Institutional members access full text with Ovid®

Share this article on:

Case Study: Dying with a Stage IV Pressure Ulcer

Kayser-Jones, Jeanie S. PhD, RN, FAAN; Beard, Renée L. PhD; Sharpp, Tara J. PhD, RN

AJN The American Journal of Nursing: January 2009 - Volume 109 - Issue 1 - p 40–48
doi: 10.1097/01.NAJ.0000344036.26898.e3

This case study of the care received by a terminally ill nursing home resident in his late 80s describes the many organizational and clinical factors that led to the progression of his pressure ulcer from stage II to stage IV. The patient suffered weight loss, an increase in tissue load, and deterioration of the wound and finally died in pain with a large stage IV pressure ulcer that exposed his coccyx. The authors examine the ethical aspects of the case and explore the ways in which inadequate staffing, staff education, and supervision contributed to insufficient help with meals, infrequent and improper repositioning, and unrelieved pain. To hear AJN editor-in-chief Diana J. Mason's audio interview of Jeanie S. Kayser-Jones, in which the coauthor discusses the ethical dilemmas she encountered while conducting research in this case, go to and click on "Podcasts."

The authors describe a case in which inadequate staffing, education, and supervision led to a worsening pressure ulcer and untreated pain in a nursing home resident—and the ethical questions that remained after his death.

Jeanie S. Kayser-Jones is a professor emerita at the University of California, San Francisco, School of Nursing. Renée L. Beard is a National Institutes of Health postdoctoral fellow in Gerontological Public Health at the University of Illinois at Chicago. Tara J. Sharpp is a Claire M. Fagin Postdoctoral Fellow at the proposed Betty Irene Moore School of Nursing at the University of California, Davis.

Contact author: Jeanie S. Kayser-Jones,

The research discussed in this article was funded by a grant (AG15806) from the National Institute on Aging, the National Institute of Nursing Research, and the National Cancer Institute. The authors wish to thank all who participated in the research, the residents, their families, and the nursing facility staff.

For more than 16 additional continuing nursing education articles related to the topic of ethics, go to

Case Study: Dying with a Stage IV Pressure Ulcer: Erratum

We inadvertently omitted the financial disclosure statement. This article should have included the following statement saying, "The authors of this article have no significant ties, financial or otherwise, to any company that might have an interest in the publication of this educational activity."

This erratum is published in the March 2009 issue of AJN.

Case Study: Dying with a Stage IV Pressure Ulcer: Erratum

In the continuing education (CE) article that was published in January, it was stated that the Minimum Data Set (MDS) form "must be completed within 48 hours of admission to a nursing home." In fact, the MDS for Medicare Part A residents must be completed within five days of admission. For residents who are on Medicaid, are private payers, or are insured by health maintenance organizations, it must be completed within 14 days. The day of admission counts as day 1 for all residents. This information affects CE test question #6, which will not be counted against test takers.

This erratum is published in the April 2009 issue of AJN.

© 2009 Lippincott Williams & Wilkins, Inc.