Pressure Sores and Negligence in Nursing Homes


“If he has a bed-sore, it is generally the fault not of the disease, but of the nursing.” Nightingale, Florence. Notes on Nursing: What It Is, and What It Is Not. New York: D Appleton and Company, 1860.

    Pressure Sores and Their Effects on the Body

Pressure sores, also known as bed sores or pressure ulcers, are an injury to the skin and its underlying tissue. They are caused by a reduction of mobility and develop on various areas of the body where the bone is prominent and prone to pressure in certain positions. Common sites where pressure sores form are overlying the sacrum, coccyx, heels, hips, elbows, knees, ankles or the back of the cranium. Several factors increase the risk and likelihood of pressure sore development such as protein-calorie malnutrition, skin moisture caused by sweat or incontinence, and diseases that reduce blood flow or sensation to the skin such as paralysis or neuropathy.

Pressure sores manifest in four main stages and can range from simple redness and irritation to permanent tissue damage and severe infection.

Stage 1 sores become apparent when the skin appears reddened or discolored depending on the skin tone. At this stage, there can also be a change in consistency or temperature of the skin. Though the skin remains intact and the underlying tissue is relatively unaffected, stage 1 sores are often painful and serve as a warning that something is wrong.

Sores move into stage 2 when the skin breaks open or forms an ulcer. This stage causes pain and tenderness as the sore expands into deeper layers of the skin. At stage two, skin may either die or become damaged beyond repair.

At stage 3, the sore extends into the tissue underneath the skin and forms a cavern. The underlying bone and muscle can become visible at this stage, though not yet affected.

Once a sore enters stage 4, it becomes very deep as it reaches into the muscle and bone. At stage four, deep tissue, tendons and joints can become damaged. Infections to the blood (sepsis) or bone (osteomyelitis) can also occur and become life-threatening.

Some pressure sores do not fit into any of the stages, and are designated as deep tissue injuries where the skin has not yet broken, but significant tissue damages has manifested underneath.

    Prevention and Negligence

Though preliminary stages of pressure sores can be difficult to prevent in bedridden residents, their exacerbation is preventable by simply turning or repositioning a patient on a regular basis to redistribute the pressure. Maintaining a diet with adequate protein as well as keeping the skin clean from moisture is crucial.

Unfortunately, many nursing home residents develop severe pressure sores due to a lack of proper treatment and care. Many residents suffer from malnutrition and are left to lie in their own sweat, urine and stool before anyone thinks to check on them. As mentioned in an earlier post, nursing homes are too often understaffed, which only invites the prevalence of negligence. Consequently, residents suffer injury, fall ill, or even die from these easily preventable sores.

    Not Just Physical Trauma

Betrayed by their own bodies and unable to move, bedridden residents are at the absolute mercy of the nursing home staff to care for them and assist them with basic needs like eating, stretching and going to the bathroom. They no longer have control over their diet, their hygiene, or movement. Many feel like more of a burden than a person, and as a result of their condition, they suffer from depression, anxiety, and loss of self-esteem. Consequently, negligent care resulting in the development of pressure sores only worsens if not causes psychological trauma, as residents are left with festering sores, completely unable to save themselves or their dignity.

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