Protect the skin before it breaks
A practical guide to pressure-injury prevention, early recognition and nursing care.
A patient admitted with a stroke may be unable to turn. Another patient can walk but spends most of the day sitting because movement hurts. Both need a thoughtful pressure-care plan. Prevention starts with noticing what the person cannot do comfortably and arranging help before skin damage develops.
This guide focuses on adult nursing care. Use it for learning alongside your facility’s current policy, patient-specific care plan and supervised clinical training.
1. Understand what you are preventing
Pressure injuries, also called pressure ulcers or bedsores, involve damage to skin or underlying tissue. Areas over bones—such as the sacrum, heels, hips and elbows—are vulnerable. Limited movement, reduced sensation, poor circulation, previous pressure damage and serious illness increase concern. A person does not have to be elderly to be at risk.
Early damage may appear as persistent discolouration, unusual warmth, hardness, softness or pain. On dark skin, obvious redness may be absent: compare the area with nearby skin and listen when the patient describes tenderness or a change in how it feels. Do not wait for an open wound before taking action. NHS overview.
2. Turn assessment into a useful plan
A risk score is only useful when its findings change care. Record whether the patient can reposition independently, whether movement causes pain, whether sensation is reduced, and what assistance is needed. Check pressure areas with consent and privacy, and review the assessment when the patient’s condition changes.
NICE guidance, summarised by the Royal College of Physicians, supports an individual plan based on skin findings, mobility, additional pressure relief, other conditions and patient preferences. Appropriate pressure-redistributing surfaces and assistance with movement form part of that plan. Read the guideline summary.
3. Make repositioning achievable
Agree and document an individual repositioning schedule using the patient’s risk, skin response, tolerance and local guidance. Arrange the staff and equipment required to move safely; avoid dragging the patient across the bed. Check comfort and alignment afterwards. A pressure-redistributing mattress supports prevention but does not remove the need to assess movement and skin.
For example, a patient may avoid turning because of postoperative pain. A useful nursing response is to discuss pain relief with the team, coordinate the move when the patient is more comfortable, and record whether the revised approach worked. Simply writing “refused turning” does not explain the barrier or the help offered.
4. Include moisture, nutrition and teamwork
Pressure prevention involves more than a turning chart. Skin assessment, risk assessment and an individual care plan need to work together. Involve the wider team when reduced intake, continence problems, equipment needs or difficulty moving are identified. Explain the plan to the patient and, with permission, to carers. AHRQ’s prevention toolkit emphasises coordinated, repeated care tailored to the individual. AHRQ prevention toolkit.
In a busy ward, make responsibilities visible: who is helping with repositioning, who is following up the requested mattress, and who will review the skin concern? If equipment is unavailable, escalate the gap and document the interim plan agreed by the team. A request alone is not evidence that the patient received the intervention.
5. Respond when you find a concerning area
Relieve pressure from the affected site, document the location and findings, and obtain prompt clinical or wound-care review. Worsening pain, pus, fever or hot and swollen surrounding skin require urgent assessment. Treatment depends on the nature and severity of the damage; avoid choosing a dressing solely because it is available on the trolley. Symptoms and treatment guidance.
6. Document care so the next nurse can continue it
A useful entry records the assessment, assistance provided, patient response, escalation and review plan. Avoid vague statements such as “pressure areas attended to.” Use the patient’s actual findings and your facility’s approved terminology.
Example documentation structure
Assessment: Site, appearance, discomfort and ability to reposition.
Action: Position change, equipment used and referrals or escalation.
Response: Comfort and tolerance following care.
Next review: Timing and the person responsible.
This is a learning template, not a completed patient record. Never copy findings that you did not assess.
Your end-of-shift check
- Have new skin concerns been assessed and handed over?
- Does the patient have the assistance and equipment specified in the plan?
- Were barriers such as pain or discomfort addressed?
- Is the next review clear to the incoming nurse?
Sources: NHS pressure-ulcer information; Royal College of Physicians summary of NICE CG179; AHRQ pressure-ulcer prevention toolkit, linked above. Educational content; follow current local protocols and individual clinical assessment.