Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Definition of Terms

  • Alternating Pressure
  • Clinical Practice Guidelines or Best Practice Guidelines
  • Consensus
  • Education Recommendations
  • Envelopment
  • Family
  • Friction
  • Immersion
  • Incidence of Pressure Ulcer
  • Interdisciplinary
  • Interface Pressure (Tissue)
  • Low Air Loss
  • Meta-analysis
  • Offload
  • Organization and Policy Recommendations
  • Overlay
  • Practice Recommendations
  • Pressure (Interface Pressure)
  • Pressure Redistribution:
  • Pressure Ulcers
  • Prevalence of Pressure Ulcer
  • Prevalence Study
  • Randomized Controlled Trials
  • Stakeholder
  • Standard Hospital Mattresses
  • Support Surfaces
  • Active Support Surface
  • Reactive Support Surface
  • Shear
  • Systematic Review
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    Alternating Pressure 
    A feature of a support surface that provides pressure redistribution via cyclic changes in loading and unloading as characterized by frequency, duration, amplitude, and rate of change parameters” (NPUAP, 2006, p.4).

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    Clinical Practice Guidelines or Best Practice Guidelines
    are systematically developed statements (based on best available evidence) to assist practitioner and patient decisions about appropriate health care for specific clinical (practice) circumstances (Field and Lohr, 1990).

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    Consensus 
    is a process for making policy decisions, not a scientific method for creating new knowledge. At its best, consensus development merely makes the best use of available information, be that scientific data or the collective wisdom of the participants (Black et al., 1999).

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    Education Recommendations 
    are statements of educational requirements and educational approaches/strategies for the introduction, implementation and sustainability of the best practice guideline.

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    Envelopment 
    The “ability of a support surface to conform to irregularities in the body” (NPUAP & EPUAP, 2009, p. 127).

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    Family 
    is whomever the person defines as being family. Family members can include: parents, children, siblings, neighbours, and significant people in the community.

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    Friction 
    “The resistance to motion in a parallel direction relative to the common boundary of two surfaces.” (National Pressure Ulcer Advisory Panel, 2007, p.124).

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    Immersion 
    The “depth of penetration (sinking) into a support surface” (NPUAP & EPUAP, 2009, p. 127).

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    Incidence of Pressure Ulcer 
    New pressure ulcer cases appearing during a specified period in the “at risk” population identified in the prevalence survey. For instance, a surgical nursing unit that had admitted 100 patients over a period of a month and showed documentation of 10 ulcers would have an incidence rate of 10 per cent. Definition of quality improvement purposes may take into account all new occurrences even if it is a multiple occurrence during the time-frame for an individual. For example, if five of the 10 cases on the surgical unit had two ulcers during the one-month period, the incidence rate would be 15 per cent. It is important to make the formula used explicit (RNAO, 2007).

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    Interdisciplinary 
    is a process where health care professionals representing expertise from various health care disciplines participate in the support of clients and their families in health care delivery.

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    Interface Pressure (Tissue) 
    “The force per unit area that acts perpendicularly between the body and a support surface. This parameter is affected by the stiffness of the support surface, the composition of body tissue, and the geometry of the body being supported” (NPUAP & EPUAP, 2009, p. 125).

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    Low Air Loss 
    A series of interconnected woven fabric air pillows that allow some air to escape through the support surface. The pillows can be variably inflated to adjust the level of pressure relief (RNAO, 2007).

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    Meta-analysis 
    is the use of statistical methods to summarize the results of independent studies, therefore providing more precise estimates of the effects of health care than those derived from the individual studies included in a review (Alderson, Green & Higgins, 2004).

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    Offload 
    Removal of pressure from an area and spreading it over a larger area away from the bony prominence.

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    Organizationand Policy Recommendations 
    are statements of conditions required for a practice setting that enables the successful implementation of the best practice guideline. The conditions for success are largely the responsibility of the organization, although they may have implications for policy at a broader government or societal level.

