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Dr. Neesha Oozageer Gunowa PhD, DN, RN, QN, SFHEA

Pathway Lead in Community Nursing, Teaching Fellow

Pressure ulcers are more likely to be missed in people with darker skin tones because of the technique used to assess the condition, according to research.

Pressure ulcers are traditionally assessed through red discolouration on the skin, this approach results in them being missed, or picked up later, especially in people with darker skin. Research is reshaping the way pressure ulcers are assessed in people with darker skin tones.

Skin tones

Educator and researcher Dr Neesha Oozageer Gunowa, community pathway lead in community nursing at the University of Surrey, conducted a study on pressure ulcers in people with darker skin for her PhD.

With a background in district and community nursing, she says: “I was working in an area highly-populated with people with dark skin tone and recognised in my practice that dark skin tone patients with pressure ulcers were more likely to be picked up later.”

She found little research had been conducted on why people with darker skin develop more severe pressure ulcers than people with lighter skin tones.

Nursing education

The investigations highlighted a gap in nursing education, with the diagnosis of pressure ulcers still determined by the so-called “react-to-red” approach. Red areas, she explains, show up on lighter skin but are not so prominent on darker skin tones but may be just as serious.

“Nurse educators need to talk about skin tone differences and that not everyone is the same,” she says. “The evidence is saying that people with dark skin tones are more likely to be getting more severe pressure ulcers; therefore, we need to recognise that there are differences.”

The language, she continues, needs to change from the “react-to-red” pressure ulcer prevention initiative to the Stop the Pressure programme, shifting the emphasis away from colour alone.

Her research has influenced healthcare policy, with the National Wound Care Strategy Programme acknowledging the findings. Additionally, Wound UK recently published a best practice statement on wounds in people with dark skin tones.

Nurse educators need to talk about skin tone differences and that not everyone is the same.

The role of technology to eliminate inequalities

Emphasising that pressure ulcers are generally preventable wounds, Dr Oozageer Gunowa says technology also has a role with SEM (sub-epidermal moisture) scanners able to identify increased localised oedema in vulnerable areas of the skin (regardless of skin tone) such as the heels at an earlier stage than the current pathway – allowing for earlier treatment to help prevent the condition worsening.

She says an “element of systemic racism” surrounding pressure ulcers is leading to health inequalities for people with darker skin tones.

“Once that is addressed, people are less likely to die from pressure ulcers and more likely to be picked up sooner. We as nurses and clinicians need to see people as individuals.”

Scanners better assess and guide treatment of pressure ulcers

Martin Burns

CEO, Bruin Biometrics

Technology modernises a standard of care that fails to fully protect patients, especially those with dark skin tones.

Bedsores, also known as pressure ulcers, occur most frequently on the bottom or heels. Usually caused by deformation of the skin due to poor mobility, they vary from small, reddened areas to large open wounds.

“They can be painful, distressing and embarrassing,” explains Martin Burns, CEO of biometric sensor technology specialists Bruin Biometrics LLC.

They can be painful, distressing, and embarrassing.

Risk assessment

He explains that current care requires healthcare practitioners to undertake a risk assessment, assess vulnerable areas like the heels and look for redness as an early indicator of ulceration.

“Since redness is not readily observable on dark skin tones, this in particular fails the dark skin tone population.

“Broken skin is observable but once the skin breaks, treatment complexity rises four-fold,” he says. Patients with dark skin tones are four times more likely to die from pressure ulcers.

Scanner technology

“The current standard of care is not good enough,” he adds. Localised oedema/sub-epidermal moisture (SEM) is a recognised biomarker for pressure ulcer management and identified by hand-held medical devices, such as Bruin Biometrics’ Provizio® SEM Scanner technology.

Irrespective of skin tones, it identifies skin damage on average five days earlier than nursing staff can see them on the skin surface, says Burns and can be used in different care settings.

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