Pressure Ulcers And Patients Over The Age Of 18

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.

The research article "What influences the impact of pressure ulcers on health-related quality of life? A qualitative patient-focused exploration of contributory factors" was recently published (2012) in the Journal of Tissue Viability by Gorecki, Nixon, Madill, Firth, and Brown. This is a qualitative study.

Pressure ulcers continue to be a prevalent issue in the health care system and causes “pain, slow recovery from morbid conditions, infection and death” (Kwong, Pang, Aboo, & Law, 2009, p. 2609). In the field of nursing turning and repositioning patients is a well-known nursing intervention to prevent development of pressure ulcers. However, many hospitals and facilities still neglect to apply this as a standard policy. This gives room for nurses and nursing aides to overlook the importance of this intervention resulting in increased pressure ulcer development. The purpose of turning and repositioning patients is to prevent oxygen

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).

Pressure ulcers are a problem and can lead to poor patient outcomes as well as hospital fines. Evidence based studies have shown that “the average cost of care in an acute care hospital for a patient with a stage III or stage IV pressure ulcer reported by the Centers for Medicare & Medicaid Services (CMS) is $43,180” (Jackson, 2008). Pressure ulcers and other skin breakdowns are among the most significant adverse events causing distress for patients and their care givers and compromising patients’ recovery from illness or injury (Gardiner, 2008). It is the tasks of nurses to ensure prevention of these complications is part of the daily care regimen.

The worse possible outcome of a pressure ulcer is death, with an approximation of 60,000 patients dying each year as a direct result of a pressure ulcer (Stotts & Gunningberg, 2007). This is significant to nursing practice because if we can prevent more pressure ulcers from occurring, we can dramatically improve patient outcomes, patient family and satisfaction, and even prevent the death of a loved one.

What influences the impact of pressure ulcers on health-related quality of life? A qualitative patient-focused exploration of contributory factors (Gorecki, Nixon, Madill, Firth and Brown, 2012)

According to Agency for Healthcare Research and Quality (AHRQ), 90% of all pressure ulcer related hospitalizations are due to secondary pressure ulcer diagnosis, 72% of patients are 65years or older and about 60,000 patients die each year as a result of a pressure ulcer. Some states legislation has declared secondary pressure ulcer as elderly abuse not covered by malpractice insurance. Fluid and

20). Further, the presence of pressure ulcers places a burden on patients and their family (Grinspun, 2005, p.21). As recommended by Grinspun (2005), pillows and foam wedges to separate prominences of the body and lifting devices have been beneficial to avoid friction (p. 32). Research suggests that the majority of pressure ulcers can be avoided. Although, the population at risk likely suffers from the possible contributors, as stated repositioning at least every 2 hours or sooner was effective (Grinspun, 2005, p. 32). When practicing I will reposition patients at appropriate times to reduce the risk of damage to the skin. Additionally, when moving a patient up in bed, I will request adequate assistance from other nursing staff to use a lifting device. This will help to avoid friction while the patient is being moved, ultimately reducing the development of pressure

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.

Pressure Ulcers affects patients the older patients due to the problem of immobility. A pressure

The INTACT trial showed a significant reduction in pressure ulcers (PU) incidence in the intervention group at the hospital (cluster) level, but this difference was not significant at the

We then assessed the patient on the 7 subscales of the Braden Q. These include mobility, activity, sensory perception, moisture, friction/shear, nutrition, tissue perfusion and oxygenation. Each of these sections is scored from 1-4 with the highest score being 28 (very little risk of pressure ulcer development) and the lowest is 7 (high risk of pressure ulcer development) (See appendix for full scale for Patient P). Based on our assessment date we scored Patient P as bedfast, has no sensory perception below his neck, wears a brief, is G-tube fed and he experiences bouts of decreased oxygen saturation < 95%. His cumulative score for the Braden Q was a 13 and categorizes him at high risk for developing a pressure ulcer (PU). In particular, the scale highlighted lack of mobility, bedfast-ness and friction and shearing as being risk factors in PU development in Patient P. Based on this information I targeted my interventions to address these

Pressure ulcers remain an issue in nursing, as they cause financial losses to not only the patients, but also the healthcare sector. In addition, the expenses arising from extended hospital stays, an increase in readmissions, and admissions to the hospital are included as well. Over the years, preventive interventions have focused on the elimination of pressure ulcers. In such cases, the prevention strategies have concentrated on the role of nurses in preventing the occurrence of pressure ulcers. Current texts reveal strategies that can be implemented in order to effectively manage and prevent pressure ulcers in the healthcare sector. The use of a proficient wound care team is common in many skilled nursing facilities. The failure for the effective management of this ulcer demonstrates a need for the adoption of new beneficial strategies. While previous researchers have proposed investigations on the effectiveness of a wound care team in the management of a pressure ulcer patient, the gap between writings and implementation still persists. Nurses have a role in presenting a plan that will encourage effective prevention and management of

As mentioned above, pressure ulcer also called pressure sores, which are caused by pressure. Pressure from sitting for a longer period of time on a particular part of the body, results in oxygen deprivation (Defloor et al., 2005), which results in tissue damage due to occlusion of the blood supply (More et al., 2011). Repositioning is one of the preventive strategies used to relieve pressure and to prevent the pressure development (Moore et al., 2011; (EUAP/ NUAP,2010). However, there was no research study conducted by any researchers to calculate the turning frequency, which means there is no evidence of turning intervals from any previous studies. It is important to reposition patient regularly after inspecting the condition of the patient and evaluation of the skin integrity, along with supportive surfaces.