Kennedy terminal ulcer : a retrospective chart review of ulcers in the hospice setting and educating providers and nurses on the importance of skin changes at life's end

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Montana State University - Bozeman, College of Nursing


The geriatric population is growing in the United States and caring for geriatrics can be complex. This population is at an increased risk for skin injury. There are some skin changes that are seen specifically at the end of life. One of the ulcers that can be seen at the end of life is the Kennedy Terminal Ulcer (KTU). This type of ulcer is a result of hypoperfusion to the skin. Currently, there is a limited amount of literature available on the KTU. Also, some nurses and providers are unaware of this type of ulcer. The purpose of this study was to gather data on pressure ulcer prevalence, characteristics and location in hospice patients. Sacral/coccyx ulcers identified after hospice admission were used as a proxy for the KTU to gather data on the average length of life after ulcer onset and prevalence. A retrospective chart review at a local hospice home was completed to gather data on pressure ulcers and the KTU over an 18 month period. Three education sessions were also completed using the cognitive load theory to educate nurses and providers on the disease process and implications of the KTU. The pressure ulcer prevalence in a hospice setting was found to be 27.8%. The majority of pressure ulcers were stage 2 (43%). The coccyx (45%), buttock (18%) and heels (16%) were the most common areas for pressure ulcer development in this setting. The average length of life was 17.7 days and the median was 9.5 days after sacral/coccyx ulcer onset. The estimated prevalence in this sample of the KTU was 6.1%. During the education sessions only 61.5% of participants had previously heard of the KTU. The education session showed a significant difference in participant's knowledge in unavoidable pressure ulcers, pathophysiology of the KTU and usual presentation of the KTU. Being aware of the skin changes that occur at the end of life is important for providers and nurses. It gives them the opportunity to educate the family and patient about the disease process and implications. There is a need for further research on skin changes at life's end.




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