Pressure Ulcer Practice In Nursing Practice
SYNTHESIZING EVIDENCE PRACTICE
IFEOMA DIMKPA, RN/BSN
BRADLEY UNIVERSITY
Introduction
Pressure ulcer is simply a compromise to skin integrity. It is caused by immobility, poor nutrition, poor circulation and even little things like creases from the bed sheet. The issue of pressure ulcer in the elderly especially in long term facility is a growing concern because it could lead to infection, discomfort and even depression. This leads me to my research question: In patients admitted in a skilled Nursing facility who are over 65 years (P), how does teaching nurses the risk factors of pressure ulcer, implementing a tool for assessment and providing appropriate preventive measures to high risk patients (I) compared to not providing teaching, tools for assessment and appropriate preventative interventions (C) affect the decrease in pressure ulcer occurrence in this patient population (O) within six months of admission. I am interested in knowing if there will be a decrease in pressure ulcer cases when effort is put into educating nurses and also providing the tools for assessment …show more content…
and modification.
Synthesis of the evidence
The three studies that this paper will focus on are: repositioning for pressure ulcer prevention in adults ( Gillespi, Chaboyer, Mclness, Kent, witty & Thalib, 2014). Resource for this article is from the Cochrane Library. The second study is the comprehensive assessment and management of the critically ill. In: Evidence-based geriatric nursing protocols for best practice (HIGN, 2012). Resource is from National Guideline Clearing House. The third study is Support surfaces for pressure ulcer prevention (Mclness, Blasi, Syer, Dumville & Cullum, 2015). Resource is also from the Cochrane Library.
All three studies have one similarity which is on prevention or reduction of the incidence of pressure ulcer. The first study “Repositioning for pressure ulcer prevention in adults” ” (Gillespi, Chaboyer, Mclness, Kent, witty & Thalib, 2014) sheds light on proper positioning and routine repositioning schedules to improve body alignments and decrease pressure on the ulcer prone areas of the body. The study suggests that the area of the body that carries the weight of the body is deprived of oxygen after a long period of time which results in pressure ulcer (Defloor 2000). Frequent repositioning helps redistribute weight and increases circulation of oxygen around the tissues. This will lead to a decrease in the risk of pressure ulcer. The objective of the second study was on preventing skin breakdown and prompt identification of early signs of pressure ulcer. (HIGN, 2012). The study shows us that early detection of patients at risk is also a tool for preventing pressure ulcer (HIGN, 2012). The third article also focuses on prevention with emphasis on the appropriate surface that patients at risk should be placed on. Study suggests that placing patients on a pressure relieving mattress reduces stress in the press prone areas which then helps in preventing ulcer in patients. All three articles agree that prevention is the first and important step in reducing pressure ulcer incidence.
In as much as that they have similar objectives; these three studies all have unique elements to them. The first study recommends that bed bound patients be repositioned on a more frequent schedule. E.g. every 2 hours. . Study adds that it reduces the amount of pressure on the tissue and helps with oxygen circulation to that tissue (Gillespi, Chaboyer, Mclness, Kent, witty & Thalib, 2014). The second study emphasizes on prompt recognition of high risk patients and prompt recognition of the disease (HIGN, 2012). This is unique from the other studies because it focuses on teaching the clinician on tools to assess a patient and when to assess the patient. It adds that a complete head to toe assessment be done upon admission into the facility (HIGN, 2012). The third study’s unique addition to the evidence is the emphasis on the prevention instrument. It sheds light on the importance of pressure relieving surfaces that will even out weight proportionally in order to prevent skin breakdown (Mclness, Blasi, Syer, Dumville & Cullum, 2015).
The three articles presented above have no disagreement or different outcomes. They all agree on prevention as the key in reducing pressure ulcer. The strengths of the first study (repositioning) and third study (support surfaces) is the randomized controlled trials (RCTs) and quasi-randomized trials that was carried out. These trials fall under the level 1 and level 2 on the evidence pyramid. Test population, methods, materials were clearly stated. The strength of the study on comprehensive assessment and management was that there were multiple identified potential benefits to the patients, the physicians and the institution and no potential harm identified.
The three studies have narrowed the answers to the research question asked.
The question of the importance of educating nurses on identifying risk factors related to pressure ulcer was addressed. The second article on comprehensive assessment recommends that the clinicians should focus identifying risk factors and patients at risk of developing pressure ulcer (HIGN, 2012). This answers the question of the importance of educating nurses on risk factors. The other two studies shed light on the tools and intervention in prevention and treatment of pressure ulcer. The first article talks about implementing the use of pressure relieving surfaces to relieve pressure prone areas (Mclness, Blasi, Syer, Dumville & Cullum, 2015). The third article suggests that repositioning patients on a scheduled time will assist in preventing ulcer (Gillespi, Chaboyer, Mclness, Kent, witty & Thalib,
2014).
Conclusion
The evidences from these three articles will bring about a positive view to the treatment of patients who are 65 years and older. The proposed change would be a decline in the incidents of pressure ulcer among this group. Nurses will pay attention to the nutritional status, mobility and functional status of the patients. Patients 65 years or older will be free from pressure ulcer since the level of care will increase.
The recommendations to these changes would be to perform initial head to toe assessment on newly admitted patients. The information gathered should be documented properly because it will be a source of reference and comparison. Nurses will be educated on risk factors, identifying patients at risk and the prevention interventions needed to prevent ulcer. A pressure relieving surface should be provided to at risk patients. Education on importance of repositioning should be provided to nurses, caregivers and even patients. This will equip staff, family members and patients on working together to prevent pressure ulcer.
