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The Activities on these Portfolio Pages correspond with the learning objectives of the Guided Learning unit published in Nursing Times 105: 24 (23 June, 2009) and 105: 25 (30 June, 2009). The full reference list for this unit follows Activity 4.

Before starting to work through these Activities, save this document onto your computer, then print the completed work for your professional portfolio. Alternatively, simply print the pages if you prefer to work on paper, using extra sheets as necessary.

Recording your continuing professional education

To make your work count as part of your five days’ CPD for each registration period, make a note in the box below of the date and the total number of hours you spent on reading the unit and any other relevant material, and working through the Activities.

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|Hours: |Date: |

|ACTIVITY 1 |

Learning objective: Understand the risks and potential for pressure ulcer development in seated patients.

Activity: Describe the threats to tissue viability in a seated patient vulnerable to pressure ulcer development.

|RESPONSE |

Begin your response here.

|ACTIVITY 2 |

Learning objective: Identify measures that nurses can take to help maintain tissue viability in seated patients.

Activity: Identify the factors which nurses in acute and community settings can observe and monitor to prevent pressure ulcers developing in seated patients.

|rESPONSE |

Begin your response here.

|ACTIVITY 3 |

Learning objective: Understand the role of sitting position in pressure ulcer development in seated patients.

Activity: Identify any action that a nurse could carry out in an attempt to prevent pressure ulcer development in seated patients:

• At the sacrum;

• Behind the knees;

• Beneath the ischial tuberosities.

|RESPONSE |

Begin your response here.

|ACTIVITY 4 |

Learning objective: Know preventive techniques that nurses can use to help maintain tissue viability in this group.

Activity: a) Describe what happens to the position of your spine, head, shoulders and arms when you carry out the following sitting posture: sit in a chair, place feet on floor, assuming a neutral position. Close eyes, put hands in lap. Rotate pelvis backwards and forwards very slowly (posterior and anterior pelvic tilt) Focus on your spinal movement and the position of head and shoulders when rotating the pelvis.

b) Describe what happens when you carry out the following sitting posture: from a neutral sitting position, perform a posterior pelvic tilt and breathe deeply; now perform an anterior pelvic tilt and breathe deeply.

c) Describe what happens when you carry out the following sitting posture: from a neutral sitting position, perform a posterior tilt and reach forwards as if trying to get a drink on the table in front of you. Now perform an anterior tilt and reach forwards.

|RESPONSE |

Begin your response here.

|FULL REFERENCE LIST |

Bader, D.L., Hawken, M.B. (1990) Ischial pressure distribution under the seated person. In: Bader, D.L. (ed) Pressure Sores: Clinical Practice and Scientific Approach. London: Macmillan.

Barbenel, J.C. et al (1977) Incidence of pressure-sores in the Greater Glasgow Health Board area. Lancet; 2: 8037, 548–550.

Bennet, G. et al (2004) The cost of pressure ulcers in the UK. Age and Ageing; 33: 230–235.

Bliss, M.R. (1993) Aetiology of pressure sores. Reviews in Clinical Gerontology; 3: 379–397.

Brienza, D.M. et al (1996) Seat cushion design for elderly wheelchair users based on minimization of soft tissue deformation using stiffness and pressure measurements. IEEE Transactions on Rehabilitation Engineering; 4: 4, 320-7.

Clark, M. (2009) Guidelines for seating in pressure ulcer prevention and management. Nursing Times; 105: 16 (Supp), 40-41.

Clark, M. (2004) Pressure Ulcers: Recent Advances in Tissue Viability. Wiltshire: Quay Books.

Coggrave, M.J., Rose, L.S. (2003) A specialist seating assessment clinic: changing pressure relief practice. Spinal Cord; 41: 692–695.

Collins, F. (2007) A practical guide to wheelchair cushions. International Journal of Therapy and Rehabilitation; 14: 12, 557–561.

Cullum, N. et al (2004) Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews; 3: CD001735.

Dinsdale, S.M. (1974) Decubitus ulcers: role of pressure and friction in causation. Archives of Physical Medicine and Rehabilitation; 55: 4, 147–152.

Gebhardt, K.S., Bliss, M.R. (1994) Preventing pressure sores in orthopaedic patients. Is prolonged chair nursing detrimental? Journal of Tissue Viability; 4: 51-54.

Gefen, A. (2008) The Compression Intensity Index: a practical anatomical estimate of the biomechanical risk for a deep tissue injury. Engineering and Medicine Technology Health Care; 16: 2, 141–149.

Henderson, J.L. et al (1994) Efficacy of three measures to relieve pressure in seated persons with spinal cord injury. Archives of Physical Medicine and Rehabilitation; 75: 535-539.

Medical Devices Agency (1997) Wheelchair Cushions, Static and Dynamic: a Comparative Evaluation. London: HMSO.

McInnes, E. et al (2008) Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews; Issue 4, Art No: CD001735. DOI: 10.1002/14651858.CD001735.pub3.

NHS Choices (2008) Pressure ulcers. Preventing pressure ulcers. preventing-pressure-ulcers

NICE (2005) The Management of Pressure Ulcers in Primary and Secondary Care. A Clinical Practice Guideline. London: NICE.

Rithalia, S., Kenny, L. (2001) The art and science of evaluating patient support surfaces. World Wide Wounds, September 2001. patient-support-surfaces

Rithalia, S.V., Gonsalkorale, M. (1998) Assessment of alternating air mattresses using a time-based interface pressure threshold technique. Journal of Rehabilitation Research and Development; 35: 2, 225-30.

Stockton, L., Rithalia, S. (2009) Pressure-reducing cushions: Perceptions of comfort from the wheelchair users' perspective using interface pressure, temperature and humidity measurements. Journal of Tissue Viability; 18: 2, 28-35.

Stockton, L., Rithalia, S. (2008) Is dynamic seating a modality worth considering in the prevention of pressure ulcers? Journal of Tissue Viability; 17: 1, 15–21.

Stockton, L., Parker, D. (2002) Pressure relief behaviour and the prevention of pressure ulcers in wheelchair users in the community. Journal of Tissue Viability; 12: 3, 84–90.

Stockton, L. (2000) Guide to choosing the right pressure-reducing cushion. Community Nurse; 6: 2, 33–34.

Swearingen, J.J. et al (1962) An Analysis of Sitting Areas and Pressures of Man. Oklahoma City, OK: Civil Aeronautics Medical Research Lab. sitting-areas

Tissue Viability Society (2009) Seating and Pressure Ulcers. Clinical Practice Guideline. Cardiff: TVS. TVS-publications

Trumble, H.C. (1930) The skin tolerances for pressure and pressure sores. Medical Journal of Australia; 2: 724–726.

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