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Published on: September 2, 2011
The Role of Shear Stress and Shear Strain in Pressure Injury Development
Caroline Portoghese1, Michelle Deppisch, Sharon Sonenblum
1Caroline Portoghese, OTR/L, ATP/SMS, is Assistive Technology Professional and Rehabilitation Consultant, Handi Medical, Saint Paul, Minnesota. Michelle Deppisch, PT, CWS, is Wound Care Consultant, Michele Deppisch PT, CWS, LLC, Hertford, North Carolina. Sharon Sonenblum, PhD, is Principal Research Scientist, George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia. Barbara Samson, OTR/L, MBA, CWS, CSPHC, is Executive Clinical Specialist, Mölnlycke Health Care, Peachtree Corners, Georgia. Cassendra Munro, PhD, RN, RNFA, CNOR, Nurse Scientist, Stanford Health Care, Office of Research, Patient Care Services, Menlo Park, California. Virginia Capasso, PhD, ANP-BC, ACNS-BC, CWS, is Advanced Practice Nurse and Nurse Scientist, Massachusetts General Hospital, Boston, Massachusetts, and Instructor in Surgery, Harvard Medical School, Boston. Evan Call, MS, CSM-NRM, is Adjunct Faculty, Weber State University, Ogden, Utah. Joyce Black, PhD, RN, FAAN, is Florence Neidfelt Professor of Nursing, University of Nebraska Medical Center, College of Nursing, Omaha, Nebraska. David Brienza, PhD, is Professor, University of Pittsburgh, Pittsburgh, Pennsylvania. The authors have disclosed no financial relationships related to this article. Submitted March 12, 2023; accepted in revised form July 5, 2023.
Abstract:
Although other patient safety indicators have seen a decline, pressure injury (PI) incidence has continued to rise. In this article, the authors discuss the role of shear stress and shear strain in PI development and describe how accurate assessment and management can reduce PI risk. They provide explanations of shear stress, shear strain, friction, and tissue deformation to support a better clinical understanding of how damaging these forces are for soft tissue. Clinicians must carefully assess each patient's risk factors regarding shear forces within the contexts of activity and mobility. The authors also provide a toolbox of mitigation strategies, including support surface selection, selection of materials that contact the individual, management of immobility using positioning techniques, and the use of safe patient handling techniques. With a clear understanding of how shear forces affect PI risk and mitigation strategies, clinicians will more accurately assess PI risk and improve PI prevention care plans, ultimately reducing PI incidence to become more aligned with other patient safety indicators.
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