Lessons from Haiti: A Reflection on Pressure Injury Care

Fiona Stephenson has established and delivered education on best practices in nursing, pressure injury prevention, and wound management for over 40 years. She is a highly sought-after expert witness, reporting on liability and breach of duty.

Little did I know that my interest in skin integrity and pressure injuries would be clarified when I volunteered to go to Haiti following the devastating earthquake in 2010.

Along with life-changing injuries such as spinal cord injury, our patients had the deepest and widest pressure ulcers I had ever seen.

“You could fit four fists into a wound over the sacral area.”

With no opportunities for plastic surgery referrals or advanced treatments like vacuum suction or first-world dressings, we served our patients in the best way we could.

During all my nurse training and beyond, I had been taught to treat the patient as an individual and holistically.

I’m proud to say that those huge, deep pressure ulcers healed conservatively. Yes, it took teamwork, time, courage, and determination - but we did it. I remain incredibly proud of the local Haitian nurses, our patients, and their carers.

How did we do it? Holistically, of course:

• ›Nutrition: 3 free meals per day, freshly cooked
• ›Hydration: Safe water
• ›Pressure relief: Educating carers on turning and positioning
• ›Assessment: Systematic, individualised wound assessments - documented
• ›Monitoring: Regular photographs
• ›Dressing: Daily or twice-daily dressings, depending on exudate
• ›Patient engagement: Involving patients as part of the team
• ›Encouragement and praise: For both patients and Haitian nurses

As an expert witness for Tessa Gough Associates, I provide an opinion on skin integrity as well as general nursing care, including spinal cord injury care.

“If it’s not written down, it hasn’t happened.”

However, on the balance of probabilities, my strategy is to look for evidence of a systematic assessment - of both the patient and their wound - along with care planning, implementation, and regular evaluation.

It’s important to document escalation to show that concerns were acted upon. Please don’t presume anything.

As expert witnesses, we need the evidence.