Case Study: Dying with a Stage IV Pressure Ulcer

• Published in: The American journal of nursing Vol. 109; no. 1; pp. 40 - 49
• Main Authors: Kayser-Jones, Jeanie S., Beard, Renée L., Sharpp, Tara J.
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-01-2009; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Aged, 80 and over; CE Continuing Education; Certified nursing assistants; Ethical codes; Food; Humans; Male; Nurse-Patient Relations; Nurses; Nursing; Nursing Care - ethics; Nursing Homes; Pain; Pain - etiology; Pain management; Pressure ulcer; Pressure Ulcer - etiology; Pressure Ulcer - nursing; Pressure Ulcer - pathology; Pressure ulcers; Quality of care; Quality of Health Care; Registered nurses; Staffing; Terminal illnesses; Virtue ethics; Wound healing
• ISSN: 0002-936X; 1538-7488
• DOI: 10.1097/01.NAJ.0000344036.26898.e3

This 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. [PUBLICATION ABSTRACT]