a desriptive evaluation of pressure reducing cushions
TRANSCRIPT
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Clinical
A descriptive evaluation of
pressure-reducing cushions
Sylvia Banks, Jane Bridel
This article provides
a descriptive
evaluation of HNE
Hun tleigh s
Vaperm, Multitec
and Supatec
pressure-reducing
cushions in relation
to skin response,
comfort and posture
and their
effectiveness in an
overall pressure sore
prevention strategy.
Sylvia Banks is Practice
Devciopment Nurse and
Jane Bridel is Head of
Nursing Research and
Practice Development at St
Jam es s and Seacroft
University Hospitals,
Leeds
review of the literature reveals a
link between seating and the development
of pressure sores (Barbenel et al, 1977;
Barton and B arton, 1981; Geb hardt and
Bliss, 1994). A number of pressure-reduc-
ing cushions have been developed in an
attempt to reduce the risk of pressure-sore
development associated with sitting. In
1983, a national survey of the prevalence
of pressure sores highlighted the diversity
of pressure-reducing products available in
the NHS (David etal, 1983).
Figure la . The Vaperm pressure-reducing
cushion from the Seatec range.
Polyhedron-shaped channels
provide extra pressure relief
by helpirig reduce shear
lorces ol cushion and also
allow air lo circulate
throughout cushion
mnltl x cover provides:
1. 2-way slretch prevents
hammocking and shear
2.
42 vapour permeable
improves
s r
movement around
cushion
3. Waler-resistant prevents
foam Irom getting wet
Comfort layer of foam
takes up body contours
and provides comfort
The literature on pressure-reducin
cushions currently focuses mainly on th
measurement of interface pressures. I
1974, Souther et al examined a number o
these products and concluded that: N
cushion evaluated reduced mean pressu
below mean capillary pressure. How eve
the application of interface pressure me
surements to clinical practice was recent
challenged by Bridel (1993a), who ind
cated that at an individual level th
response to pressure varied widely. Th
reliability and validity of the tools used t
measure interface pressures have also bee
questioned (Clark, 1994), demonstratin
that these measurements cannot be used
an absolute indicator of the effectivene
of product.
Sitting is a dynamic, unstable postur
and the performance of pressure-reducin
cushion cannot be properly evaluated inde
pendently of the overall seating situatio
There is little information in the literatur
with regards to the effect of adding such
cushion to a seat, particularly in terms o
skin response. In view of th is, a descriptiv
study of the Vaperm, Multitec and Supate
cushions was undertaken.
Aims
The aims of the study w ere to:
1. D ete rm ine the effectiveness of th
Vaperm, Multitec and Supatec cushion
m relation to skin response
2. Assess the comfort of the cushions
3. Observe the effects of the cushions o
posture.
The Vaperm, Multitec and Supatec cush
ions form part of the Seatec range pro
duced by HN E Huntleigh.
The Vaperm cushion {Figure la ha
been designed to meet the needs of use
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Adescriptive ev aluation of pressure-reducing cushions
Breathable film covering
(Platilon)
Fire-reslsiant foam
walls take up
contours of patient's
to allow an even distribution of pressure.
The foam is vcntil.ucd to .illow .lir to cir-
culate through the cushion
{Figure
Ib .
The Multitec cushion
{Figure 2a
has
been designed to meet the needs of users
who are assessed to be at medium-high
risk of developing pressure sores, or as
part of the treatment for established sores
up to grade 2 or grade 3 healing (Torrance,
1983).
The centre of the cushion contains a
polyurethane envelope containing fluid
and a lattice of welds links the top and
bottom of the envelope to prevent exces-
sive fluid movement. The envelope is
housed in thin foam, allowing the patient
to sit into the fluid, while taking up the
contours of the body. If the patient shifts
his/her position, the fluid displaces accord-
ingly and redistributes the pressure over
the seating surface{Figure2b .
