An Assessment of Cognitive Schema for Pressure Ulcer Staging

Although the skin is the largest organ of the body, skin integrity was rarely, if ever considered a fundamental aspect of patient care.  The development of a pressure ulcer was thought of as an unfortunate outcome during a patient’s hospitalization.  Today, they are considered a preventable occurrence of unnecessary harm.  So much so that the occurrences of pressure ulcers are now deemed a nursing sensitive indicator.

Recently, however, there has been a conflicting consensus regarding the accuracy of the current staging system available for nurses to use for staging pressure ulcers.  Clinicians indicate that there is little to no evidence that the current method of staging accurately represents the clinical progression of a lesion caused by pressure necrosis.  Doughty et al. (2006)

The purpose of this study is to understand the decision-making process of nurses in the staging of pressure ulcers.  Specifically, this study seeks to determine if there is a process that a nurse uses to stage a pressure ulcer and whether or not this process is systematic, standardized, and accurate.  Once the decision-making process is better understood, future research could be employed for the development, dissemination, and evaluation of a staging tool to assist nurses in more accurate staging of pressure ulcers.  This qualitative study will utilize cognitive evaluation methods to examine the schema, mental processes, and knowledge structure of nurses during a staging task.