Essay on Pressure Ulcers

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,

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.

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 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.

While nurses encounter patients with pressure ulcers in home care and acute care settings, they are mainly a problem with elderly adults in long term care facilities. This is because of decreased sensory perception, decreased activity and mobility, skin moisture from incontinence, poor nutritional intake, and friction and shear (Stotts and Gunningberg, 2007).

As cited by Jarvis (2012, p.203), “the skin is the sentry that guards the body from environmental stresses and adapt it to other environmental influences.” Maintaining the elderly patient’s skin integrity requires a holistic care approach. As a nurse, one of our best practices is performing a thorough skin assessment of the whole body of our patients. A detailed head-to-toe skin assessment and clear documentation can help the interdisciplinary team in generating individualize plan of care. I perform a thorough assessment by inspecting the patient’s skin color, temperature, texture, moisture, and for presence of wounds. I ensure that the information I obtained from the skin inspection is clearly documented in the patient’s chart and plan of care, and any skin changes are communicated to the physician or nurse practitioner.

Despite advancement of technology, pressure ulcer continues to be a primordial in the health care system. Prevention of pressure ulcer remains an important issue in the health care facility. The critically ill ICU patient is the main target of this disease. Prevention remains the key for this problem. Some facility have standard policy for the eradication of pressure ulcer However the question is will the sacrum pressure ulcer formation be reduced in adult critically ill clients

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.

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

In the first step knowledge creation and distillation, I would conduct a research and find out what are the best practices and specific recommendations in pressure ulcer prevention. Then, I would evaluate each guideline’s quality, currency, and recommendations, in order to assess the efforts needed for the translations in practice. Lastly, I would select the recommendations with the strongest evidence and the recommendation that can easily be implemented into my clinical practice.