Practice of expert critical care nurses in situations of prognostic conflict at the end of life.
A small group of peer-identified expert nurses was studied using qualitative methods to identify how they assessed patients' risk for pressure ulcers. The factors used by these expert nurses were compared to those used in formal pressure ulcer risk assessment instruments. The analysis revealed that the expert nurses weighed risk factors used in the formal scales preferentially. There was a close association in their reports between experiences with wound healing and pressure ulcer prevention. They used subjective sensory modalities such as appearance and odor. Setting and specialty-specific factors figured prominently in their evaluations and they included psychosocial as well as physiological factors in their assessments.