Nurse-led research: Improving pressure injury care for patients with dark skin tones

Understanding skin tone and how it relates to pressure injuries and tissue damage can be challenging, and the issue is widespread. Hospital-acquired pressure injuries affect more than 2.5 million Americans annually. Pressure injuries can lead to poor patient outcomes and longer hospital stays, negatively impacting quality measures and financial reimbursement.

Traditionally, nurses are taught to look for redness to detect first signs of pressure injury, but this is challenging with patients with dark skin tones who require tactile and sensory assessments as well. Under-recognized or misdiagnosed deep-tissue pressure injuries are affecting patients with dark skin tones with greater severity of complications.

That’s why Courtney Maurer, DNP, RN, focused her doctorate project on improving assessment and documentation of pressure injuries for patients with dark skin tones. “As nurses, we are educated in healthcare disparities, but resources on the acute care needs of patients with dark skin tones is limited,” says Courtney. “I did not feel confident in my skin assessment skills for dark skin tones, and I recognized a need for more resources and education that are inclusive of diverse patient populations .”

Courtney first completed a needs assessment to compare current documentation and resources with international guidelines. She collaborated with UW Health’s Burn and Wound Center team and a clinical nurse specialist to create a Translating Research into Practice (TRIP) resource sheet and a video modeling a skin assessment.

With visual examples of different-stage pressure injuries, nurses were able to better identify pressure wounds on dark skin tones. This work led to bringing together UW Health’s Diversity, Equity and Inclusion (DEI) team, Nursing Documentation Committee, Center for Clinical Knowledge Management, Nursing Informatics and the Nursing Practice Council—to implement recommended terms in the skin and wound nursing documentation flowsheets in our electronic health record (EHR).

Courtney also worked closely with ICU clinical nurse specialists, skin care nurses, and wound teams in four ICUs at University Hospital, surveying nurses (pre and post) to understand perceptions, attitudes, education and resource availability.

Courtney’s resources are now available on UW Health’s intranet and included in the University of Wisconsin School of Nursing curriculum. “I’ve seen our resource materials laminated at nursing stations and on bulletin boards. The feedback from nurses has been positive and the adoption of documentation changes and resources from other facilities – including Agrace, American Family Children’s Hospital and UW Health SwedishAmerican Hospital – has shown the profound need for these resources.”

Courtney hopes this work empowers other nurses to improve processes and education to continue to work together to eliminate healthcare disparities. “As nurses, we feel proud when we know our betterment efforts are what’s right for our patients and ultimately improve the quality of our care and their health outcomes.”

Check out more stories featuring the great work of our nurses in the 2021 Nursing Annual Report (pdf).