The Supatec cushion {Figure 3a has been
designed to meet the needs of users who are
assessed to be at a high-very high risk of
developing pressure sores, or as part of the
Figure 2a. The Mult i tec pressure-reduc ing
cushion from the Seatec range.
Choice o( outer cover
1. atchdogTerrtowelling
2. OmnHIeK'
Cotton cover to
strengthen foam
assembly
Fluid:
treatment for established sores up to grade
(Torrance, 1983). The Supatec contains mo
fluid than the M ultitec, allowing for better di
tribution of weight and pressure{Figure3b
The cushions used for evaluation were a
protected by a waterproof, vapou r-perm
able cover cal led Omnif lex. The cov
stretches two ways to reduce hammockin
and shear forces, and can be removed fo
laundering. The cushions used for evaluatio
had already been in use in the hospital for
months and no attempt was made to com
pare the performance of the cushions after
months with their performance when new.
Method
Sample
Patients admitted to a 32-bedded medic
ward and a 30-bedded elderly care war
were considered for entry into the stud
The ward nurses identified patients requi
ing a pressure-reducing cushion, by asses
ing the risk, skin quality and mobility of th
patients in accordance with the St James
University Hospital Trust (1993) pressur
area care policy. Patients were included i
the study if they met the following criteria:
1. The patient/carer was able to participat
in
a
simple, semi-structured interview
2. In the ward nurses clinical judgmen
the patient s mobility and conditio
were unlikely to alter during the 7-da
study period week
3.
On entry to the study, the patien t
Waterlow score (Waterlow, 1985) wa
5
or above.
A full explanation of the study wa
given and verbal consent to participate wa
obtained from all patients as determine
by the local ethics committee.
The cushions were allocated by the war
nurses according to the skin assessment
and the mobility of the patient describe
by the subscale contained within th
Braden scale (Braden and Bergstrom
1987). The guidelines for allocation ar
shown inTable 7.
Patients with dark pigmentation of th
skin were not considered for entry into th
study because of the difficulties associate
with the reliable identification of blanchin
and non-blanching areas of rednes
Patients assessed to have existing pressur
damage of grade 3 or worse (Torranc
1983) at the sacrum or ischial tuberositie
were also excluded from the study. It wa
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Adescriptive evaluation
of
pressure-reducing cushions
ultimately alter
the
dimensions
of the
ch.\ir.
In an
attempt
to
etisure that patients
were able
to
maintain their functional abil-
ity while sitting, the total scat height
of
the
chairs with the cushioninplace was chosen
to match the lengthof thepatient 'sleg
from the popliteal fossa to the floor. Where
a suitable chair height
was not
available,
aids such
as
foot-blocks were used
to
sup-
port the feet and maintain a 90 angle
at
the
hip and knee. All chairs used were covered
with polyvinyl chloride and had armrests.
Other pressure area care was determined
by ward staff who assessed the risk, skin and
mobihty
of the
patients
and
evaluation
of
skin response,
in
accordance with
the St
James's University Hospital Trust (1993)
pressure area care policy. Mattress allocation
and repositioning schedules while
in bed
therefore varied among the study sample.
Data collection
As well as demo graphic information,
descriptive data pertainingto theresponse
Figure
3a The
Supatec pressure-re ducing
cushion from the Seatec range.
2-way stretch cover ^^^^^k
Available in
Omn lilex'
or
^ ^ ^ ^ ^ ^ ^ ^ H
WatchdogTemiowelling ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ H
Extrafluidens ures that ^ ^ - - ^ ^ ^ ^ / ^ - ^ ^ i > I l ^
.y^
patients wtth fixed pelvic
^ --....y^
^^^^^^rr;^
displacement can use y' ^^ -^, ,,^ ^
j-
Supatee'
/
^ ~ ~ - - . ^ ^
Lattice work inside fluid modu le:
1.
Prevents user bonoming out on
cushion
Welds link outer layers of
polyurethane envelopes together:
1.
