Making a difference in pressure injury prevalence: the community nurse's guide

Managing the impact of prolonged bedrest in patients comprises a significant proportion of the community nurse's caseload. A patient may choose or require prolonged bedrest for a number of reasons, including injury, recovery from surgery, neurocognitive decline, disability, and age-related frailty or decreased mobility and difficulty in performing activities of daily living.

Prolonged bedrest can have harmful effects on both a patient's psychological wellbeing and physiological functioning. Just 10 days of bedrest has been found to result in a substantial loss of lower extremity strength, power and aerobic capacity, even in healthy older adults, and 20 days of bedrest was associated with the development of depression in a cohort of young, healthy adults (Ishizaki et al, 1994; Kortebein et al, 2008).

One of the primary areas of concern for the healthcare professional caring for individuals who are bedridden should be the patient's skin and soft tissue. In the absence of movement, pressure injuries can develop quickly-sometimes in only a matter of hours-especially in those with fragile skin or long-term chronic conditions, such as diabetes. These types of injuries pose a massive financial burden on the healthcare system and a substantial personal cost to affected individuals, because of their prevalence and severity. An incidence rate ranging from 4.5–25.2% has been approximated for the UK, with over 700 000 people affected by pressure ulcers each year across all care settings, including people in their own homes, at an estimated annual cost to the NHS of £1.8–2.6 billion (El-Saidy and Aboshehata, 2019).