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Pressure Ulcers: What Are the Implications?

Spear, Marcia DNP, ACNP-BC, CWS, CPSN

doi: 10.1097/PSN.0b013e3182a57622
Departments: Wound Care Management

Pressure ulcers are not a new phenomenon. Their occurrence was noted as far back as the 17th century BC in the oldest known medical document, the Edwin Smith Papyrus. In 2013, pressure ulcers remain a significant health care problem in spite of better assessment tools, new technologies that reduce pressure and aid in the movement of individuals to eliminate shearing and friction, and a new Centers for Medicare and Medicaid Services (CMS) ruling that eliminates hospital reimbursement when a Stage III or Stage IV pressure ulcer is hospital acquired. Traditionally, the prevention and treatment of pressure ulcers have been recognized as more of a nursing responsibility. Florence Nightingale, in her book Notes on Nursing: What It Is and Is Not, wrote about the responsibilities and duties of caregivers to prevent pressure ulcers. “If a patient is cold, if a patient is feverish, if a patient is faint, if he is sick after taking food, if he has a bed-sore, it is generally the fault not of the disease, but of the nursing” (Taylor, 1994). There may still be some truth to this statement but the implications expand beyond the quality of the nursing care. Today, it is viewed as a health care community problem with each member being a stakeholder. The purpose of this article was to discuss implications of pressure ulcers.

Marcia Spear, DNP, ACNP-BC, CWS, CPSN, received her Doctor of Nursing Practice from Vanderbilt University School of Nursing. She is faculty at both the School of Medicine and the School of Nursing at Vanderbilt University. She has more than 15 years of experience in plastic surgery and wound care and is presently working as a nurse practitioner and certified wound specialist for the Department of Plastic Surgery at Vanderbilt University Medical Center.

Address correspondence to Marcia Spear, DNP, ACNP-BC, CWS, CPSN, Department of Plastic Surgery, Vanderbilt University Medical Center, S-2221, Medical Center North, Nashville, TN 37232 (e-mail:

The author reports no conflicts of interest.

Copyright © 2013 by American Society of Plastic Surgical Nurses