Allows moreofthe fluid to be
available to take up the body
of the skin were collected by thewa
nurses
and
were determined
by the
pre
ence
or
absence
of
redness. Skin
wa
assessed
at
the sacrum and ischial tubero
ties using
an
adapted version
of the
pre
sure sore classification described
b
Torrance (1983). These assessments wer
documented
on
entry
to the
study
and
each position change (24-hour clock)
for
7-day study period.
Additional information collected
by th
ward nurses
and
author included descri
tive data relating
to the
risk
of
pressu
sore development,
the
comfort
of th
cushions and posture.
Pressure sore risk was described
by ca
culation
of
the Waterlow score. Owing
t
the problems associated with interrate
reliability
of the
Waterlow score (Deale
1989; Bridel, 1993b),
the
documente
scores were used onlyas ageneral indic
tor
of
the level
of
risk
in
the description
the results
and no
attempt
was
made
t
improve the reliability among raters.
Data pertainingto thecomfort of th
cushions were collected by the auth
using a visual analogue scale and were sup
ported
by
descriptive inform ation fro
semi-stnictured interviews.
Ward nurses were given detailed expla
nations
of the
tools
and
data collectio
forms
to be
used. Since
the
focus
of th
evaluation was skin response, preparation
before data collection included interrate
reliability checksof skin assessments wi
level
registered ward nurses. A total
of
nurses (nine pairs) undertook skin assess
ments
on
four anatomical sites (buttoc
and heels)
of
18 patients, generating
a
to
of 72 paired assessments scores. There wa
92 absolute agreement
of
grades
{ ^yH
equating to aPearson product-mome
correlation
of .92
(P
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descriptive evaluation of pressure-reducing cushions
also defined. Transient skin changes refer
to the observation of skin redness (either
blanching or non-blanching) for less than
24 hours and persistent skin changes are
def ined as redne ss (ei ther blanch ing or
non-blanching) observed at the same site
for 24 hours or longer.
Ten of the 48 patients had superficial skin
loss (grade 2b) on entry to the study and a
further patient developed a pressure sore.
The per iod prevalence of pressure sores
was 22 .9 (11/48) and the inciden ce, i.e.
the proportion of subjects who first present
with a pressure sore, was 2.6 (1/38).
Vaperm
Sixteen patients were allocated a Vaperm
cushion; detai ls of the resul ts are sum-
marised in
Table 3
Eleven (69 ) had no
disco loration (grade 0) and five (31 ) had
reddened blanching areas on entry to the
study. Waterlow scores ranged from 15 to
23 (median 16) and mobility was recorded
as slightly limited for all patients (Braden
subscale 3). The total time spent sitting per
day rang ed from 4 to 11 ho urs (m ean 8
hours) and the length of time spent sitting
for any one per iod ra nged f rom 1.5 to
3 hours (mean 2.3).
Seven patients (44 ) had transient skin
changes during the study. Adjustments to
the indiv idu al r epo s i t ionin g schedules
were made by the ward nurses when red-
ness was observed and no persistent skin
changes occurred. Al l pat ients had skin
assessments of grade 0 at the end of the
study per iod.
Tab le I Gu idelines for alloca tion of cushions
Mobility
Multitec
Table 4 shows the results of the 16 patien
allocated a Multitec cushion. Nine patient
(56 ) had no disco loration (grade 0) and
seven (44 ) were classified as grade 1 on
entry to the study. Waterlow scores ranged
from 16 to 24 (median 22) and m obility wa
very l imited (Braden subscale 2) in al
patients. Tim e spent sitting varied w idely in
this group, ranging from 4 to 19 hours/day
(mean 8) for periods of1.5 3.5hours (mea
2.5 hours). Four patients experienced som
skin changes dur ing the study. Change
were made to their repositioning schedule
and no persistent changes occurred.
