A quality improvement programme including technical and non-technical interventions, data feedback to staff and clinical leadership was associated with a sustained reduction in the incidence of pressure ulceration in the critically ill. Strategies used in this programme may be transferable to other critical care units to bring more widespread patient benefit.

Inadequate assessment and management of faecal incontinence may have implications for critically ill patients. Further evaluation is required in order to demonstrate over time whether the changes made, as a result of this quality improvement programme, have led to sustainable improvement.

This clinical focus and literature review describe the effect of psychosocial factors on coping and living with a venous leg ulcer (VLU). The associated stressors of living with a VLU include: pain, loss of self-esteem, and social isolation, with subsequent negative emotions that could potentially lead to anxiety and depression. The ability to cope with a VLU depends upon the individual, with some patients employing negative coping strategies such as denial, depending on the stage of the illness and level of acceptance reached (Husband, 2001; Brown, 2014). Psychosocial interventions by health professionals have been shown to reduce the stress of living with a VLU, to improve a patient's coping ability, and subsequently enhance wound healing. This article highlights the importance of holistic assessment and joint treatment planning, to incorporate patients' psychosocial needs and individual coping methods in order to reduce the associated stress of living with a VLU.

Deep tissue injury affects patients of all ages in a variety of healthcare settings. It is therefore essential that nurses are aware of the underlying pathogenesis, in order to accurately assess the pressure ulcer risk of vulnerable patients, and to subsequently reduce patient harm. The majority of pressure ulcers are avoidable, however, a variety of intrinsic and extrinsic factors can contribute towards the development of deep tissue injury. Understanding the body's internal responses to external pressure will enable nurses to recognise that a visual assessment alone may not necessarily identify patients at risk of deep tissue damage. This article reviews the evidence for the internal causative mechanisms of deep tissue injury, while linking to clinical practice and pressure ulcer prevention.

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