Current Perspectives on Pressure Injuries in Persons with Dark Skin Tones from the National Pressure Injury Advisory Panel

Joyce Black, PhD, RN, FAAN; Jill Cox, PhD, RN, APN-C, CWOCN, FAAN; Virginia Capasso, PhD, CNP, CNS, CWS, FAAN; Donna Z. Bliss, PhD, RN, FAAN; Barbara Delmore, PhD, RN, CWCN, MAPWCA, IIWCC, FAAN; Vignesh Iyer, MS; Jacqueline Massaro, MSN, RN, CWOCN; Cassendra Munro, PhD, RN, CNOR; Joyce Pittman, PhD, RN, ANP-BC, FNP-BC, CWOCN, FAAN; and Elizabeth A. Ayello, PhD, RN, CWON, MAPWCA, FAAN

BACKGROUND: Pressure injury (PI) development is multifactorial. In patients with dark skin tones, identifying impending PIs by visual skin assessment can be especially challenging. The need for improved skin assessment techniques, especially for persons with dark skin tones, continues to increase. Similarly, greater awareness of the need for inclusivity with regard to representation of diverse skin colors/tones in education materials is apparent.
OBJECTIVE: To provide current perspectives from the literature surrounding skin assessment and PI development in patients with dark skin tones.
METHODS: The following elements will be discussed through the lens of skin tone: (1) historical perspectives of PI staging from the National Pressure Injury Advisory Panel, (2) epidemiology of PI, (3) anatomy and physiology of the skin, (3) skin tone assessment and measurement, (4) augmented visual assessment modalities, (5) PI prevention, (6) PI healing, (7) social determinants of health, and (8) gaps in clinician education.
CONCLUSIONS: This article highlights the gap in our clinical knowledge regarding PIs in patients with dark skin tones. Racial disparities with regard to PI development and healing are especially clear among patients with dark skin tones. Skin tone color assessment must be standardized and quantifiable in clinical education, practice, and research. This work is urgently needed, and support from private and governmental agencies is essential.
KEYWORDS: dark skin tones, disparities, health equity, pressure injuries,
skin assessment, social determinants of health

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