Skin status remained undamaged in al
nine patients with no discoloration on entry
to the study (grade 0) and resolved in 5 of
the 7 patients who were initially assessed a
grade 1. Th e skin cond i t ion of the tw o
remaining patients was unchanged, i.e. ini
tial skin changes were persistent. The lack of
improvement in these two patients could
not be explained by longer periods of sitting
(6 and 6.5 hou rs per day) than other patient
in the group or by their risk scores of23.
Supatec
The results of the 16 patients allocated a
Supatec cushion are shown in Table
Only one (6 ) had no d i scolora t ion
(grade 0) on entry to the study. The major
ity (6 3 ; 10/16) of the patients had super
ficial skin loss (grade 2) on either the
sacrum or the ischial tuberosities, and the
remainder had either non-blanching (n=l
or blanching (M=4) erythema.
I. Com pletely Immobile:
2
Very limited:
Doe s not make even Makes occasional
3. Slightly limite d:
4.
No limitations:
slight changes in body
or extremity position
without assistance
Skin assessment
slight changes in body
or extremity position,
but unable to make
frequent or significant
changes independently
Makes frequen t though Makes major and
slight changes in body
or extremity position
independently
frequent changes in
posit ion without
assistance
Grade 0:
no discoloration
Grade 1:
redness/blanching
Grade 2a:
redness/non-blanching
Supatec or
Multitec
Supatec or
Multitec
Supatec
Multitec
Multitec
Supatec
Vaperm
Vaperm
Multitec
Vaperm
Vaperm
Multitec
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descriptive evaluationofpressure-reducing cushions
All patients were either completely
immobile n
=5) ,
or their mobility was
severely limited n=l I). Risk of pressure
damage was high or very high in all cases
Waterlow score 18-34, median 25).
The total time spent sitting within this
group was less than that in the Vaperm and
Multitec groups, ranging from 3 to 7.5 hours
per day mean 5 hours). However, the
length of time sitting for any one period was
only slightly shorter than that in the othe
two groups range 1-2 hours, mean 1.7).
Table
2.
Characteristics
of
the patient population
i
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A descriptive evaiuation of pressure reducing cushions
Table 4.
Patient
no.
3
7
12
14
18
19
24
26
29
32
34
39
41
43
46
Multitec cushion results
Skinassessmentsa t
entry toevaluation
Ischial Sacnim
tuberosity
0
0
0
0
1
0
0
0
0
1
0
1
0
0
0
0
0
0
1
0
1
0
1
0
0
0
0
1
0
1
1
0
Skin assessments at
end of evaluation
Ischial Sacrum
tuberosity
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
1
0
0
0
0
0
0
0
0
0
Waterlow
score
21
21
23
16
24
19
23
18
24
24
20
24
17
23
23
19
Braden
mobility
1-4)
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
Mean time
sitting/day
hours)
19
4
6
I I
6
5
6.5
iO
8.5
7
5.5
9
6.5
8
8
13
Mean time
sitting/session
hours)
3
1.5
2
3
3
1.75
2.5
3.5
3
2
2.5
1.5
2.5
2
2.5
3.5
Table 5.
Patient
no .
2
5
9
10
15
17
20
22
27
30
33
35
37
42
Supatec cushion results
Skin assessments at
entry to evaluation
Ischial Sacrum
tuberosity
0
0
0
1
2b
2b
2a
0
0
0
0
0
0
2b
2b
2b
2b
2b
2a
2a
2a
2b
2b
2b
1
1
0
0
Skin assessments at
end o f evaluation
Ischial Sacrum
tuberosity
0
0
0
1
2b
2a
1
0
0
0
0
0
0
2b
2b
2b
2a
2b
2a
2a
1
2b
2b
2a
2a
1
0
0
Waterlow
score
25
26
28
27
34
32
28
26
25
24
21
22
18
20
Braden
mobility
1-4)
2
2
2
2
2
2
2
2
2
2
1
1
1
2
Mean tim e
sitting/day
hours)
3
4
5.5
6
3
5
5.5
6.5
4.5
5
5
4
7
5.5
Mean time
sitting/session
hours)
1
1.5
1.5
2
1.5
1.5
1.5
2
1.5
1.5
2.5
2
1.5
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A descriptive evaiuation ofpressure-reducing cushions
On entry to
the
study the posture
of the patient was
observed when
the
patient was
initially
seated
and the
observation was
repeated a fter 1
hour.
