A New Theoretical Model for the Development of Pressure Ulcers and Other Dependence-Related Lesions

  1. García-Fernández, F.P. 2
  2. Agreda, J.J.S 4
  3. Verdú, J. 1
  4. Pancorbo-Hidalgo, P.L. 3
  1. 1 Universitat d'Alacant

    Universitat d'Alacant

    Alicante, España

    ROR https://ror.org/05t8bcz72

  2. 2 Hospital Universitario de Jaén

    Hospital Universitario de Jaén

    Jaén, España

    ROR https://ror.org/02ecxgj38

  3. 3 Universidad de Jaén

    Universidad de Jaén

    Jaén, España

    ROR https://ror.org/0122p5f64

  4. 4 Universidad de La Rioja

    Universidad de La Rioja

    Logroño, España

    ROR https://ror.org/0553yr311

Journal of Nursing Scholarship

ISSN: 1527-6546

Year of publication: 2013

Volume: 46

Issue: 1

Pages: 28-38

Type: Article

DOI: 10.1111/JNU.12051 SCOPUS: 2-s2.0-84892894594 WoS: WOS:000329931700005 GOOGLE SCHOLAR

More publications in: Journal of Nursing Scholarship

Sustainable development goals


Objective: To review the risk factors included in pressure ulcer risk assessment scales and construct a theoretical model for identifying the etiological factors of skin ulcers, excluding those of systemic origin (e.g., venous, arterial, and neuropathic). Methods: Consensus study with expert panel (Delphi Method) based on a structured review of the literature. A search was conducted of the main databases between 1962 and 2009 with no language limitations. All descriptive or validation studies were included, but the grey literature was excluded. After identifying the risk factors in each scale, they were grouped into risk dimensions as a basis for constructing a new theoretical model. Results: Eighty-three risk factors were identified in the 56 scales reviewed, and the risk factors were then classified by the expert panel into 23 risk dimensions. These dimensions were used to construct a new theoretical model (middle-range theory) for chronic wound development that explains the production mechanism of seven types of lesion: moisture, pressure, friction, combined pressure-moisture, combined pressure-friction, multifactorial lesions, and coadjuvant factors. These lesions were generically defined as dependence-related injuries. Conclusions: Based on the classification of risk factors from the different scales into risk dimensions, a new middle-range theory was constructed that explains the production mechanism of seven dependence-related lesions considered to date as pressure ulcers. Clinical Relevance: The prevention and treatment of these lesions requires a correct diagnosis and differentiation of their cause and management of the risk dimensions involved. The type of lesion also influences the selection of local approach. © 2013 Sigma Theta Tau International.