Lived Experience Paper

The district nursing team were now to be responsible for the wound care of an ulcer on the sole of her right foot on her impending discharge. She had previously attended the practice nurse and a podiatry service based within her local clinic. Due to a change in circumstances, she was now clearly housebound for the near future due to mobility issues. Prior to an arranged visit, the patient had called the nurse to advise her that she was pyrexial and was experiencing a pain in her right foot that was different from her normal neuropathic pain, which was often problematic. She was also finding it difficult to mobilise and was disinclined for diet but was taking oral fluids.

Quality improvement issues in healthcare focus on the care that patients receive and the outcomes that patients experience. Nurses play a major advocacy role for ensuring safe and quality care to all patients. Also, nurses share the responsibility in leading the efforts in improving patient care in all settings (Berwick, 2002). One of the ongoing problems plaguing hospitals and nursing homes is the development of new pressure ulcers in patients after admission. A pressure ulcer can be defined as a localized area of necrotic tissue that is likely to occur after soft tissue is compressed between a bony prominence and a surface for prolonged periods of time (Andrychuk, 1998). According to the Centers for Medicare and Medicaid,

A) There are several issues in the case of Mr. J that need to be examined. Using nurse sensitive indicators “reflect patient outcomes that are determined to be nursingsensitive because they depend on the quality or quantity of nursing care” (American Sentinel University, 2011). Mr. J. was not receiving acceptable care, because his daughter noticed a red, depressed area over Mr. J’s lower spine, similar to a severe sunburn. This skin condition is the first stage of a developing pressure ulcer. a. Nurses should be aware that a patient with limited mobility is at risk for skin breakdown, and 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.

Maria Niceforo, a 75-year-old woman receiving in-home nursing care, had died of infection due to numerous pressure wounds (Le May, 2016). She was admitted to the hospital presenting with a bleeding pressure wound across her back and legs that had penetrated through the bone (Le May, 2016). It was also observed that the wounds were soiled with urine and dried faeces (Le May, 2016). She was receiving in-home support from registered nurses, who according to her son, were not consistent nor reliable in their care of Mrs. Niceforo (Le May, 2016). Another contributing factor to her death was inadequate communication and documentation of her treatment (Menagh, 2016). For example, one of the nurses had reported not providing treatment to Mrs. Niceforo's bottom as she was not aware of it (Menagh, 2016). I was quite

Fortunately, according to Chan et al., (2008), 95% of pressure ulcers can be prevented and nursing care is believed to be a primary method of preventing pressure ulcer development. Research was conducted on accredited search databases such as CINAHL, Nursing Resource Center and OvidSP on prevention measures for pressure ulcers. A number of credible evidence based research was found that supported the nursing intervention of

A study conducted over seven years by Amir et al (2011) showed a significant decline of pressure ulcer development after three years of the study. This was partly due to strategies being implemented in regards to repositioning along with adequate nutrition, pressure ulcer prevention information leaflets were given to patients and skin assessments (Amir et al., 2011). It must also be considered that different patients will have different comorbidities and the use of a risk assessment tool is vital to assess and implementing a plan for pressure ulcer prevention according to the patient’s score (Tannen et al., 2010).

The knowledge of nursing sensitive indicator can be helpful in providing the patient care which meets the quality and ethical standards. Nursing sensitive indicators rely on evidence to take patient care decisions (Patrician, 2010). According to Patrician (2010), Evidence Based Nursing is the use of personal expertise and research to take decisions on patient care. In case of Mr. J, there is a clear lack of evidence based nursing. Mr. J was kept in restraint without considering that Mr. J was not trying to get out of bed by himself. When the pressure ulcer was identified, the nurse

The primary goals for conducting nursing research are to generate new knowledge to promote positive outcomes for patients, enhance quality and cost-effectiveness of care, improve the healthcare delivery system, and validate the credibility of the nursing profession through evidence-based practice (Schmidt & Brown, 2012). The purpose of this paper is to explore the practice-related problem of pressure ulcers and the importance of the problem in the nursing profession.

By educating staff on nursing sensitive indicators and the issues that need to be addressed, could advance the quality of patient care throughout the hospital. In this case, educating hospital staff on ways to prevent restraint use and pressure sore prevention, the staff could have possible prevented the use of restraints and the pressure sore. Also, by educating staff on how to use restraints would be

Pressure ulcers occur over bony prominences when skin is compressed for long periods of time, affecting the blood supply to certain areas, leading to ischaemia development (Waugh and Grant, 2001). Compression of skin is caused by pressure, shearing and friction, but can also occur due to pressure exerted by medical equipment (Randle, Coffey and Bradbury, 2009). NICE (2014) states that the prevalence of pressure ulcers in different healthcare settings in December 2013 was 4.7%, taken from data available for 186,000 patients. The cost of treating ulcers can vary depending on severity from £43 up to £374 (NICE, 2014). Evidence based practice skills are essential in nursing as it allows the best available evidence to be used to improve practice and patient care, while improving decision-making (Holland and Rees, 2010). I will be critiquing two research papers; qualitative and quantitative, using a framework set out by Holland and Rees (2010), and will explore the impact on practice. Using a framework provides a standardised method of assessing quality and reduces subjectivity.

The assessment was done in my patient’s room at the Memorial South Hospital on 12th of April, 2015. During the interview, I have used active listening, holistic approach, and focus interview, open-ended and closed-ended questions to determine the cause of the patient’s skin Integrity; however, it can be characterized as a Stage II pressure ulcer; therefore, by using this therapeutic communication help me to get a better understanding of what the patient is experiencing and the type of psychosocial problem exists. As a student nurse, my chief goal of therapy is to monitor my patient skin integrity and prevent infection and further skin breakdown. The interview went well for the first time; however, after the interview, I have educated the patient

The qualitative research article selected for critique is the study by Athlin et al. (2009), with the title of, “Factors of importance to the development of pressure ulcers in the care trajectory: perceptions of hospital and community care nurses”. This study looked at contributing factors promoting the growth or relapse of pressure ulcers, and how the nurses working in hospitals or group care, comprehend them in the care trajectory.

Mr. J.’s daughter noticed a red mark on her father who then reported this to the nursing assistant and her concerns were immediately dismissed. If the nursing assistant was properly trained in the use of restraints and had knowledge of patient outcomes, this patient would not have developed a pressure ulcer. The nursing assistant should have immediately informed the nurse and measurements should have been taken to prevent further breakdown of the patient’s skin which was not done. It is evident in reading this case that Mr. J developed a Stage I pressure ulcer from being retrained in one position with no assessment or release for an undetermined amount of time.

Select either the qualitative or quantitative study method for this assignment. In an essay of 750-1,000 words, summarize the study, explain the ways in which the findings might be used in nursing practice, and address any ethical considerations associated with the conduct of the study.