Apple P.I.E a Pressure Injury Explanation Tool

Patricia Turner, RN BSN CWS CWOCN, Nursing, Medline Industries, hopatcong, NJ
Recent 2016 NPUAP changes to the pressure injury definition and to the staging definitions, brings to the forefront the importance of accurate assessment and staging.  Accuracy is important because of the clinical implications of inaccuracy and also because of the financial implications of various stages of facility acquired pressure injuries to those facilities. The NPUAP staging system gives descriptive definitions for each stage of pressure injuries.  It may be difficult to apply that theory to the application of practice in assessing and staging appropriately.  This may be especially true with novice wound care clinicians.

Adult learning styles are more visual in nature.  Principles of adult learning include self-direction and internal motivation.  Adults bring to the learning process experience and past knowledge.  In addition to the information available through the NPUAP and  WOCN, finding an easy, simple reference and educational tool for in-servicing and reviewing the NPUAP pressure injury staging system can be challenging.

Utilizing adult learning principles, an apple analogy was developed to help identify the various pressure injury stages and levels of tissue involvement. The “Apple P.I.E” Pressure Injury Explanation Staging Educational Tool gives comparisons and pictures for quick and easy evaluations.  For example, a Stage 4 pressure injury, which involves loss of epidermis and dermis, is into the subcutaneous tissue and involves underlying structure, is equated to an apple with a large bite out of it, showing the skin layers are gone, it is into the white part of the apple, and the apple’s core, or structure, involved. 

For all levels of staff, this analogy is a simple, effective way to teach the NPUAP staging definitions, and can assist the WOC nurse or anyone responsible for educating on Pressure Injury Staging.

The “Apple P.I.E” concept was originally known as “Apples to Ulcers” and its content is patent pending.