By Neesha Oozageer Gunowa, PhD Candidate Oxford Brookes University @ne55hao

STOP Pressure Ulcer Day is a global annual event occurring every 3rd Thursday in November.  This year the event is taking place on the 19^th November where industry, healthcare professionals, the public and media come together to bring to light the topic of pressure ulcers.  This blog is not only to highlight the STOP pressure ulcer day but to also address an often forgotten component of the topic, people with darker skin tones and the presentation of pressure ulcers.

Pressure ulcers are costly both for organisations and individuals ^1,2.  Organisations in the UK have to bear the burden of treatment costs whilst patients have had to deal with the physical and physiological toll.  However, people with darker skin tones are disproportionately affected by more severe pressure ulcers³.  It remains unclear to the cause of this disparity however upon further exploration there is an indication that empirical research dismisses people with darker skin tones due to the difficulties of identifying early signs of pressure ulceration.  The Black Lives Matter movement reminds us this omission forms part of structural racism and needs to be addressed.

With nurse education drawing on evidence based information it is important to consider if nurse educators are bearing in mind areas which have not be explored in significant detail due to whiteness being the norm.  In a recent publication⁴ in the Journal of Clinical Nursing written by senior academics the authors emphasise that nurse academics only briefly acknowledge pressure damage among people with darker skin tones in the classroom.  This tokenistic approach to inclusion may appear to be an omission due to a lack of evidence however the impact on the next generation of nurses leads to serious consequences and inequities for people with darker skin tones.

The assumption that words such as redness, mottling and discoloration infer visual skin changes may be viewed as personal ignorance of skin changes among people with darker skin tones.  But, we as nurse academics and clinicians need to question the underlying meaning of this colour blind approach and emphasis on white centricity.  We need to move forward in our thinking and delivery of care to question our practice, research and education.  We need to empower and encourage nurses to speak up about inequities in healthcare.  By acknowledging that the visual identification of pressure ulcers among people with darker skin tones may not always be apparent we highlight a type of inequity currently being faced.

References

1. Guest, J.F., Vowden, K., Vowden, P. (2017) The health economic burden that acute and chronic wounds impose on an average clinical commissioning group/health board in the UK. Journal of Wound Care. 26 (6). doi: https://www.magonlinelibrary.com/doi/full/10.12968/jowc.2017.26.6.292
2. Jackson, D., Durrant, L., Hutchinson M., Ballard, C., Neville, Usher, K. (2017) Living with multiple losses: Insights from patients living with pressure injury, Collegian.
3. Oozageer Gunowa, N., Hutchinson, M., Brooke, J., Jackson, D. (2018) Pressure injuries in people with darker skin tones: A literature review. Journal of Clinical Nursing, 27 (17-18): 3266-3275. doi: 10.1111/jocn.14062
4. Oozageer Gunowa, N., Brooke, J., Hutchinson, M., Jackson, D. (2020) Embedding skin tone diversity into undergraduate nurse education: Through the lens of pressure injury. Journal of Clinical Nursing. 29: 4358– 4367. doi: https://doi.org/10.1111/jocn.15474