The Big Picture
A skin tear happens when the top layer of skin separates from the tissue underneath. Skin tears often affect the hands, arms, and lower legs. Older people with thin, dry, fragile skin face greater risk.
Careful movement and skin protection help prevent these injuries. If you cause or find a skin tear, bruise, bump, or scrape, tell your supervisor at once.
Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.
Quick tip: Tap, click, or press Enter on any term with a dotted underline and an ⓘ icon to see its plain-English definition.
Start Here If You’re Overwhelmed
Focus on these core ideas:
- A skin tear is a break or rip in the skin where the top skin layer separates from the tissue below.
- Friction happens when skin rubs against another surface.
- Shearing happens when skin stays against a surface while deeper tissues move.
- Clients who are older, very thin, poorly hydrated, poorly nourished, or need substantial help moving face greater risk.
- Prevent skin tears by following the care plan, reducing friction and shearing, moving clients carefully, and protecting fragile skin.
- Report a skin tear, bruise, bump, or scrape to your supervisor at once.
Jump to:
Course Notes: Key Ideas You Need to Know
What Is a Skin Tear?
A skin tear is a break or rip in the skin. The epidermis, which is the top skin layer, separates from the tissue underneath.
Common areas include:
- hands
- arms
- lower legs
Older clients often have thinner, more fragile skin. Even light pressure or rubbing can injure fragile skin. Clients with dry, paper-thin skin face greater risk.
Friction and Shearing
Two important causes of skin injury are friction and shearing.
Friction is the resistance created when skin rubs against another surface. The surface might be clothing, bedding, or another area of skin.
Shearing happens when the skin stays against a surface while deeper tissues move downward. This movement damages tissues and blood vessels. It reduces blood flow to the area and raises the risk of a pressure injury.
Shearing can happen when a client slides down in a bed or chair.
Common Causes of Skin Tears
Skin tears can result from friction, shearing, pulling, or direct pressure.
Common situations include:
- bumping a hand, arm, or leg against a hard surface
- holding a client’s arm or leg too tightly
- moving, repositioning, or transferring a client without a transfer sheet or another nonfriction surface
- bathing or dressing
- dragging buttons or zippers across fragile skin
Hard surfaces that can cause injury include beds, bed rails, chairs, wheelchair footrests, and tables.
Who Is at Greater Risk?
Clients face a higher risk of skin tears when they:
- need moderate to complete help with moving
- have poor nutrition or are very thin
- are poorly hydrated
- have altered mental awareness
- are older
A client with dementia, for example, might resist care or move quickly without warning. Those sudden movements can lead to skin tears.
Why Skin Tears Need Prompt Reporting
Skin tears are painful. They also create an opening where pathogens can enter the body.
Report: Tell your supervisor at once if you cause or find a skin tear, bruise, bump, or scrape.
Nova Scotia CCA Note
Sorrentino’s Canadian Textbook for the Support Worker, 5th Edition tells you to report a skin tear, bruise, bump, or scrape to your supervisor at once. In Nova Scotia, current CCA standards make the observation role more specific. A CCA performs an observational point of care assessment, which includes observing a person’s skin integrity and recognizing changes that need to be escalated to a supervisor.
This observational assessment is not a nursing assessment. A CCA does not perform the comprehensive evaluation used to analyze information for clinical decision-making or care planning. The CCA uses observations to help apply the care plan and recognize changes that require escalation.
Why this matters in Nova Scotia: You need to know the difference between observing skin integrity and completing a nursing assessment. Skin changes belong within the CCA’s observation and escalation role.
Official source: Continuing Care Assistant Occupational Standards of Practice (CCA OSoP)
Last checked: September 14, 2026
Follow the Care Plan During Care
Careful, safe care helps prevent skin tears and further injury.
Follow the care plan when:
- moving the client
- lifting the client
- repositioning the client
- transferring the client
- dressing the client
- bathing the client
Follow safety guidelines when lifting or transferring a client between a bed and wheelchair. Prevent friction and shearing during moving, lifting, transferring, and repositioning.
Protect the Skin
Important skin-protection steps include:
- keeping the skin moisturized, as directed by the care plan
- offering fluids, as directed by the care plan
- dressing and undressing the client carefully
- using soft clothing with long sleeves and long pants
- allowing the client to make clothing choices
- using pillows to support the arms and legs, as directed by the care plan
These measures help reduce injury to fragile skin.
Watch Fingernails, Toenails, and Jewellery
Keep your fingernails short and smoothly filed.
Keep the client’s fingernails short and smooth as well. Tell your supervisor if the client has long, rough toenails.
Do not wear rings with large or raised stones or edges that might catch on something.
Use Support and Padding
A turning sheet helps move and turn a client in bed while reducing friction.
Other protective measures include:
- supporting the arms and legs with pillows, according to the care plan
- padding bed rails
- padding wheelchair arms, footrests, and leg supports
- placing pillows, soft blankets, or towels between body parts so they do not press against each other
Follow the care plan for pillow support and for padding bed rails, wheelchair arms, footrests, and leg supports.
Keep the Environment Safer
Good lighting helps prevent a client from bumping into furniture, walls, and equipment.
When a client is confused, agitated, or resisting care, stay patient and calm.
Know the Treatment Role Limit
The physician and nurse direct skin care treatment. They may also order dressings.
Elastic wraps protect the skin from injury and support healing.
CCA action: Follow the care plan and your supervisor’s instructions.
Exam Clue Words
- Report: Tell your supervisor at once if you cause or find a skin tear, bruise, bump, or scrape.
- Follow the care plan: Use the care plan for moving, lifting, repositioning, transferring, dressing, bathing, moisturizing, fluids, and supported positioning.
- Avoid: Do not wear rings with large or raised stones or edges that might catch on something.
Fast Review
For a quick review, focus on risks, causes, prevention, reporting, and care-plan directions. Keep the difference between friction and shearing clear.
- A skin tear happens when the epidermis separates from the tissue underneath.
- Hands, arms, and lower legs are common sites.
- Friction means skin rubbing against another surface.
- Shearing happens when skin stays against a surface while deeper tissues move downward.
- Shearing damages tissues and blood vessels, reduces blood flow, and raises pressure-injury risk.
- Clients who are older, poorly nourished, poorly hydrated, very thin, or need substantial help moving face greater risk.
- Prevent friction and shearing when moving, lifting, transferring, and repositioning clients.
- Follow the care plan for skin protection, movement, dressing, bathing, fluids, and positioning.
- Report a skin tear, bruise, bump, or scrape to your supervisor at once.
- The physician and nurse direct skin care treatment. Follow the care plan and your supervisor’s instructions.
Final Pep Talk
There are several prevention details here, so focus first on the big pattern: protect fragile skin, reduce friction and shearing, follow the care plan, and remember what needs immediate reporting. Review those ideas a few times, then add the smaller safety details.