Element: Prevention of pressure ulcers This essay is going to explore the nursing process with regard to the prevention of pressure ulcers. 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). This essay, using case study 4, will explore the holistic nursing process, and also the biological, sociological, psychological and ethical issues regarding the prevention of pressure ulcers. Lily is frightened due to her shortness of breath (dyspnoea), and as lying down exasperates her ability to breath effectively, has been sleeping in a chair. This is the primary concern of Lily. There has also been recent weight loss. The aim of …show more content…
Losing weight, combined with sleeping in a chair, may have contributed to Lily having a suspected pressure ulcer. Unrelieved pressure, from sitting in a chair for long periods, squeezes the tiny blood vessels in the skin which supply the tissues with oxygen and nutrients. The tissues die when deprived of oxygen and nutrients for too long (Harris, 2009). Older people and those experiencing impaired nutrition are among the groups at risk of developing pressure ulcers (NICE, 2005). The Malnutrition Advisory Group of BAPEN (British Association for Parenteral and Enteral Nutrition) developed the Malnutrition Universal Screening Tool (MUST), (Perry, 2009). The MUST is a 5 step screening tool to identify adults who are malnourished, at risk of malnourishment or obese. Lily’s body mass index (BMI) will be calculated to obtain her overall risk of malnutrition. By talking to Lily and consulting her medical notes, the nurse can establish Lily’s weight loss over the last 3-6 months (BAPEN, 2009). Asking leading questions regarding Lily’s dietary habits and appetite will give the nurse an understanding of her nutritional intake. If Lily scored 2 or more in the MUST tool then she would be considered high risk (Perry, 2009). Lily will be assessed for her risk of developing a pressure ulcer. A number of evidence-based tools have been developed but the Waterlow pressure ulcer risk
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.
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
Nurses need to realise what they are looking for when performing skin assessments for patients. A study conducted by Thoroddsen et al (2013), found that out of 45 patients that had pressure ulcers only 27 were correctly recorded in the patient’s records.
Thus, the expected outcome is that there is prevention of skin breakdown relating to pressure ulcers during hospitalizations for patients.
as well. Evidence-based practice could be used to see what could have been done to prevent pressure ulcers,
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.
Most patients who end up in intensive care unit are most of the time so unstable that any little movement will put them at risk for further complications which can lead to death. However, finding a way to prevent pressure ulcer in the most critical ills patients in the healthcare system is very crucial.
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.
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
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
I will methodically analyze all parts of the study to assess the validity of the article, by contrasting and comparing the information provided, with previous literature. I will try to make sure that recommendations provided by the authors are congruous with nursing practice and beneficial to the advancement of it. I will as much as possible provide in depth detail of previous studies on the same topic that either support or contradict the analysis provided by this study and its authors.
There are many literatures insist on improving health care and patient involvement, as part of nurses 'roles, nurses facilitate patients' ability to make decisions, so that patients actively participate so that their health problems. This study was aimed at to help nurses to understand how patients could involve in their health issue in particular pressure injury prevention (PIP). It also helps researchers develop their knowledge and improve existing and future strategies of PIP.