Skintegrity is all about putting it into action

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Martie L. Moore, RN, MAOM, CPHQ
Martie L. Moore, RN, MAOM, CPHQ

The other day I had a conversation with a friend of mine about skin health.  I raved about what she should be doing in order to keep her skin healthy and functional. As I finally paused to take a breath, she interjected, “I get it: You're all about that skin health.” 

Well, yes. Yes, I am. 

I have shared with you the whys: my own personal journey of elderly parents and loved ones whom I have witnessed in pain and suffering when skin breaks down. What I have not shared is my own sense of letdown and failure when I think about the patients I have cared for, or had accountability for their care. When our patients' skin breaks down, there is pain and there is suffering.

When I reflect back on my practice, skin health was not my highest priority. I focused on heart, lungs, kidneys and the vital organs. When I developed quality programs, I addressed pressure ulcers but missed asking different types of questions. I allowed myself to have conventional thinking. 

What I have discovered is that it is time for the unconventional thinking and action. 

So here is my call to action for unconventional thinking and practice:

1.   Use a pH-balanced cleanser. Do you know what you are using on your patients? Do not assume that what you grab out of the supply closet is what you need to not only cleanse but also condition the skin.

2.   Do not massage or vigorously rub skin that is at risk for pressure ulcers. Conventional thinking used to think that rubbing would increase blood flow. Research now indicates that it causes more harm than good. 

3.   Skin moisturizers are not all the same. Read the label and assure that what you are applying hydrates and nourishes the skin. Look for moisturizers that contain natural emollients, potent antioxidants and essential fatty acids. Stay away from moisturizers that are formulated with mineral oil or other petrochemicals so that the skin can still breathe. Some lotions have ingredients that may dry out skin. This is the area that I feel the worst about as a nurse leader. Many times, I did not question what was used on our patients. I simply assumed that the right products were being selected. In hindsight, even the best-intentioned people did not understand what they were selecting. Myself included.

4.   Feed the skin: Most elderly are malnourished and skin tells the story. A protein-rich diet helps heal skin breakdowns and build intact skin. Ask questions about protein nutritional supplements. Know which one is best for your patients. I have seen cans of supplements sitting in windowsills unopened. Supplements do no good if they are not consumed. New protein supplements are now available that are two sips of a medicine cup, and whey-based supplements are the best. 

5.   Be skin vigilant. Skin insults can happen any time and any place.  According to one study, more than 1.5 million Americans suffer skin tears in America.1

This seems like a lot to keep track of on top of what you already do for your patients. So how can you easily implement all these tips? Medline, for one, offers a way to customize skin care solutions for each patient first through a variety of skin care and moisture management products to help encourage skin health, prevent skin breakdown, and treat skin issues should they occur. In addition to skin care solutions, the Skintegrity program offers complete skin health organizational education for a variety of roles and skill levels, with information on various skin challenges and conditions and the best practices with which to treat them.

I personally want to thank you for joining me in asking deeper questions and being advocates for those who trust us with their care and their skin. 


1.   Malone ML, Rozario N, Gavinski M, Goodwin J. The epidemiology of skin tears in the institutionalized elderly. J Am Geriatr Soc 1991;39:591-5.

Martie Moore is chief nursing officer at Medline Industries and a member of NPUAP's Corporate Advisory Council.


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