IFEOMA DIMKPA, RN/BSN
BRADLEY UNIVERSITY
Introduction
Pressure ulcer is simply a compromise to skin integrity. It is caused by immobility, poor nutrition, poor circulation and even little things like creases from the bed sheet. The issue of pressure ulcer in the elderly especially in long term facility is a growing concern because it could lead to infection, discomfort and even depression. This leads me to my research question: In patients admitted in a skilled Nursing facility who are over 65 years (P), how does teaching nurses the risk factors of pressure ulcer, implementing a tool for assessment and providing appropriate preventive measures to high risk patients (I) compared to not providing teaching, tools for assessment and appropriate preventative interventions (C) affect the decrease in pressure ulcer occurrence in this patient population (O) within six months of admission. I am interested in knowing if there will be a decrease in pressure ulcer cases when effort is put into educating nurses and also providing the tools for assessment …show more content…
and modification.
Synthesis of the evidence
The three studies that this paper will focus on are: repositioning for pressure ulcer prevention in adults ( Gillespi, Chaboyer, Mclness, Kent, witty & Thalib, 2014). Resource for this article is from the Cochrane Library. The second study is the comprehensive assessment and management of the critically ill. In: Evidence-based geriatric nursing protocols for best practice (HIGN, 2012). Resource is from National Guideline Clearing House. The third study is Support surfaces for pressure ulcer prevention (Mclness, Blasi, Syer, Dumville & Cullum, 2015). Resource is also from the Cochrane Library.
All three studies have one similarity which is on prevention or reduction of the incidence of pressure ulcer. The first study “Repositioning for pressure ulcer prevention in adults” ” (Gillespi, Chaboyer, Mclness, Kent, witty & Thalib, 2014) sheds light on proper positioning and routine repositioning schedules to improve body alignments and decrease pressure on the ulcer prone areas of the body. The study suggests that the area of the body that carries the weight of the body is deprived of oxygen after a long period of time which results in pressure ulcer (Defloor 2000). Frequent repositioning helps redistribute weight and increases circulation of oxygen around the tissues. This will lead to a decrease in the risk of pressure ulcer. The objective of the second study was on preventing skin breakdown and prompt identification of early signs of pressure ulcer. (HIGN, 2012). The study shows us that early detection of patients at risk is also a tool for preventing pressure ulcer (HIGN, 2012). The third article also focuses on prevention with emphasis on the appropriate surface that patients at risk should be placed on. Study suggests that placing patients on a pressure relieving mattress reduces stress in the press prone areas which then helps in preventing ulcer in patients. All three articles agree that prevention is the first and important step in reducing pressure ulcer incidence.
In as much as that they have similar objectives; these three studies all have unique elements to them. The first study recommends that bed bound patients be repositioned on a more frequent schedule. E.g. every 2 hours. . Study adds that it reduces the amount of pressure on the tissue and helps with oxygen circulation to that tissue (Gillespi, Chaboyer, Mclness, Kent, witty & Thalib, 2014). The second study emphasizes on prompt recognition of high risk patients and prompt recognition of the disease (HIGN, 2012). This is unique from the other studies because it focuses on teaching the clinician on tools to assess a patient and when to assess the patient. It adds that a complete head to toe assessment be done upon admission into the facility (HIGN, 2012). The third study’s unique addition to the evidence is the emphasis on the prevention instrument. It sheds light on the importance of pressure relieving surfaces that will even out weight proportionally in order to prevent skin breakdown (Mclness, Blasi, Syer, Dumville & Cullum, 2015).
The three articles presented above have no disagreement or different outcomes. They all agree on prevention as the key in reducing pressure ulcer. The strengths of the first study (repositioning) and third study (support surfaces) is the randomized controlled trials (RCTs) and quasi-randomized trials that was carried out. These trials fall under the level 1 and level 2 on the evidence pyramid. Test population, methods, materials were clearly stated. The strength of the study on comprehensive assessment and management was that there were multiple identified potential benefits to the patients, the physicians and the institution and no potential harm identified.
The three studies have narrowed the answers to the research question asked.
The question of the importance of educating nurses on identifying risk factors related to pressure ulcer was addressed. The second article on comprehensive assessment recommends that the clinicians should focus identifying risk factors and patients at risk of developing pressure ulcer (HIGN, 2012). This answers the question of the importance of educating nurses on risk factors. The other two studies shed light on the tools and intervention in prevention and treatment of pressure ulcer. The first article talks about implementing the use of pressure relieving surfaces to relieve pressure prone areas (Mclness, Blasi, Syer, Dumville & Cullum, 2015). The third article suggests that repositioning patients on a scheduled time will assist in preventing ulcer (Gillespi, Chaboyer, Mclness, Kent, witty & Thalib,
2014).
Conclusion
The evidences from these three articles will bring about a positive view to the treatment of patients who are 65 years and older. The proposed change would be a decline in the incidents of pressure ulcer among this group. Nurses will pay attention to the nutritional status, mobility and functional status of the patients. Patients 65 years or older will be free from pressure ulcer since the level of care will increase.
The recommendations to these changes would be to perform initial head to toe assessment on newly admitted patients. The information gathered should be documented properly because it will be a source of reference and comparison. Nurses will be educated on risk factors, identifying patients at risk and the prevention interventions needed to prevent ulcer. A pressure relieving surface should be provided to at risk patients. Education on importance of repositioning should be provided to nurses, caregivers and even patients. This will equip staff, family members and patients on working together to prevent pressure ulcer.