How the nursing home can work with diet, activity and function-preserving efforts to prevent pressure ulcers

Pressure ulcers are a serious healthcare injury that can cause great suffering for the residents and require a long healing period. To prevent pressure ulcers, a holistic approach is required where diet, activity and a function-preserving way of working are at the center. By working systematically with these factors, the nursing home's staff can reduce the risk of pressure ulcers and improve the quality of life for the residents.

The importance of diet in preventing pressure ulcers

Malnutrition is one of the biggest risk factors for pressure ulcers as undernutrition leads to impaired wound healing and reduced skin resistance. Therefore, it is important that the nursing home actively works to ensure that the residents receive a nutritious and balanced diet.

How the nursing staff can work with the diet:  
- Individual nutrition assessment: All residents should undergo a nutrition assessment at the time of moving in and regularly thereafter. Senior alert can be used to identify the risk of malnutrition.  
- Protein- and energy-rich diet: For residents with a high risk of pressure ulcers, extra protein and energy in the diet may be needed. Protein-rich foods such as eggs, fish, meat, legumes and dairy products can reduce the risk of pressure ulcers.  
- Nutritional drinks and dietary supplements: For those who have difficulty getting enough food, nutritional drinks with high protein content can be a good complement.  
- Adequate fluid intake: Dehydration makes the skin fragile and more susceptible to injuries. The nursing staff should ensure that the residents drink enough fluids during the day and encourage regular fluid intake.  
- Adaptation of the meal environment: A pleasant and calm environment at meal times can increase the appetite. Nursing staff can also assist with feeding if needed to ensure that the resident gets enough nutrients.  

Activity and movement to reduce the risk of pressure ulcers

Physical activity is an important factor in maintaining blood circulation and reducing the risk of pressure ulcers. A resident who sits or lies still for long periods has an increased risk of pressure ulcers as the pressure on the skin becomes too high.

How the nursing staff can work with movement and activity:  
- Daily movement activities: Encourage the residents to be physically active according to their ability. This could involve short walks, chair gymnastics or simple movements in bed for those who are bedridden.  
- Position changes and pressure relief: Residents who have difficulty changing position themselves should receive help to turn in bed according to a turning schedule. Even while sitting, small position changes can reduce the pressure on the skin.  
- Support for maintaining independence: The nursing staff can encourage and support the residents in participating in their own care, for example by helping them adjust their position or change position in the wheelchair.  

Function-preserving working methods and pressure ulcer preventive measures

A function-preserving working method means that the residents receive support to use and retain their physical ability as long as possible. By actively working with function-preserving measures, the risk of pressure ulcers is reduced.

How the nursing staff can work to preserve function:  
- Helping the residents move themselves: Encourage residents to change their position in bed or the wheelchair as much as they can.
- Using adapted aids: Correctly adapted mattresses, seat cushions and heel-relieving aids can reduce pressure on sensitive areas.  
- Training and physiotherapy: A physiotherapist can help assess the need for movement training to strengthen the muscles and improve blood circulation.  

How can the nursing staff identify residents at increased risk of pressure ulcers?

Some residents have a higher risk of developing pressure ulcers. Therefore, it is important that the nursing staff is aware of signs indicating increased risk.

Signs that a resident is at increased risk:  
- The person is bedridden or has reduced mobility.  
- Residents who have low body weight or reduced nutrient intake.  
- Visible redness on the skin, especially at bony prominences or pressure points.  
- Dry and fragile skin that easily cracks.  
- Swelling or signs of circulation problems.  

How should documentation and reporting be done?

Documentation of pressure ulcer prevention work is important to ensure that the right measures are taken in time.  

How the nursing staff should document and report:  
- Risk assessment at the time of moving in and regular follow-up.  
- Report and document changes in the appearance of the skin. If the nursing staff discovers redness, irritation or small sores, this should be documented and reported to the nurse.  
- Description of implemented measures. For example, if a pressure-relieving mattress has been used, a turning schedule has been followed or if dietary and fluid needs have been reviewed.  
- Communication with the rest of the team. It is important that information about pressure ulcers and preventive measures reaches the entire staff group, so that everyone works uniformly to reduce the risk.  

Reflection questions - Pressure ulcers
Care staff:  
- How do you work to promote movement and activity to reduce the risk of pressure ulcers?  
- How can you improve the routines to notice early signs of pressure ulcers?  
- Are you aware of how diet and fluid affect the risk of pressure ulcers?  

Manager, nurse, occupational therapist and physiotherapist:  
- Is there a clear routine to identify residents with a high risk of pressure ulcers?  
- How often are risk assessments and care plans for pressure ulcers updated?  
- Do you have enough pressure-relieving aids available?  

Residents and relatives:  
- Do you feel that your relative gets enough support to be active?  
- Does your relative have access to a diet that is adapted to their needs?  
- Do you notice any changes in weight or skin condition in your relative?  

Erland Olsson
Specialist nurse
Sofrosyne - Better care every day