutrition assessment should be conduct upon identifying at risk individuals (Lecko, 2018). During showering nurses can
protect patient’s skin integrity by avoid using hot water and harsh soaps and reducing prolonged moisture exposure after showers by drying patients
thoroughly (Lawrence et al., 2015).
While assisting with clothing, showering and toileting, nurses can complete a skin inspection routinely to prevent PI (Queensland Health, 2018). Additionally,
registered nurses are required to conduct daily skin assessments and complete weekly Waterlow risk assessment scale by complying with best-practice
guidelines (Queensland Health, 2014). The Waterlow risk assessment involves assessing the patient on nine clinical categories and adding up the score which
determines the patient’s risk of developing a PI (Queensland Health, 2014).
Environmental changes such as lack governmental funding for specialised mobility devices, repositioning equipment and reduced human
resources and social changes such as loneliness can hugely impact the occurrence of PI in elderly within hospital settings (Latimer et al., 2015).Therefore,
nursing staff must be involved in creating age-friendly environments by promoting integrated care such as making accurate referrals and taking preventative
measures as listed on the poster to reduce the occurrence of PI in elderly (WHO, 2017). Research proves that using strength-based approache by encouraging
family involvement during meal-times can improve malnutrition thus, reducing PI occurrence (Moyle, Parker, Bramble, 2014; Ramic et al., 2011).
Rational for poster content and images:
The title of this poster “Preventing pressure injuries” has been kept short, simple yet effective to convey the topic message quickly. The use of
clear icons and grouping of the “nursing risk assessments and considerations” on the right side, allows the reader to promptly identify the key strategies to
follow for prevention of PI (Connelly, 2018). Using bright colours, contrasting text and maintaining an overall theme grabs the reader’s attention, maintains
harmony and allows them to identify different information. This poster had an appropriate ratio of coloured content to white-space as per suggested
guidelines: 30% white space in a scholarly poster ensures visual breathing room for the eyes (Connelly, 2018).
The icons used are fitting to each risk factor as they are visually communicating the topic of that risk through clear symbols (Connelly, 2018).
For example, immobility as a risk factor is symbolised at the top-middle with a person on the bed suggesting bed-bound patients who are unable to
mobilise are at risk of developing PI. The top-left risk factor icon is a sad person in pain suggesting that patients can become highly agitated when they are
in pain and unable to mobilise. The top-right icon is a pin referring to impaired sensation as a pin would hurt a patient if it was felt, however with
neuropathy sensation is impaired thus more susceptible to PI. The bottom-middle icon depicts an empty plate representing malnutrition and dehydration as
a risk for PI. The bottom-left icon depicts the human brain referring to patients with neurological impairments or unconsciousness in acute settings posing
as a risk for developing pressure areas. The bottom-right icon depicts a water droplet representing moisture and urine as a risk to skin integrity thus
Additionally, the picture used from Yuchenko (2019), with the bright quote underneath, recommends that nurses must work in partnership with
patients to prevent PI. This is supported by research which suggests that patients must play an active role in PI prevention as it can reduce financial,
physical and time burden associated with nursing delivery of PI prevention thus improving patient outcomes (McInnes, Chaboyer, Murray, Allen & Jones,
Australian Commission on Safety and Quality. (2018a). Hospital-Acquired Complication Pressure Injury. Retrieved 15 September 2019, from