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    Overlay 
    An “additional support surface designed to be placed directly on top of an existing surface” (NPUAP & EPUAP, 2009, p. 125).

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    Practice Recommendations 
    are statements of best practice directed at the practice of health care professionals that are ideally evidence-based.

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    Pressure (Interface Pressure) 
    is the force per unit area that acts perpendicularly between the body and the support surface. It is affected by the stiffness and thickness of the support surface, the composition of the body tissue, and the geometry of the body being supported (AHCPR, 1994).

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    Pressure Redistribution: 
    Pressure Reducing Surfaces are surfaces that lower the interface pressure as compared to a standard hospital mattress or chair surface, but do not consistently reduce pressure to less than capillary closing pressure (Wound, Ostomy and Continence Nurses Society, 1987).
    Pressure Relieving Surfaces are surfaces that consistently lower interface pressure below capillary closing pressure (WOCN, 1987). Capillary closing pressure is the amount of pressure required to close capillaries, impairing blood flow to tissue and resulting in tissue anoxia and eventual cell death. It is often measured to be between 28-32 mmHg in healthy individuals. The amount of pressure required decreases to 12 or lower in compromised individuals.

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    Pressure Ulcers 
    are any lesions caused by unrelieved pressure that results in damage to underlying tissue. Pressure ulcers usually occur over a bony prominence and are staged to classify the degree of tissue damage observed.

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    Prevalence of Pressure Ulcer 
    A cross-sectional count of the number of cases at a specific point in time. The rate includes all old and new cases during the defined prevalence period (e.g. 12 hours). The formula for prevalence is based on one ulcer per case, thus the highest stage of ulcer is counted on those with multiple ulcers. The results are expressed as a percentage of the total number of clients assessed (RNAO, 2007).

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    Prevalence Study 
    The number of cases of a disease in a population at a given point in time. This survey represents a “snapshot” of the pressure ulcer population. It measures the presence or existence of pressure ulcers (admitted and hospital acquired) on the day surveyed with the population that is currently being managed by an organization (RNAO, 2007).

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    Randomized Controlled Trials 
    are clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process.

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    Stakeholder 
    is an individual, group, or organization with a vested interest in the decisions and actions of organizations who may attempt to influence decisions and actions (Baker et al., 1999). Stakeholders include all individuals or groups who will be directly or indirectly affected by the change or solution to the problem.

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    Standard Mattresses 
    A non-pressure reducing institutional mattress usually constructed of cold foam with 10 to 20 per cent of the body being supported (Defloor et al., 2005).

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    Support Surface 
    Special beds, mattresses, mattress overlays or seat cushions for pressure redistribution (NPAUP & EPUAP, 2009).

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    Active Support Surface 
    “A powered surface with the capability to change its load distribution properties, with or without applied load” (NPAUP, 2007, p. 5).

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    Reactive Support Surface 
    “A powered or non-powered support surface with the capability to change its load distribution properties only in response to applied load” (NPAUP, 2007, p. 5).

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    Shear 
    “The force per unit area exerted parallel to the plane of interest” (NPAUP, 2007, p.127). Mechanical force that acts on a unit area of skin in a direction parallel to the body’s surface. Shear is affected by the amount of pressure exerted, the coefficient of friction between the materials contacting each other (i.e. how easily one surface slides over another), and the extent to which the body makes contact with the support surface (RNAO, 2007).

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    Systematic Review 
    is an application of a rigorous scientific approach to the preparation of a review article (National Health and Medical Research Centre, 1998). Systematic reviews establish where the effects of health care are consistent and research results can be applied across populations, settings, and differences in treatment (e.g., dose); and where effects may vary significantly. The use of explicit, systematic methods in reviews limits bias (systematic errors) and reduces chance effects, thus providing more reliable results upon which to draw conclusions and make decisions (Alderson, Green & Higgins, 2004).

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