All patients
were observed
to
maintaina9
angle
at
the
hip
and kn ee after 1
hour and feet
remained flat on
the floor
or
supported by
a
foot-block.
The
one
patient
in
this group
who had
no discolorat ion of skin on entry to the
s tudy did not experience persistent skin
changes during the study period,and skin
assessments of grade 0 were observed for
all areas
at the end of the
study.
Of the
tour patients with blanching redness,one
deter iorated
to
non-blanching (grade
2a)
but
did not
result
in
superficial loss
of the
e p i d e r m i s , and three per s i s t ed but
remained unchanged (grade
1).
One patientwasinitially assessed to have
non-blanching for all areas (grade 2a) on
entry
to the
evaluation
and
subsequent ly
developed a pressure sore (grade2b) at the
sacrum.At the end of the study, however,
improvement wasshown and skin assess-
mentsofgrade1were observedfor allareas.
Ten patients
(62%) had
skin assessments
of grade2b at one ormore sitesonentryto
t he s t udy . Of these , seven showed no
change over the study period.Theremain-
ing three patients entering the study with
skin assessments
of
grade
2b
s h o w e d
improvement, with assessmentsof grade2a
for all areasat the end of thestudy.
Comfort
Patients w ere askedtoratethecomfort of the
cushions on entry to the study and at the end of
the study period, using
a
horizontal 1 cm
visual analogue scale, where 0 cm represented
very unconrfoitable aiid
1
cm indicated ver}'
comfortable. Tlie visual arilo gue scores ranged
from6.2 to9.7 (mean 7.84).Asimilar rangeof
scores was ob tainedforeach cushion type .
Additional descriptive information relat-
ingto thecomfortof thecushionswas col-
lected during
a
semi-structured interview
with each patient. This information
sup-
ported
the
visual analogue scores.
A
selec-
tion
of
quotations from these interviews
are shown below:
*The cushion
is
more comfortable than
the cha ir.' (Vaperm)
'The chair makes
my
back ache,
but the
cushion's very comfortable.' (Multitec)
'(The cushion)
has
more give than others
I've used.' (Supatec)
Nine patients were unable to complete
the visual analogue scale. Five patientshad
i m pa i r ed senso r y pe r cep t i on and four
were unable
to
understand
the
concept
of
the scale. However, none
of the
patients
indicated that the cushions were uncom-
fortable when mterviewed.
init ially seated, and theobservat ion was
repeated after 1hour . All patients wer
observed
to
maintam
a 90
angle
at the hip
and knee after
1
hourand feet remained f
on
the
floor
or
supported
by a
foot-block.
Discussion
The period prevalence
of
22.9
and
pres
sure sore incidenceof 2,6% are compara
ble to those found in previous s tudies
Prevalence studies that include the mobil
ity levels of the patients surveyed enabl
the calculation of group-specific rates.For
exam pl e , for pat i en t s who have ver
res t r i c t ed mobi l i ty
or are
c o m p l e t e l
immobile,
a
point prevalence
of
21.7
can
be calculated from
the
study reported
by
Barbenel
et al
(1977)
and a
period preva
lence of 36.5% from tha t r ep or t e d by
Waterlow (1988).
O n l y G ebha r d t and Bliss (1994) hav
studied the association between pressur
sore incidenceand sitting.In a randomised
control led t r ial of 57 postopera t iv
or thopaedic pat ients, Gebhardt and Blis
(1994) found thatthepressure sore incidenc
was 63 among patients
who
were allowe
unl imited chair nursing
and 7%
am on
patients
who
were restricted
to
2 hours cha
nursing
per
session. Three differences
in
research aims
and
methodology' account
for
the lower incidenceofthis study.