Australian Commission on Safety and Quality in Health Care. (2018b). Hospital-Acquired Complications Information Kit. Retrieved 15 September 2019,
Butler, R., Monsalve, M., Thomas, G., Herman, T., Segre, A., Polgreen, P., & Suneja, M. (2018). Estimating Time Physicians and Other Health Care Workers
Spend with Patients in an Intensive Care Unit Using a Sensor Network. The American Journal Of Medicine, 131(8), 972.e9-972.e15. doi:
Connelly, L. M. (2018). Designing Effective Conference Posters. MedSurg Nursing, 27(1), 64+. Retrieved from https://link-galecom.libraryproxy.griffith.edu.au/apps/doc/A529490134/AONE?u=griffith&sid=AONE&xid=acc1496c
Edemekong, P., Bomgaars, D., Levy, S. (2019). Activities of Daily Living (ADLs). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019
Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470404/
Ilic, D., & Rowe, N. (2013). What is the evidence that poster presentations are effective in promoting knowledge transfer? A state of the art review. Health
Information & Libraries Journal, 30(1), 4-12. doi: 10.1111/hir.12015
Jaul, E., Barron, J., Rosenzweig, J., & Menczel, J. (2018). An overview of co-morbidities and the development of pressure ulcers among older adults. BMC
Geriatrics, 18(1). doi: 10.1186/s12877-018-0997-7
Jaul, E., & Meiron, O. (2017). Dementia and Pressure Ulcers: Is There a Close Pathophysiological Interrelation?. Journal Of Alzheimer’s Disease, 56(3), 861-
866. doi: 10.3233/jad-161134
Joyce, P., Moore, Z., & Christie, J. (2018). Organisation of health services for preventing and treating pressure ulcers. Cochrane Database Of Systematic
Reviews, (12). doi: 10.1002/14651858.cd012132.pub2
Lachenbruch, C., Ribble, D., Emmons, K., & VanGilder, C. (2016). Pressure Ulcer Risk in the Incontinent Patient. Journal Of Wound, Ostomy And
Continence Nursing, 43(3), 235-241. doi: 10.1097/won.0000000000000225
Latimer, S., Chaboyer, W., & Gillespie, B. (2015). The repositioning of hospitalized patients with reduced mobility: a prospective study. Nursing Open, 2(2),
85-93. doi: 10.1002/nop2.20
Lecko, C., (2018). Assessing nutritional status to reduce risk of pressure ulcers. Nursing Times [online]; 114: 6, 44-46.
Mahmoodpoor, A., Shadvar, K., Sanaie, S., Saghaleini, S., Dehghan, K., & Ostadi, Z. (2018). Pressure ulcer and nutrition. Indian Journal Of Critical Care
Medicine, 22(4), 283-289. doi: 10.4103/ijccm.ijccm_277_17
Menzel, J. (2014). Pressure Ulcers in the Elderly, as a Public Health Problem. Journal Of General Practice, 02(05). doi: 10.4172/2329-9126.1000174
McInnes, E., Chaboyer, W., Murray, E., Allen, T., & Jones, P. (2014). The role of patients in pressure injury prevention: a survey of acute care patients. BMC
Nursing, 13(1). doi: 10.1186/s12912-014-0041-y
Moyle, W., Parker, D., & Bramble, M. (2014). Care of older adults: A strengths-based approach. Melbourne, Australia: Cambridge University Press.
Primiano, M., Friend, M., McClure, C., Nardi, S., Fix, L., & Schafer, M. et al. (2011). Pressure Ulcer Prevalence and Risk Factors During Prolonged Surgical
Procedures. AORN Journal, 94(6), 555-566. doi: 10.1016/j.aorn.2011.03.014
Queensland Health. (2018). Assess showering and provide basic/bridging intervention. Retrieved 15 September 2019, from
Queensland Health. (2014). NSQHS Standard 8 Pressure Injury Definitions sheet. Retrieved 15 September 2019, from
Ramic, E., Pranjic, N., Batic-Mujanovic, O., Karic, E., Alibasic, E., & Alic, A. (2011). The effect of loneliness on malnutrition in elderly population. National
Center For Biotechnology Information. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21585182
World Health Organization. (2017). Global strategy and action plan on ageing and health. Retrieved 15 September 2019, from
Yurchenko, Y. (2019). Illustration of an elderly nursing home patient and nurse [Cartoon]. Retrieved from https://www.123rf.com/photo_30566283_stockvector-illustration-of-an-elderly-nursing-home-patient-and-nurse.html
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