Guest Editorial: Advancing the Science of Pressure Ulcer Prevention

  In August 2007, the Center for Medicare and Medicaid Services (CMS) endorsed a policy of nonpayment for Stage III and Stage IV hospital-acquired pressure ulcers effective October 2008.¹ Policy has an interesting way of shaping both science and practice. Undoubtedly, this new CMS ruling will be a stimulus for intensifying prevention practice and developing new approaches for systematically monitoring the effectiveness of prevention efforts. However, we hope it will have the added effect of advancing the science of pressure ulcer prevention.

  The science of pressure ulcer prevention, like medicine and nursing, is a practical one. The focus of practical sciences is to develop and structure knowledge about things that are doable^2,3 — eg, curing a disease, promoting patient self-care, preventing pressure ulcers. Thus, the aim of practical sciences might be understood as one of developing responsible descriptions and explanations (conceptual models or theories) about things that are doable. When it comes to the science of pressure ulcer prevention, the focus seems to be on describing and explaining three doable things: 1) identifying who is at risk for getting pressure ulcers, 2) designing appropriate prevention plans, and 3) effectively implementing prevention interventions. However, what unifying conceptual model or theory drives our investigation of these prevention activities?

  Maritain² maintains that practical sciences have both theoretically practical and practically practical components. The theoretically practical component presents the conceptual features of the science in the form of conceptual models and/or theories. The practically practical component specifies things to be done under specific conditions. To date, greater attention has been given to developing the practically practical features of the science of pressure ulcer prevention (eg, how to assess for risk, how to offload pressure) with virtually no attention given to developing the theoretically practical features of the science. In other words, we seem to be theory light.

  Having a theory of pressure ulcer prevention might accelerate the pace at which systematic investigation leads to discovering the principles and laws that govern pressure ulcer prevention activities, as well as to understanding the barriers to engage in these activities. However, when it comes to theory development, the questions Where should we start? and How do we proceed? are daunting. It may be worthwhile to first identify features common to all “prevention situations” (such as patients at risk, risk factors, prevention agents, and environments of care), the interrelationships among these features, and the impact of each on the doable components of prevention — ie, risk assessment, prevention planning, and implementation of prevention interventions. Assuming this recommendation gets us off to a good start on theory development, we are still left to address the most important question: Who will do it?

1. Medicare program: changes to the hospital inpatient prospective payment systems and fiscal year 2008 rates. Fed Regist. 2007;72:47379–47428.

2. Maritain J. The Degrees of Knowledge, translated under the supervision of Gerald B. Phelan. New York, NY: Charles Scribner & Sons:1959:456 – 464.

3. Wallace WA. Essay XIII: Being scientific in a practice discipline. In: Wallace WA. In a Realist Point of View: Essays on the Philosophy of Science, 2nd Edition. Lanham, Md: University Press of America;1983.