First, thefocus of the study conducte
b y G e b h a r d t and Bliss (1994) was to
establish whether prolonged chair nursing
was detrimental , whereas theprimaryaim
of this studywas to evaluatethe effective
ness of three pressure-reducing cushion
in relationtoskin response.
Second,the chairs used during this evalu
ation were selected by the ward nurses to
suit the dimensions of the patients.The
importance
of
chair dimensions
and
desig
has been highlightedbyGilsdorfetal (1991
who repor t ed tha t a rmres t s suppor ted
between5% and 9% of thebody weighto
spinal cord-injured subjects,and by Lowr
(1992, 1993)whodescribed theproblemso
poor posture
and
seating provision
in
rel
tion
to
pressure sore developm ent.
Third, following a review of the liter
ture, Bridel (1993a) identified the impo
tance of recognising skin redness (reactiv
hyperaemia)as aprecursortopressure so
development. Consequent ly,a keyemph
sis
of the St
Jaines 's Un iversi ty Hosp i t
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A descriptive evaiuation
o
pressure reducing cushions
/ /isgenerally
accepted that
visual n logue
sc lesare of most
value wherescores
are obtained
pre- an d post-
intervention from
the same
individual
...and/or used in
combination with
a qualitative
description of
the given
experience...The
combination of
data collected in
this studyin
relationto
comfort llowsthe
generalconclusion
that the three
cushionswere
ccept bleand
comfortable to
patients.
The ward n urses role in the implementa-
tion of thepolicy is of impor tance in the
interpretation
of
the results
of
this evalua-
tion, as they were responsibleforprescrib-
ing all nursing care, including seating and
mai t r css provi s ion and r epos i t i on i ng
schedules.Theward nurse s response to
skin redness is demonstrated by the adjust-
ments madeto repositioning schedulesfor
18 pa t i en t s when sk in change s we re
obse r ved . N one of the 18pat ients were
observedtohave persistent skin cha nges.
The skin response toVap erm, Mu ltitec
and Supatec cushions is described. H owev er,
the results
are
limited
by the
fact t ha t
no
attempt was madetocompare the perfor-
manceofthe cushions with thatofa control.
As reposit ioning schedules were adjusted
accordingto skin response,thevariationin
repositioning times supports the conclusion
drawnbyBndel (1993a) that,at anmdivid-
ual patient level,theresponseof the skin to
pressure varies widely
and is
likely
to be
dependent upon anumberoffactors.The
individual natureof skin tolerance isalso
demonstrated by thedifferent outc om es in
terms of skin changes for these patients.
Comfon
is an
abstract, multidimensional
concept which is difficult to defineand
measure (Redfern, 1976). The useofvisual
analogue scales
as a
measure
of
pa t i en t s
subjective experiences were discussedby
Ghapmanetal (1985) and Mag uire (1984)in
relation to pain. These studies highhghted
problems
of
poor sensitivity associated with
treatment effects and difficulties in compari-
so nofscores berween grou ps.Itis generally
accepted that visual analogue scalesare of
most value where scoresareobtained pre-
and post-intervention from thesame indi-
vidual (Maguire, 1984) and/or usedincom-
bination with a qualitative descriptionofthe
given experience (Redfern, 1976). The com-
bination of data collected in this studyin
relationto comfort allowsthegeneral con-
clusion that the three cushions were accept-
able and com fortable to patients.
Thi sis thef irst rep ort of theeffectof
cushions upon the postureofpatients. Th e
observation undertaken simply described
the pos ture of thepat ient whi le on the
cush i on
and the
i n forma t ion genera ted
that initial sitting posture wasmaintained
for periodsofu pto1 hour .It does, there-
fore, provide useful data.
