research
Turning for Ulcer ReductioN: A Multisite Randomized Clinical
Trial in Nursing Homes
Nancy Bergstrom, PhD, RN,* Susan D. Horn, PhD,†‡ Mary Pat Rapp, PhD, RN,*
Anita Stern, PhD, RN,§ Ryan Barrett, BS,†‡ and Michael Watkiss, BFA†‡
OBJECTIVES: To determine optimal repositioning frequency of nursing home (NH) residents at risk for pressure ulcers (PrUs) when cared for on high-density foam mattresses. DESIGN: Multisite, randomized, clinical trial, known as
Turning for Ulcer ReductioN (TURN Study).
SETTINGS: NHs in the United States (n = 20) and
Canada (n = 7) using high-density foam mattresses.
PARTICIPANTS: Consenting residents (N = 942) aged 65 and older without PrUs at moderate (scores 13–14) or high
(scores 10–12) risk of PrUs according to the Braden Scale.
INTERVENTION: Participants were randomly allocated using risk stratification (moderate vs high) to a repositioning schedule (2, 3, or 4 hour) for 3 weeks. Blinded assessors assessed skin weekly.
MEASUREMENTS: PrU incidence (coccyx or sacrum, trochanter, heels).
RESULTS: Participants were mostly female (77.6%) and
Caucasian (80.5%) and had a mean age of 85.1 Æ 7.7.
The most common diagnoses were cardiovascular (76.9%) and dementia (72.5%). Nineteen (2.0%) participants developed superficial PrUs. There was no significant difference (Wilcoxon test for ordered categories) in PrU incidence (P = .68) according to repositioning group
(2 hour, 8/321, 2.5%; 3 hour, 2/326, 0.6%; 4 hour, 9/
295, 3.1%), nor was there a statistically significant difference in the incidence of PrU between the high and moderate-risk groups (P = .79). Also, PrU incidence was not statistically significantly different between high-risk participants based on repositioning schedule (6/325, 1.8%,
P = .90) or between moderate-risk participants based on repositioning schedule (13/617, 2.1%, P = .68).
From the *School of Nursing, University of Texas Health Science Center at, Houston, Houston, Texas; †International
Trial in Nursing Homes
Nancy Bergstrom, PhD, RN,* Susan D. Horn, PhD,†‡ Mary Pat Rapp, PhD, RN,*
Anita Stern, PhD, RN,§ Ryan Barrett, BS,†‡ and Michael Watkiss, BFA†‡
OBJECTIVES: To determine optimal repositioning frequency of nursing home (NH) residents at risk for pressure ulcers (PrUs) when cared for on high-density foam mattresses. DESIGN: Multisite, randomized, clinical trial, known as
Turning for Ulcer ReductioN (TURN Study).
SETTINGS: NHs in the United States (n = 20) and
Canada (n = 7) using high-density foam mattresses.
PARTICIPANTS: Consenting residents (N = 942) aged 65 and older without PrUs at moderate (scores 13–14) or high
(scores 10–12) risk of PrUs according to the Braden Scale.
INTERVENTION: Participants were randomly allocated using risk stratification (moderate vs high) to a repositioning schedule (2, 3, or 4 hour) for 3 weeks. Blinded assessors assessed skin weekly.
MEASUREMENTS: PrU incidence (coccyx or sacrum, trochanter, heels).
RESULTS: Participants were mostly female (77.6%) and
Caucasian (80.5%) and had a mean age of 85.1 Æ 7.7.
The most common diagnoses were cardiovascular (76.9%) and dementia (72.5%). Nineteen (2.0%) participants developed superficial PrUs. There was no significant difference (Wilcoxon test for ordered categories) in PrU incidence (P = .68) according to repositioning group
(2 hour, 8/321, 2.5%; 3 hour, 2/326, 0.6%; 4 hour, 9/
295, 3.1%), nor was there a statistically significant difference in the incidence of PrU between the high and moderate-risk groups (P = .79). Also, PrU incidence was not statistically significantly different between high-risk participants based on repositioning schedule (6/325, 1.8%,
P = .90) or between moderate-risk participants based on repositioning schedule (13/617, 2.1%, P = .68).
From the *School of Nursing, University of Texas Health Science Center at, Houston, Houston, Texas; †International