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A Prospective Study of the Pressure Ulcer Scale for Healing (PUSH)

¹ The University of Iowa College of Nursing, Iowa City.
² Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City VA Medical Center.
³ The University of Kansas School of Nursing, Kansas City.
⁴ The University of Iowa College of Education, Iowa City.

Address correspondence to Sue E. Gardner, PhD, RN, University of Iowa College of Nursing, 320 NB, Iowa City, IA 52242-1121. E-mail: sue-gardner{at}uiowa.edu

Background. Although the recently developed Pressure Ulcer Scale for Healing (PUSH) was created to monitor healing over time, prospective evidence of its validity in measuring healing is lacking. The purpose of this study was to assess the validity of PUSH (version 3.0) when used to assess pressure ulcers in clinical practice.

Methods. The authors chose a prospective research design using a convenience sample of nursing home residents with pressure ulcers. The patients' pressure ulcers were assessed each week with the PUSH and the Pressure Sore Status Tool. Surface area measurements derived from wound tracings were also obtained. Weekly assessments continued until the ulcer healed, the resident died, the resident transferred from the nursing home, or 6 months of assessments were complete.

Results. Thirty-two pressure ulcers comprised the study sample. Twenty-one (66%) healed during the 6-month study period and 11 (34%) did not heal. The PUSH scores decreased significantly over time among the healed ulcers but did not among the unhealed ulcers. Similarly, PUSH scores were significantly lower among the healed compared with the unhealed ulcers. Finally, total scores on PUSH were highly correlated with both the Pressure Sore Status Tool and surface area measurements.

Conclusions. The PUSH provides a valid measure of pressure ulcer healing over time and accurately differentiates a healing from a nonhealing ulcer. It is a clinically practical, evidence-based tool for tracking changes in pressure ulcer status when applied at weekly intervals.