A Critical Understanding Of An Older Adult

Evidence suggests that pressure ulcers greatly increase mortality rates in both hospitals and nursing homes (Thomas, 2001). Patients who develop a pressure ulcer within six weeks of admission to an acute-care facility are three times more likely to die than patients who do not develop pressure ulcers (Thomas, 2001). Moreover, patients who develop a pressure ulcer within three months of admission to a long-term care facility are associated with a 92% mortality rate compared with a 4% mortality rate for patients who do not develop them (Thomas, 2001). This evidence alone shows how significant this problem is to the overall health status of patients. In my personal nursing experience, I have heard many complaints voiced from patients and their family members concerning the development of new pressure ulcers. Patients and family members have expressed dissatisfaction because of the increased stress and prolonged hospital stay often associated with the treatment of pressure ulcers.

Although the situation was quite challenging, it provided me with some useful experiences for the future practice. I understand that all institutions should have a policy for documenting the assessment of patients, including pressure ulcers (Morison 2001). I have come to be familiar with the homes assessment policy using the Sterling Pressure Sore Severity Scale and most importantly I have learned that by using a universal assessment tool it supports a systemic and consistent approach to pressure ulcer evaluation. This therefore supporting continuity of care.

“Pressure ulcers are key clinical indicators of the standard and effectiveness of care (Elliott, Fox & McKinley, 2008).” L.M. was at high risk for pressure ulcers for multiple factors such as immobility, poor nutrition, age, and health. Therefore, I used the Braden Scale as a quality indicator in order to assess the risk of pressure ulcers and also to

Pressure ulcers are areas of localised damage to the skin and underlying tissue caused by pressure. (Stechmiller et al., 2008) Pressure ulcers still one of the most significant health problem in our hospitals today, It affects on patients quality of life patient self-image and how long they will stay in hospital then the cost of patient treatment . Moore (2005) estimate that it costs a quarter of a million euro’s per annum to manage pressure ulcers in hospital and community settings across Ireland .which allows one to take immediate actions and prevent the ulcer if possible. To support pressure ulcer risk assessment several standardized pressure ulcer risk assessment scales have been introduced

Pressure ulcers are a widespread and often underestimated health problem in the UK. They occur in 4-10% of patients admitted to hospital (Ward et al, 2010).

The aim of this article was to assess the validity of the Waterlow Scale instrument using a longitudinal cohort of internal medical patients. To identify risk factors contributing to the injury of pressure ulcers (information outlined in the abstract overview of the study) (BJN, 2010).

According to the Agency for Healthcare Research and Quality (AHRQ), 2.5 million patients are affected by pressure ulcers and incur costs anywhere from $9.1 billion to $11.6 billion per year in the United States (AHRQ, 2014). As of October 1, 2008, the Centers for Medicare and Medicaid Services (CMS) will not reimburse hospitals for cases in which the pressure ulcer was acquired after admission (CMS, 2008). Because of this high cost, the number of patients affected each year, and insurances no longer reimbursing hospital acquired pressure ulcers (HAPU), an accurate skin assessment upon admission is critical to reduce costs, ease pain in patients, and lower incidences of pressure ulcers. This paper will address what leadership and management skills and functions are required of a wound care nurse who identifies a problem with the accuracy of skin assessments on newly admitted patients.

This paper will explore a clinical practice guideline from the National Guideline Clearinghouse and will focus on hospital-acquired- pressure ulcers. The development of hospital -acquired pressure ulcers are a great concern in today’s health care. Pressure ulcer treatment is costly, and the development of ulcers is prevented by the used of evidence-based nursing practice. According to the Centers for Medicare and Medicaid Services (2008), announces that they will no longer pay for additional costs incurred for hospital-acquired pressure ulcers. The development of stage 111 and the 1V ulcer is considered a “never event” Therefore, this new change has resulted in an increased focus on preventive measures and institutional scrutiny of pressure

Wolters Kluwer Health, I. (2017). Pressure ulcers get new terminology and staging definitions: Staff repor. Nursing Management,

Pressure ulcers remain a major health problem for many years. However, pressure ulcers have received minimal attention when we talk about patient safety issues. It is no doubt a patient safety issue as it can lead to serious damage such as life-threatening infections (Robyn). On a med/surge unit, individuals may experience long or short hospital stays depending on the situation. For the short stays, the focus of care is often on maximizing regaining activities of daily living and assessment and education regarding pressure ulcers is often minimal or non-existent (RNAO). What we fail to realize is that every patient who is at risk needs to be assessed and educated regarding pressure ulcers and the harm it can cause. During the hospital stay, patients may have limited movement and the pressure ulcers can extend into the muscle, tendon, and bone (RNAO). In many cases, patients do not notice the formation of an ulcer and as it may be in areas that are not as visible such as the coccyx. On a unit where there is short staffing, it is more vital to remember to assess for pressure ulcers and prevent the formation of an ulcer. Often, patients are admitted with the presence of a stage one or two pressure ulcer, whether it was from home or long-term care. In that case, patient education need to take place and teachings should be reinforced regarding the prevention of new pressure ulcers forming. Clients should also receive education regarding how to prevent

This study evaluates the decision making of nurses in relation the prevention and management of pressure ulcers. There are many assessment tools create to help nurses assess the level of risk a patient have, and from there, they can create a plan of care in pressure ulcer prevention.

Using a case study which was highlighted in a report presented by the Parliamentary and Health Service Ombudsman (2011), I will be identifying and reflecting on issues raised in the complaint concerning the quality of care for elderly people given by the NHS. Throughout this assignment, I will be using a wide variety of research sources in order to evaluate my own personal and professional developments in accordance to the Nursing and Midwifery Council (NMC) Code (2015). The NMC sets out professional standards and guidelines that nurses and midwives should adhere to in order to practice and maintain a high quality of care to patients. Within this assignment, I will be using Bortons’ (1970) framework as a structure to my reflection on issues identified in the case study. This useful reflective model consists of three main components; ‘What’, ‘So what’ and finally ‘Now what’. Bortons’ model is highly recommended by Jasper (2003) as a useful model, particularly for student nurses, as it allows beginner practitioners to reflect on their practice in an analytical manner. In order to protect the identity of the patient’s case in which I will be utilising, for the purposes of this assignment the patient will be referred to as Mrs H.

Although pressure ulcers prevention is very cost effective, it positively impact the health status of the patient. It is very important that healthcare providers reduce the incidence of pressure ulcers because it can slow the patients’ recovery, prolong their hospital stay, they can acquire complications or worse die. According to the Institute of Healthcare

A pressure ulcer is an area of skin with unrelieved pressure resulting in ischemia, cell death, and necrotic tissue. The constant external pressure or rubbing that exceeds the arterial capillary pressure (32 mm Hg) and impairs local normal blood flow to tissue for an extended period, results in pressure ulcer (Brunner and Smeltzer, 2013). According to National Pressure Ulcer Advisory Panel, 2014, pressure ulcers are a major burden to the society, as it approaches $11 billion annually, with a cost range from $500 to $70,000 per person pressure ulcer. It is a significant healthcare problem despite much investment in education, training, and prevention equipment. This paper includes two different studies to link cause-effect and prevention of pressure ulcers.

Many family members view the development of pressure ulcer (bedsore) us nurses fault, though it is associated with poor or nonexistent nursing care. The general condition of the patient is never put into consideration as the reason(s) for the development of pressure ulcers. Because of this, preventing pressure ulcers have been nursing priority/concern for many years now.