Example of Problem Based Learning applied to a pressure

scenario
♦ Step 1: Read scenario together
♦ Step 2 (Define issues): pick apart the scenario and identify terms, phrases or topics in the
scenario that you think you need to know more about (or identify the important parts of the
scenario that impact your decisions). Ask yourself what do I need to know in order to make
the best possible decision about what to do.
♦ Step 3 (Gather information): Figure out how you will get the information you need to make a
decision (does someone in the group have the answer? do you know a trusted book or
website where you could go and look it up? what about a peer or a health professional). Get
that information. Once you have the information make a determination about how serious
the problem is (or you may figure this out as you devise your plan).
♦ Step 4 (Devise your plan): Bring the information you have gathered or what you already
know and discuss what you will do. Make a plan for what you will do.
♦ Step 5: Discuss how you will know you made the right decision or devised an appropriate
plan.
♦ Step 6: Clarification with tutor.

Scenario 1: (re: pressure): You have been home from the Rehab Hospital for about 2 months
now. You notice that over the past week, your right hip bone has been red when you wake up
in the morning. You are sleeping on a regular bed. You transfer into the chair and within 20
minutes there is no more redness. What do you do?

♦ Step 2 – things you have identified that you need to know

o How long it is healthy for skin to stay red after a period of pressure?
o Where are the areas on the body that are most susceptible to pressure sores?
o Options for mattresses
o What comprises a good pressure sore prevention program?
o How serious is the problem?

♦ Step 3:
o Redness that doesn’t resolve within 30 minutes is cause for concern.
o Areas of greatest concern for pressure – hips, heels, sides of ankle bones,
tailbone, back of head, shoulder blades, front of knees (Facilitators could probe
re: what positions cause pressure on each of these areas).
o There is a small section (pg 213) in the education manual about mattresses. You
need more information than this. Go on the internet, or to medical supply stores
– many will loan you a mattress for a trial. Recognize that all mattresses are not
right for everyone (and that the softer the mattress, the more difficult the transfer
– that is the value of an air bed that can be made softer or harder depending on
the situation). Discuss within the group what other people have found out about
mattresses.

Developed by the Glenrose Rehabilitation Hospital Page 1 of 2

July 2005
 o Review parts of a good pressure sore prevention program (frequent pressure
relief including position change every two hours at night, skin inspection,
nutrition, weight management [not too heavy and not too light], good hygiene,
avoid smoking, avoid friction/sliding with transfers as much as possible.
o The problem is not very serious at this stage but definitely requires close
monitoring to ensure the redness doesn’t turn into a pressure sore (recognize
that this scenario is how all pressure sores start).

♦ Step 4 (The plan)

♦ Continue to monitor my skin every morning as I have been doing. I’ll also monitor
my skin periodically (3-4 times daily during bathroom routine to check the area)
ƒ Recognize that taking care of skin is a multi-faceted process and includes frequent
skin inspection, frequent position changes, good nutrition, appropriate equipment,
clearance on transfers
ƒ I’ll try to change my position in bed more during the night (i.e. I won’t sleep 4 hours in
a row on my right side as I have been).
ƒ I’ll ask around about possible mattress options maybe at the CPA, equipment
vendors.

♦ Step 5: How will you know that your plan was effective? If the redness resolves (in less
and less time everyday) I know my plan was sound. Nevertheless, in order to be
proactive I need to learn more about other mattress options and maybe see if I can trial
an air mattress.

♦ Step 6: Clarification with tutor

o Note: up until this point the tutor should only have been a facilitator (i.e. if the
group has questions the tutor should just turn the question back to the group)
o The tutor should not be someone who does a lot of information giving (until Step
6 which shouldn’t take more than 5 minutes anyway).

Scenario Two (continued from above scenario or could be made to stand alone): It is now 3
weeks later and in spite of trying to change positions at night, you always seem to end up
sleeping on your right side. Now when you wake up in the morning there is redness that doesn’t
totally disappear during the day – the skin over your hip bone almost looks like it has a scratch
on it. What should you do?

Developed by the Glenrose Rehabilitation Hospital Page 2 of 2

July 2005