title: The Skin Safety Model: Reconceptualizing Skin Vulnerability in Older Patients.
abstract: OBJECTIVE
  To develop a unique skin safety model (SSM) that offers a new and unified perspective on the diverse yet interconnected antecedents that contribute to a spectrum of potential iatrogenic skin injuries in older hospitalized adults.
  
  
  METHODS
  Discussion paper.
  
  
  METHODS
  A literature search of electronic databases was conducted for published articles written in English addressing skin integrity and iatrogenic skin injury in elderly hospital patients between 1960 and 2014.
  
  
  RESULTS
  There is a multiplicity of literature outlining the etiology, prevention, and management of specific iatrogenic skin injuries. Complex and interrelated factors contribute to iatrogenic skin injury in the older adult, including multiple comorbidities, factors influencing healthcare delivery, and acute situational stressors. A range of injuries can result when these factors are complicated by skin irritants, pressure, shear, or friction; however, despite skin injuries sharing multiple antecedents, no unified overarching skin safety conceptual model has been published.
  
  
  CONCLUSIONS
  The SSM presented in this article offers a new, unified framework that encompasses the spectrum of antecedents to skin vulnerability as well as the spectrum of iatrogenic skin injuries that may be sustained by older acute care patients. Current skin integrity frameworks address prevention and management of specific skin injuries. In contrast, the SSM recognizes the complex interplay of patient and system factors that may result in a range of iatrogenic skin injuries. Skin safety is reconceptualized into a single model that has the potential for application at the individual patient level, as well as healthcare systems and governance levels.
  
  
  CONCLUSIONS
  Skin safety is concerned with keeping skin safe from any iatrogenic skin injury, and remains an ongoing challenge for healthcare providers. A conceptual framework that encompasses all of the factors that may contribute to a range of iatrogenic skin injuries is essential, and guides the clinician in maintaining skin integrity in the vulnerable older patient.
authors.affiliation: Phi Delta-at-large, Doctoral student, School of Nursing, Queensland University of Technology, and Clinical Nurse, Skin Integrity Service, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
authors.forename: Jill L
authors.initials: JL
authors.lastname: Campbell
authors.affiliation: Phi Delta-at-large, Professor of Nursing, School of Nursing, Queensland University of Technology, Royal Brisbane and Women's Hospital, Metro-North Hospital Health Service, Herston, Queensland, Australia.
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Coyer
authors.affiliation: School of Nursing, Senior lecturer, Queensland University of Technology, Kelvin Grove;, Joint appointment Royal Brisbane and Women's Hospital, Metro-North Hospital Health Service, Herston, Queensland, Australia.
authors.forename: Sonya R
authors.initials: SR
authors.lastname: Osborne
mesh_terms: D000368:Aged; D015897:Comorbidity; D003422:Critical Care; D006760:Hospitalization; D006801:Humans; D008962:Models, Theoretical; D012449:Safety; D012871:Skin Diseases / Q000453:epidemiology*
keywords: Acute care; incontinence-associated dermatitis; older adult; pressure ulcer; skin safety