Defense Date


Graduation Date

Spring 5-6-2021


One-year Embargo

Submission Type


Degree Name





School of Nursing

Committee Chair

Linda Goodfellow

Committee Member

Melanie Turk

Committee Member

David Brienza


pressure injury, pressure ulcer, visual skin assessment, subepidermal moisture measures


Background: Pressure injuries are an important quality measure. Most are avoidable and can be prevented by implementing nursing care strategies early. Pressure injury prevention is significant to nursing practice. There is a gap in the ability to detect early skin damage through standard visual skin assessment in dark skin toned individuals. Subepidermal moisture (SEM) values have been shown to detect early tissue damage in people with dark skin, prior to it being detected through standard visual skin assessment.

Objectives: This study sought to explore the relationship between visual skin assessment and SEM as indicators of pressure injury and if threshold SEM values as potential predictors could determine stage 1 pressure injury and deep tissue pressure injury (DTPI) in adult individuals hospitalized in the acute care setting.

Methods: This non-experimental, repeated measures, descriptive design measured visual skin assessment and SEM and their relationship to early identification of pressure injuries in people with light and dark skin tones. Daily follow-up assessments and measurements included concurrent visual skin assessment and SEM measures, and up to six time points. Data was examined to understand the effectiveness of visual skin assessment and subepidermal moisture measures to detect early signs of a pressure injury. Demographic data on characteristics of the sample population was collected to examine any confounding variables.

Results: Twenty two of the 122 individuals that participated in the study developed a total of 25 pressure injuries. Only one of the 22 individuals that developed a pressure injury was dark skin toned. Mean SEM values varied at anatomical locations, with highest values at the sacrum (M = 40.3, SD = 9.0) and above the sacrum (M = 41.1, SD = 7.4). Days to initial discovery of pressure injury through visual skin assessment averaged 4.3 days.

Discussion: These findings suggest that early skin damage may be more difficult to detect through visual skin assessment in dark and light skin toned individuals and further exploration of SEM as a more reliable method to detect pressure injuries should be conducted.



Available for download on Saturday, May 07, 2022