Royal College of Surgeons in Ireland
The Relationship between Nurses Assessment of Early Pressure Ulce.pdf (1.48 MB)

The Relationship between Nurses Assessment of Early Pressure Ulcer Damage and Sub Epidermal Moisture Measurement: A Prospective Explorative Study.

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posted on 2019-11-22, 18:19 authored by Gillian R. O'Brien

Studies have demonstrated the feasibility of using sub epidermal moisture measurement which rises in the inflammatory process, as a predictor of early pressure ulcer damage. Once identified, and prevention strategies are implemented or heightened, more severe pressure ulcer damage may be averted. This study aimed to explore the relationship between nurses’ assessment of at risk patients’ skin and the assessment of skin using sub epidermal moisture measurement. A descriptive prospective observational design was employed. Following ethical approval and written informed consent, data were collected daily for 4 weeks, from patients assessed as being at risk of pressure ulcer damage within an acute health care facility in Ireland. Data included nurses (n=372) documented assessment of the patient’s skin condition and researcher led sub epidermal moisture measurement over the sacrum and both heels. A total of 47 patients were included, 38.3 % (n=18) were male and 61.5% (n=29) were female, with a median age of 74.7 years. Of the population studied, 34% (n=16) developed signs of early pressure damage. The mean number of days for nurses to detect this damage was 5.0 (SD 5.15; max 11, min 3), whereas the mean number of days that it took sub epidermal moisture measurement to detect damage was 1.1 (SD 0.75; max 2, min 1). Correlations were low for the left heel (r=.23), medium for the right heel (r=.43) and strong for the sacrum (r=.65) between nurses’ visual assessment and sub epidermal moisture measurement. All patients with sustained elevated sub epidermal moisture levels went on to develop visual signs of pressure ulceration. However, importantly, sub epidermal moisture measurement identified early damage, on average, 3.9 days earlier than nurses’ assessment. Given that pressure ulcers develop from within the deeper tissues, knowing that early pressure ulcer damage is present can facilitate heightening of prevention strategies to avoid extension. This is of particular importance in clinical practice as the earlier that pressure ulcers can be detected; the earlier interventions can be implemented to prevent further extension, avoiding their associated morbidity and mortality.


First Supervisor

Professor Zena Moore


A dissertation submitted in part fulfilment of the degree of Master in Science in Nursing, Royal College of Surgeons in Ireland, Dublin 2015.

Published Citation

O'Brien GR. The Relationship between Nurses Assessment of Early Pressure Ulcer Damage and Sub Epidermal Moisture Measurement: A Prospective Explorative Study [Masters dissertation]. Dublin: Royal College of Surgeons in Ireland; 2015.

Degree Name

  • MSc Nursing

Date of award


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