The Role of Health Equity in PI Prevention and Management

Dr. Joyce Pittman:

Hello, I'm Joyce Pittman and I am a professor at the University of South Alabama. I am also a nurse practitioner, certified wound, ostomy, and continence nurse. I've been doing this for quite a while.

Health equity is a state where the individual has a fair and just opportunity to achieve their healthiest life. It's good to say, but CDC goes on and says that society, and I want to stop because it's not society, it's us. In order to achieve health equity, we need to address our historical and inherent biases first. Then we need to address those social determinants of health, economic, social, financial, all those things that we live in our community. And then we also need to address health disparities in care, and that's where pressure injuries come in. Because pressure injuries, for the most part, are preventable. Our care, though, related to pressure injuries has not been equitable, and we need to address that.

The challenges that clinicians encounter when they're talking about health equity and pressure injuries is, as I said, I've been a nurse and a WOC nurse for quite a while. When I went through my basic nursing education, we didn't talk about health disparities. We didn't talk about colors of your skin when you're doing a skin assessment. So we didn't learn what's the difference? How do you do a skin assessment on someone light skinned versus dark skinned? We just learned skin assessment and how to assess for erythema or redness on the skin. Well, how do you see redness in somebody who's very dark-skinned versus how do you distinguish between a pressure injury and a bruise on a light-skinned individual who maybe has some coagulant problems? So, we didn't learn it and we were raised or educated to be colorblind thinking that was fair, that's equal care. The problem is that's not equitable care. So that's one of the challenges, we don't know.

The other challenge, and I should have mentioned this one first is we are not aware. Many of us are raised in our bubble and of the elite or the privileged, and so we're not aware of many of the challenges that many individuals face, specifically people of color. The other thing is we don't have the tools that we need to do an equitable skin assessment, and we'll talk about that I think a little bit. But technology, we don't have those tools now, they're available but they're not in our practice. We haven't translated those into our practice. So those are some of the challenges I think that many of us face.

Our tools and technologies that are available, they're out there, let's say that. Are they available in practice? Not so much. But they're simple things. Turn on the lights when you walk in the room, that's a simple tool. Use your eyes. That means you need to do a thorough skin assessment. You need to ask the patient to turn over. You need to look at those specific bony prominences. The other tools, specifically technology, thermography is a big one now that's available. Subepidermal moisture measurement is another one that is available and has a lot of evidence, both of those have a lot of evidence to support their work. The problem is that they're not in our practice. In the literature, it says it takes up to 17 years for research to be implemented. I hope that's not the case with our current technology. We had a great talk, our first keynote speaker talked about artificial intelligence, and we were just thinking, that's fabulous, but is it available to us right now? It's coming. But we just need to figure out how to bring these technologies to fruition and bring them to our practice.

I hope the audience that comes to my session related to health equity and pressure injuries, I hope that they come out more aware of their own inherent heredity, injustices, and biases that maybe they're not even aware of. But I hope that they are taking a look and thinking, okay, how can I make a difference in my practice? What am I doing now that I need to change? What do I need to do to make my care more equitable to those that I serve? That's what I hope.