Data-based models of how pressure ulcers develop in daily-living contexts of adults with spinal cord injury.

ABSTRACT

OBJECTIVE: To examine the daily-lifestyle influences on the development of pressure ulcers in adults with spinal cord injury (SCI). DESIGN: Qualitative investigation using in-depth interviewing and participant observation. SETTING: Participants were studied in their homes and other naturalistic contexts. PARTICIPANTS: Twenty men and women of diverse ethnicities with paraplegia or tetraplegia who were recruited at a pressure ulcer management clinic in a large rehabilitation facility. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Detailed 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. RESULTS: The 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. CONCLUSIONS: The 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.