Ayello Elizabeth A, Levine Jeffrey M, Langemo Diane, Kennedy-Evans Karen Lou, Brennan Mary R, Gary Sibbald R
Elizabeth A. Ayello, PhD, RN, CWON, ETN, MAPWCA, FAAN • Faculty • Excelsior College School of Nursing • Albany, New York • President • Ayello Harris & Associates, Inc • Copake, New York • President • World Council of Enterostomal Therapists • Co-Editor-in-Chief • Advances in Skin & Wound Care • Philadelphia, Pennsylvania Jeffrey M. Levine, MD, AGSF, CMD • Associate Clinical Professor of Geriatrics and Palliative Care • Icahn School of Medicine at Mount Sinai • New York, New York Diane Langemo, PhD, RN, FAAN • President • Langemo & Associates • Professor Emeritus and Adjunct Professor • University of North Dakota College of Nursing • Grand Forks, North Dakota Karen Lou Kennedy-Evans, RN, FNP, APRN-BC • Wound Consultant • Foothills Rehabilitation Center • Tucson, Arizona Mary R. Brennan, MBA, RN, CWON • Assistant Director for Wound and Ostomy Care • North Shore University Hospital • Manhasset, New York R. Gary Sibbald, MD, DSc (Hons), MEd, FRCPC (Med Derm), ABIM, FAAD, MAPWCA • Professor • Medicine and Public Health • University of Toronto • Toronto, Ontario, Canada • Director • International Interprofessional Wound Care Course and Masters of Science in Community Health (Prevention and Wound Care) • Dalla Lana School of Public Health • University of Toronto • Project Lead • ECHO Ontario, Wound & Skin Care • Previous President • World Union of Wound Healing Societies • co-Editor-in-Chief • Advances in Skin and Wound Care • Philadelphia, Pennsylvania.
Adv Skin Wound Care. 2019 Mar;32(3):109-121. doi: 10.1097/01.ASW.0000553112.55505.5f.
To synthesize the literature regarding skin injuries that are found in patients at the end of life and to clarify the terms used to describe these conditions.
This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.
LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education activity, you should be better able to:1. Define the terms used to describe pressure injuries and skin changes at the end of life.2. Discuss the concept of skin failure as applied to end-of-life skin injuries and implications for practice.
This article synthesizes the literature regarding the concepts of "terminal" skin injuries that are found in patients at the end of life, including Kennedy terminal ulcers, Skin Changes At Life's End, Trombley-Brennan terminal tissue injuries, and skin failure. Also included is a discussion of avoidable and unavoidable pressure injuries as defined and differentiated by the Centers for Medicare & Medicaid Services and the National Pressure Ulcer Advisory Panel. To help clarify the controversy among these terms, a unifying concept of "skin failure" that may occur with an acute illness, chronic illness, or as part of the dying process is proposed. This proposed concept of skin failure is etiologically different than a pressure injury, although pressure injury and skin failure can occur concomitantly. These proposed concepts require further research and validated diagnostic criteria. Consensus around appropriate terminology is essential to reduce confusion among stakeholders and ensure appropriate patient care.
综合关于临终患者皮肤损伤的文献，并阐明用于描述这些情况的术语。
本继续教育活动面向对皮肤和伤口护理感兴趣的医生、医师助理、执业护士和护士。
学习目标/成果：完成本继续教育活动后，你应能更好地：1. 定义用于描述临终时压力性损伤和皮肤变化的术语。2. 讨论应用于临终皮肤损伤的皮肤衰竭概念及其对实践的影响。
本文综合了关于临终患者中“终末期”皮肤损伤概念的文献，包括肯尼迪终末期溃疡、生命末期皮肤变化、特伦布利 - 布伦南终末期组织损伤和皮肤衰竭。还讨论了医疗保险和医疗补助服务中心及国家压力性溃疡咨询小组所定义和区分的可避免和不可避免的压力性损伤。为帮助澄清这些术语之间的争议，提出了一个可能在急性疾病、慢性疾病或作为死亡过程一部分时发生的“皮肤衰竭”统一概念。尽管压力性损伤和皮肤衰竭可能同时发生，但这个提议的皮肤衰竭概念在病因上与压力性损伤不同。这些提议的概念需要进一步研究和经过验证的诊断标准。围绕适当术语达成共识对于减少利益相关者之间的困惑并确保恰当的患者护理至关重要。
