University of Southern California Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy
Smaller text Bigger text Print this page
Home USC Rancho USC/Rancho Pressure Ulcer Prevention Project USC/Rancho Pressure Ulcer Prevention Project
About the Project People Articles
Home | Articles in depth |
Read the basics about this subject

"It Just Happened"

Sometimes when things go wrong, it's difficult to look back and find the cause. Other times, it can be disheartening to review mistakes that might have been made, or to wonder, "If only it had happened differently!" Sometimes declaring, "I don't know why, it just sort of happened," is a way of denying responsibility for a bad result. Sometimes it really isn't anyone's fault, but a reason can still be found on careful examination. This is true of pressure ulcers (which means the same thing as "pressure sores" or "bedsores"); even though some of our participants had skin breakdowns that they couldn't explain, it's possible that weighing the entire story might explain that there were understandable reasons why "it just happened."

A number of our participants believed that, as Aaron phrased it, pressure ulcers are "going to happen just as a cost of living your life." (both Chris and Mitch said similar things.) It is true that there are sometimes circumstances beyond a person's control that contribute to the formation of a pressure ulcer, but believing that ulcers "just happen" can be dangerous. Billy, for example, reported feeling fearful when he first saw the signs of a pressure ulcer, so he would delay going to a doctor, thinking there wasn't much he could do about it anyway, especially if the ulcer has been developing beneath the surface of his skin. Mitch said that "no matter how much [I] seem to take care of it, it just seems to get bigger." By thinking there's nothing that can be done to stop a pressure ulcer, a person misses out on the chance of getting prompt medical care that might stop it from growing into a serious Stage 3 or Stage 4 wound.

Another problem with the philosophy that pressure ulcers "just happen" is that it can result in underestimating how severe the ulcer truly is. Alley, Billy, Helen and Rachel all had pressure ulcers that they thought would just clear up like a scab or go away on its own, but for each of them, the ulcer got much worse. Pressure ulcers have to be taken seriously, but keep in mind that you have a lot of choices for how to deal with them. How you react can help clear up a pressure ulcer quickly, or stop it from getting so severe that it requires hospitalization or surgery. For example, if you spot a pressure ulcer early, when it is small, you can go to see your doctor right away and start treatment before the wound gets infected. And if you notice redness on your skin and keep pressure off the area for a day or two, that might be enough to stop a pressure ulcer from even happening!

While it is true that pressure ulcers can occur for a number of reasons, some of which are just beyond a person's control 1, it's also true that they usually can be prevented by the best possible knowledge about pressure ulcers and a healthy lifestyle, including good nutrition, exercise, avoiding smoking or alcohol or recreational drugs, and doing daily self-care activities meant to avoid pressure ulcers (like skin checks, keeping clean and dry, and doing pressure reliefs) 2. Some of our participants, like Robert, and even some doctors 3, believe that pressure ulcers are 100% preventable! And research has shown that having that kind of positive attitude and belief in your own abilities helps give you the confidence to form the habits you need to avoid pressure ulcers 4 5. You can do it!

1 Witkowski, J. A., & Parish, L. C. (2000). The decubitus ulcer: Skin failure and destructive behavior. International Journal of Dermatology, 39, (12), 894-896.

2 Krause, J. S., & Broderick, L. (2004). Patterns of recurrent pressure ulcers after spinal cord injury: Identification of risk and protective factors 5 or more years after onset. Archives of Physical Medicine and Rehabilitation, 85, 1257-1264.

3 Olshansky, K. (1994). Essay on knowledge, caring and psychological factors in prevention and treatment of pressure ulcers. Advances in Wound Care, 7, 64-68.

4 Tenn, L., & Dewis, M. E. (1996). An evaluation of a Canadian peer-driving injury prevention programme for high-risk adolescents. Journal of Advanced Nursing, 23, (2), 329-337.

5 Wichowski, H. C., & Kubsch, S. M. (1997). The relationship of self-perception of illness and compliance with health care regimens. Journal of Advanced Nursing, 25, 548-553.