Revisions to Pressure Injury Nomenclature (Formerly Known as Pressure Ulcers)

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The National Pressure Ulcer Advisory Panel (NPUAP) recently announced a change in terminology and an update on the staging of pressure injury. The long-used term “pressure ulcer” has been revised to “pressure injury.” This change in terminology was considered to be a more accurate way to describe pressure injury to intact as well as nonintact skin and better reflect the etiology of pressure-related skin damage. New changes include, but are not limited to, use of Arabic numerals for stage designation, and revision of the definition of an unstageable pressure injury to remove “depth” and include the word “extent.” The rationale behind this terminology change was to characterize tissue injury that cannot be confirmed because it is obscured by slough or eschar.1,2 These nomenclature revisions have not affected evidence-based management guidelines. Please refer to the summary of the process and key changes in the November/December 2016 issue of the Journal of Wound, Ostomy and Continence Nursing.2
Nurses certified by the WOCNCB are recognized for their clinical expertise and evidence-based skill set. A major component of developing and maintaining that expertise involves keeping active in specialty trends and changes and adapting clinical practice to reflect current clinical guidelines. Several regulatory agencies, along with national and international clinical societies, have adopted the NPUAP revised pressure injury nomenclature including the WOCN Society.3 In keeping with the high standards of our clinical practice, the WOCNCB-certified nurse must be aware of the updated pressure ulcer/injury staging system and integrate it into their daily practice. These terminology changes take time to become common practice (and not all professional wound societies have adopted this new terminology); thus, the Certified Wound Care Nurse must be fluent in both sets of terminology. The NPUAP acknowledged that since pressure injury treatment was not affected by the revised staging system, organizations may incorporate these changes during regular policy, practice, and electronic health record updates. 3
The WOCNCB certification examinations are written to reflect current specialty practice within a broad range of care settings, based on current clinical evidence and accepted best practices. In preparing for initial certification, and especially when recertifying by examination, test takers need to be able to apply their knowledge of pressure injury staging and terminology when answering exam questions. During the transition to the new system, old terminology may occur on examinations until the current testing cycle is completed.
Successful specialty certification requires adequate testing preparation.4 Test takers should pay careful attention to key principles of practice. For example, when responding to questions related to staging and topical management of pressure injuries, the test taker must be able to apply principles of wound bed preparation (ie, necrotic tissue debridement needed to create a clean wound bed).2,5 Other simple, and effective, test preparation strategies include developing a study plan based upon the topics listed on the exam content outline with special focus on topics you are least familiar with and planning a regular study schedule to build comfort and confidence in these topics. Joining a study group and completing practice questions that provide rationale feedback are other effective study strategies. Computerized practice testing such as the WOCNCB's self-assessment examination questions has been shown to be effective in successful examination preparation.6 The WOCNCB has also developed flash cards in each of the specialties. Each card includes a practice examination question (or item) built from the detailed content outline and an explanation or rationale for correct and incorrect answer choices.
1. National Pressure Ulcer Advisory Panel.
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