Evidence indicates that peristomal skin complications (PSC) are a common problem for people with an ostomy and have serious implications on their overall health and quality of life. While there is evidence and documentation on the cause and effect of PSC, there is little written on the risk factors or on how to maintain peristomal skin integrity and prevent PSC. To address this gap, a panel of ostomy experts was convened to conduct a process to reach an international consensus on PSC risk factors. A large-scale modified Delphi consensus-building process was conducted between September 2019 and October 2020. A total of 4,285 online survey responses were received from 36 countries across six continents. The result was a consensus focused on the prevention of PSC and on the individual patient risk factors healthcare providers should consider when determining the best pouching system and care plan for ostomy patients. The consensus supported the development of a PSC risk factor model. The model was subsequently ratified in October 2020. The purpose of the model is to help guide healthcare providers in assessing the risk factors for developing a PSC for each patient and ultimately guide healthcare providers to prevent skin damage, maintain healthy peristomal skin, and support the overall health, wellbeing and quality of life of ostomy patients.

Aims We investigated changes in pressure and shear force at the heel caused by elevating the head of the bed and after offloading pressure from the heel.

Methods Data on heel pressure and shear force were collected from 26 healthy individuals aged >30 years using a three-axis tactile sensor at each angle formed as the participants’ upper bodies were raised from a supine position. Data after pressure release of either the left or right foot were collected and compared.

Results The participants’ mean age was 45.1 (±11.1) years. Pressure and anteroposterior shear force on the heel increased with elevation. These increases were especially prominent when the angle of elevation was 30˚. In the subsequent 45˚ and 60˚ tilts, body pressure and shear force increased slightly but not significantly. Pressure and shear force were released by elevating the lower extremity each time the head of the bed was elevated. However, further elevations resulted in increased pressure and shear force, particularly lateral shear force. Pressure and shear force did not change significantly when the lower limbs were elevated.

Conclusion The recommended elevation of the bed head to no more than 30˚ yielded major changes. Elevating the leg relieved the heel of continuous pressure and shear force while increasing pressure and lateral shear force. Although leg elevation is an aspect of daily nursing care, it is important to investigate such nursing interventions using objective data.

Objective This study had two objectives. First, to understand and then describe the experiences of persons who inject drugs (PWID) and who use self-care treatment(s) to deal with resulting skin and tissue abscesses. Next, to understand and describe their journeys to and experiences with formal healthcare service provision.

Methods Semi-structured interviews were conducted with ten adults who have experience with abscesses, engage in self-care treatment(s), and utilise formal healthcare services in Nova Scotia, Canada.

Results Participants lived with abscesses and utilised various self-treatment strategies, including support from friends. Participants engaged in progressive self-care treatment(s) as the abscesses worsened. They reluctantly made use of formal healthcare services. Finally, participants discussed the importance of education. Moreover, they shared their thoughts in terms of how service provision could be improved.

Conclusions Participants described their lives, including their journeys to intravenous drug use. They also described the self-care treatments they used to heal resulting abscesses. They used these self-care treatments because of a reluctance to utilise formal healthcare services. From a quality improvement perspective, participants outlined suggestions for: 1) expanding hours of service at the community wound care clinic and the centre; 2) permitting pharmacists to include prescribing topical and oral antibiotics; 3) promoting abscess prevention education for clients and healthcare providers; and 4) promising practices for the provision of respectful care during emergency care visits.