Data-Based Models of How Pressure Ulcers Develop in Daily-Living Contexts of Adults With Spinal Cord Injury

Clark FA, Jackson JM, Scott MD, Carlson ME, Atkins MS, Uhles-Tanaka D, Rubayi S. Data-based models of how pressure ulcers develop in daily-living contexts of adults with spinal cord injury.ObjectiveTo examine the daily-lifestyle influences on the development of pressure ulcers in adults with spinal cord injury (SCI).DesignQualitative investigation using in-depth interviewing and participant observation.SettingParticipants were studied in their homes and other naturalistic contexts.ParticipantsTwenty men and women of diverse ethnicities with paraplegia or tetraplegia who were recruited at a pressure ulcer management clinic in a large rehabilitation facility.InterventionsNot applicable.Main Outcome MeasuresDetailed descriptive information pertaining to the development of recurring pressure ulcers in relation to participants’ daily routine and activity, personal choices, motivating influences, lifestyle challenges, and prevention techniques and strategies.ResultsThe daily-lifestyle influences on pressure ulcer development in adults with SCI can be described through various models that vary in complexity, depending on whether they incorporate individualization, interrelations among modeled elements, situational specificity, and/or temporal comprehensiveness. Ulcers are most likely to develop when a person with a relatively high-risk background profile is exposed to an equilibrium-disrupting change event that culminates in a specific pressure ulcer risk episode.ConclusionsThe results underscore the significant degree of complexity and individualization that characterize the emergence of pressure ulcers in daily-life contexts. Prevention efforts should therefore incorporate attention to the unique constellation of circumstances that comprise a person’s everyday life.