Nursing Homes Must Increase Training of Non-Licensed Nursing Staff in Pressure Ulcer Prevention

Under California Health and Safety Code Section 1276.5, skilled nursing facilities are required to provide at least 3.2 nursing hours per patient, per day. The “nursing hours” include only the hours work performed by direct caregivers, which include not only registered nurses and licensed vocational nurses, but also aides, orderlies or certified nursing assistants.

In long-term care settings, especially nursing homes, a high proportion of these certified but non-licensed aides or nursing assistants–non-licensed care providers (NLCPs)–provide the majority of personal care to residents, including transfer, repositioning, and skin care that are necessary for pressure ulcer (pressure sore or bedsore) prevention.

The problem with nursing homes primarily relying on NLCPs for daily personal care is that NLCPs who have the most contacts with the residents lack the knowledge and skills necessary to prevent or identify pressure ulcers. Studies show that long-term care facilities’ training programs and implementation of pressure ulcer prevention protocols primarily involve licensed nurses an not the NLCPs who actually provide a majority of the care, and moreover, many nursing homes even lack established pressure ulcer prevention strategies, guidelines or protocols.

Against this backdrop, the authors of a recently published article titled “A Pressure Ulcer Prevention Programme Specially designed for Nursing Homes: Does It Work?”, published in the August 2011 volume of the Journal of Clinical Nursing conducted an empirical study on a pressure ulcer prevention program specially designed for nursing homes. This program adopted a more structured pressure ulcer risk assessment method and launched the prevention interventions that involved all types of care staff. Notably, it included a separate training course for NLCPs as opposed to licensed nurses and required more involvement from NLCPs in the pressure ulcer prevention protocol.

Twelve weeks after the training and implementation of the protocol, the result showed a statistically significant improvement: both the pressure ulcer prevalence rate and incidence rate decreased from 9% to 2.5% and from 2.5% to 0.8%, respectively. The study results revealed that after the training course, NLCPs were better equipped with the necessary knowledge and skills to prevent pressure sores and were motivated to minimize the risk factors. NLCPs understood that their everyday tasks, such as lifting and transferring residents, were relevant to pressure ulcers and thus they tried to minimize friction and shear force on residents. They were also able to identify and report stage one pressure ulcers–skin redness–to licensed nurses. The Licensed nurses were then able to conduct structured supervision and monitoring of NLCPs, thereby decreasing the risk of developing a pressure ulcer to a higher stage.

The study concludes that a feasible and acceptable pressure ulcer prevention program for nursing homes can be developed, and such a program can motivate NLCPs to improve their performance of pressure ulcer prevention care and increase communication and cooperation amongst all care staff to effectively prevent and treat pressure ulcers. The increased NLCPs’ awareness levels and compliance to pressure ulcer prevention protocols were the main factors that reduced the prevalence and incidence rates of pressure ulcers in the nursing homes studied.

Early detection of stage one pressure ulcers and their appropriate management amongst different types of care staff are crucial for the well-being of nursing home residents. More developed pressure ulcers not only cause more pain but also slow recovery from a morbid condition and require prolonged hospital care. If you have a loved one in a California nursing home, stay involved with the nursing staff and demand that they immediately notify you of any changes in condition. Speak with the nursing staff and make sure not only that they are appropriately trained in pressure sore prevention and detection, but also that they are putting their protocols into practice.


If your loved one has suffered from pressure ulcers because a nursing home in Alameda, San Leandro, Hayward, Richmond, or Pleasanton, California failed to provide adequate care to prevent or treat them, please contact us today so that we can help protect your loved one’s best interests and hold the responsible parties accountable.