Pressure Ulcer Prevention
Pressure Ulcers Prevention (PUP) is a national initiative for all hospitals. Medicare estimates an average of $146 million being spent annually for hospital acquired conditions which include pressure ulcers (Kandilov, Coomer, & Dalton, 2014). Hospital acquired pressure ulcers are among the top five adverse events reported today (Gillespie, Chaboyer, Kent, Whitty, & Thalib, 2014). Medicare will stop paying for hospital acquired conditions therefore prevention is the key (Kandilov, Coomer, & Dalton, 2014). Best practice guidelines advocate routine repositioning of patients however the studies were not based on RCT’s and were conducted well over 20 years ago, and before the improvement of mattress that are used in hospitals and long-term care facilities (Gillespie, Chaboyer, Kent, Whitty, & Thalib, 2014). The purpose of this assignment is to critique a problem (repositioning patients to prevent pressure ulcers) related to the nursing profession that will allow the reader to identify, appraise, and synthesize studies in order to draw a conclusion from the data collected. The systematic research review (SRR) “Repositioning for pressure ulcer prevention in adults” by Gillespie, Chaboyer, Kent, Whitty, & Thalib, (2014) will be critiqued in this paper by describing the relevance of preventing pressure ulcers; the rigor of the studies used; critiquing the levels of evidence of the studies; describe the clarity with which the studies are
The authors were concerned with health-related quality of life (HRQL) and how pressure ulcers impact the patient's subjective experience of care, because overall health care outcomes may be influenced by the interaction between disease burden and patient compliance. Thirty adult patients in hospital, rehabilitation, or community care in England and Ireland were recruited for the study. Inclusion in the study required being under the care of a tissue viability nurse.
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.
Pressure ulcer develops as a result of the skin that is over bony prominence. The pressure impairs blood flow leading to tissue necrosis and ulceration. Pressure ulcer can develop in several areas of bony prominence of the body such as the sacrum, greater trochanter, ankles, shoulders, head and ischia. It can develop quickly and difficult to treat, it ranges from mild to skin redness to severe tissue damage, development of infection and damage to muscle. Older people are most at risk due to thin and fragile skin,
Studies have pointed out that nurses possess a significant role and extensive knowledge in pressure ulcer prevention. Instructive programs in the hospitals give great learning to nurses about the preventive and treatment techniques for
Treatment of a pressure ulcer costs the NHS more than £3.8 million, despite the progress and management of pressure ulcers 700,000 people are still affected this remains to be a significant problem for health care professionals (NHS Improvement, 2016). Therefore, this case study will enumerate the cause, treatment, prevention and risk factors of a pressure ulcer in relation to a patient who is suffering from a grade three-pressure ulcer to his sacrum and therefore requires long-term care from the district nurses. Pressure ulcers can occur more commonly on the sacrum or heels in any health care settings (Clarkson, 2007). Although more prevalent in the elderly, people of all ages are at risk of developing a pressure ulcer
Pressure ulcer is an adverse outcome in the clinical care setting that also linked to poor quality of nursing care. Though pressure should never happen in a professional care setting, it is still prevalent throughout the world’s medical settings. This article looks at many other previous studies from 1992 to present to compare and find the underlying issues that may contribute to pressure ulcer. A closer look at the nurse’s knowledge versus actual decision will be observe, because it is the key factor in pressure ulcer prevention.
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.
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
Most mobile patients are able to reposition themselves, while others who are critically ill are not able to feel or respond to pain. Therefore, nurses need to assess those patients in repositioning to decrease the risk of developing pressure ulcers (REF).
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.
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
Pressure ulcer prevention has been the nursing worry for many years. Florence Nightingale in 1859 wrote, “If he has a bedsore, it’s generally not the fault of the disease, but of the nursing” (Nightingale, F). People may think pressure ulcers associated with poor nursing care. Prevention of pressure ulcers is a multidisciplinary responsibility; however, nurses have a primary role. Patient participation in prevention of pressure ulcers (pup) care has been shown to result in improved patient safety and satisfaction with care ((Weingart, S.N., Zhu, J., Chiappetta, L., Stuver, S.O., Schneider, E.C., Epstein, A.M. 2011). Purpose of the study includes the nurses and patients partnering together with prevention of pressure ulcers (pup) may be an effective strategy for reducing pressure ulcers (PU) among at-risk individuals. So the research team developed a pressure ulcer prevention care bundle (PUPCB) targeted at both patients and nurses, encouraging patient participation in PUP care with three simple evidence-based messages: 1) Keep moving; 2) Look after your skin; and 3) Eat a healthy diet. Messages were provided to patients with a poster, brochure and DVD. Nurses had training regarding how to be companion with patients in pressure ulcer prevention (Roberts et al. 2016).
Evidence based practice (EBP) gives nurses a method to use critical appraised data and scientific evidence that is proven to confirm the delivery of quality health care to a patient population. Pressure ulcer prevention continues to be a major and growing concern among todays patients and healthcare providers. This problem is a concern because prevention of pressure ulcers can be accomplished through good skincare techniques and increased education of nurses. The field of nursing along with the healthcare industry can benefit from simply decreased the
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.
"Hospital-acquired pressure ulcers were shown to be an important risk factor associated with mortality," per Dr. Courtney Lyder, of the UCLA School of Nursing. "It is incumbent upon hospitals to identify individuals at high risk for these ulcers and implement preventive interventions immediately upon admission." Pressure ulcers, also known as bedsores often occurs when patients have limited mobility and unable to reposition themselves in bed causing injury caused by pressure, friction and