Th e data were limited, however, as a com -
chairs for a
1-hour
per iod) .Theprecis
effectof the cushions on posture is therefor
u n k n o w n .
For
example,
was
po s t u r e
th
sameorimproved on the cushion comp are
with thechair? In view of this l imitation
addi t ional work wi th a different patien
population iscurrently being plannedin a
attempt to achieve the original aim.
Conclusion
This evaluation has shown that, irrespectiv
of thetotal timethepatient spends sittin
per day, the Vaperm, Multitec
and
Supate
cushionscan be used effectively asparto
an overall pressure sore prevention stra
egy, when careis planned accordingto th
skin responseof the individual andat ten
tion is paidtothe overall seating situation.
Aliman
DG
(1991) Practical Statisticsfor Medic
Research.Chapman and Hall, London: 405-6
BarbencI JC,l o rdan MM, Nico l SM,C la rk MO
(1977) Incid^cncc
of
pressure sore
in the
greate
Glasgow hcaith board area. Eaneet
2 :
548-50
Barton A,Barton M (1981)
TheManagement a
Prevention of Pressure Sores. Fabe r
and
Fabc
London
Braden
BJ,
Be rgs t rom
NA
(I 987)
A
c oncep tua
scheme
for the
study
of the
etiology
of
pressur
sores.RehabilNurs 12(1): 8-12 ,
16
Bridel
J
(1993a) The aetiology
of
pre s su re s o re s
Wound Care 2(4): 230-8
Bridel
J
(1993b) Assessing
the
risk
of
pressure sore
Nurs Standard
3 27) SUDDI:11-2
Chapman CR,Caseyu KL, D u b n e r R,Folcy KM
Cracciy
RH,
Reading
AF
(1985) Pain measure
ment; an overview.P am 22; 131
Clark
M
(1994) Problem s associated w ith
the me
s u r e m e n t of interface or c on tac t ) p re s s u r e .
Tissue Viability 4(2): 37^ 2
David JA, Chapman RG, Chapman EJ,Locket t
(1983)
n
Investigation
of
the Current Method
Used
in
Nursing
for the
Care
oj
Patients wit
Established Pressure Sores.
Nurs ing Prac t i c
Research Unit, Northwick Park, Middlesex
Dealey
C
(1989) Risk assessment
of
pressure sores:
comparat ive s tudy
of
N o r t o n
and
W a t e r l o w
scores.Nurs Standard i{27)Suppl:
11-2
Gebhardt KS, Bliss
MR
(1994) Preventing pressur
sores
m
orthopaed ic patients is prolonged cba
nursing detnm ental?y Tissue Viability ^{Z):5 1 ^
G i l s d o r f P . P a t t e r s o n
R,
Fisher
S
(1991) T hir t
minute cont inuous s i t t ing force measuremen
with different support surfaces m the spinal cor
m)uredandable bo died.
_
Rehabil Res
Dev
28(4
33-8
Lowry M (1992) Hospital seating and pressure area
Nurs Standard t{^4)Supp\:
10-1
Lowrj
M
(1993) Sitting
m
judgement. Elderly Ca
5(3):22-3
Maguire DB (1984) The measurement
of
clinical pain
Nurs Res HO): \i2~ >
Redfern
SJ
(1976) The comfort
of the
hospital
be
In: Kencdi
RM,
C o w d e n
JM,
Scales
JT, e
Bedsore Biomechanies. U n ive rs i ty Pa rk Pre s
Mar>-land:211-17
Souther SG, Carr SD, Vitnes
LM
(1974) Wheelcha
cushions to reduce pressure unde r bony p rom
nences.Arch Phys Med Rehabil 55: 460-4
St Jam es s U nivers ity Ho spita l Tr ust ( 1993) Pressu
Area Care Policy. Nursmg Research
and
Practic
Development Unit, Leeds
T o r r a n c e C (1983) Pressure Sores Aetiolog
-
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