From studies on Egyptian mummies, we know that tissue harm* has been around for over 5000 years. So why, when it can be prevented, is it still occurring in patients confined to bed?
Interestingly, as noted in Siobhan McCoulough’s ‘History of Pressure Ulcers’, treatments today still reflect good nutrition, pain relief and debridement first identified by surgeon Ambroise Paré (1510- 1590) and advice to relieve pressure by Charles Brown-Sequard (1817-1894). NICE for example, still gives the explanation for care homes that, “a pressure ulcer happens when an area of skin and the tissues underneath it are damaged by being under such pressure that the blood supply is reduced. They tend to occur when people spend long periods in a bed or chair.”
Sadly, the advancement of knowledge about how tissue harm occurs and therefore how to prevent them varies massively to the treatment-led approach taken by organisations and practitioners actually caring for patients.
This is partly due to society and healthcare wanting to adopt Newton’s easy-to-understand linear systems to order life and processes to give a semblance of predictability. As Einstein proved, rather than being linear, most are actually complex. Anticipatory design, as advocated by Buckminster-Fuller, therefore looks to understand and manage the external environment so that it works with nature and the human body.
Recent research has advanced our understanding of what happens in the human body when resting, moving and stabilising. It has furthered understanding on what happens under the skin, the role of fascia and the five level wound model that explains what happens before, during and after a tissue harm incident. Our research into force-related tissue damage identified unobvious causes that link both biomechanical and biological processes at several organisational (pathological) levels together with external inbed events.
By using both these and our understanding of biotensegrity, we can prevent such incidents by matching a patient’s external environment to their innate, protective environment. 2018 research by Bordoni, Lintonbon and Morabito reconsiders the Biotensegrity model by explaining the roles of solid and liquid fascia to protect the human body allowing it to move, rest and stabilise. Our own recent research, with renowned microbiologist, Harm Smit progresses this to a model of the structural elements of the biomechanical system of soft tissue. This determined that to prevent unnecessary harm at any point in the body, the protective system requires two key attributes: firstly, it must function in a continuous fashion from micro to macro (and vice versa) and secondly, it has to be robust; function under all circumstances.
At Phil-e-Slide, we have always based our products on the latest research, to ensure that our inbed care management system work for the patient confined to bed so they work intuitively to enable safe movement and rest whilst preventing tissue harm. They are designed to work together to achieve the correct interface and sliding synergies so that patients move/ can be moved by working WITH rather than against gravity to avoid tissue loading when reorienting a patient’s body mass on a resting surface.
How this is achieved is explained more fully here. In summary, it uses a programmable, multi-tilt (horizontal, angular and perpendicular) bed frame; a hybrid mattress incorporating foam encased in air (with step-up and step-down facility); an overhead hoist; plus a Biotechsis® mattress cover, Biotechsis® sheets and Biotechsis® pillowcase. These allow any external forces generated to be managed in a controlled manner, because regulating their rate and effect avoids any resting surface-patient skin interface “force focal spots”. We call this the safety dance.
This way of working with gravity on the correct interfaces and support surfaces means that potential tissue loading is avoided as it uses and complements the body’s natural, internal prevention mechanisms for maintaining tissue integrity. Instead, the patient’s internal homeostatic and tensegrity mechanisms are used to prevent tissue/ cell recovery thresholds from being exceeded. In the words of Oprah Winfrey, “Real integrity is doing the right thing, knowing that nobody’s going to know whether you did it or not” – to us it is essential that tissue integrity and tissue harm prevention should be a given, for each and every patient.
Let’s make sure 2021 is the year when we can finally say goodbye to the Egyptian curse.
References:
• https://oska.uk.com/journal/the-history-of-pressure-ulcers
• https://www.nice.org.uk/about/nice-communities/social-care/quick-guides/helping-to-prevent-pressure-ulcers
• https://thesystemsthinker.com/making-the-jump-to-systems-thinking/
• https://youtu.be/eW0lvOVKDxE
• https://functionalfascia.com/whats-it-all-about/fascia-facts/
• https://www.wounds-uk.com/journals/issue/548/article-details/five-level-model-wound-analysis-and-treatment
• http://www.biotensegrityarchive.org/styled/biotensegrity.html
• https://www.linkedin.com/posts/phil-strong-6b606668_a-much-needed-paradym-shift-in-thinking-activity-6589871727319240705-N1ie
• https://www.cureus.com/articles/29258-structural-elements-of-the-biomechanical-system-of-soft-tissue
**Tissue harm is our preferred term. Such injuries are also widely known as force-related tissue damage, bed sores, pressure ulcers, pressure sores etc.*
