Pressure Ulcers Management and Research

Abstract

The paper focuses on one of the biggest problems of the modern healthcare system: pressure ulcers. Although considerable breakthroughs in medicine have enabled medical workers to save people’s lives and provide them with the highest quality of care, a viable approach to managing pressure ulcers has not been found yet. Apart from defining the issue and outlining its classification, the project involves the intervention aimed at reducing the risk of pressure ulcers.

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The paper is divided into several meaningful parts. In the introduction, the general description of the issue and brief information on the intervention is given. Further, risk assessment tools are identified and analyzed. The next chapter is concerned with the suggested solution to the problem. The PICOT question is formulated, and a detailed explanation of the intervention is provided. The concluding section summarizes the issue and the approach to its management and offers directions for future research.

Thesis Statement

Pressure ulcers present one of the greatest burdens in the modern healthcare system, the correct management of which requires an individual approach and prevention measures, one of the most successful being the pressure ulcer protocol.

Introduction

Despite a considerable amount of achievements that have been made in the sphere of medicine over the latest decades, there remain some problems that healthcare practitioners cannot manage properly. One of such burdens is known as pressure ulcers or bed sores. Pressure ulcers are defined as the local damage of skin or tissue that has been caused by pressure and friction (Lam et al., 2018). This dangerous condition is frequently associated with insufficient nursing care. However, research indicates that the risk of developing pressure ulcers depends more on the patient’s condition than on nurses’ attitude (Mallah, Nassar, & Kurdahi Badr, 2015).

Most frequently, the cases of pressure ulcers are recorded in patients staying at intensive care units. Such prevalence is related to the fact that these individuals are immobile, which is the primary indication for the development of bedsores.

One of the most successful ways of preventing pressure ulcers is risk assessment. Qaseem, Mir, Starkey, and Denberg (2015) differentiate between the following risk assessment tools: the Waterlow scale, the Cubbin, Braden, Norton, and Jackson scales. However, it is mentioned that all of these tools have a low sensitivity to single outpatients at risk for developing pressure ulcers. Thus, one of the viable solutions is presented with preventive interventions. There is a variety of interventions offered: nutritional supplementation, low-air-low bed, wheelchair cushions, advanced static mattresses, and others (Qaseem et al., 2015).

Still, scholars admit that the quantity of interventions does not correspond to their quality. As a result, some new approaches are needed to relieve the condition of many patients suffering not only from immobility but also from its complications.

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A novel approach to preventing pressure ulcers has been introduced recently. Lam et al. (2018) note that using pressure ulcer prevention protocols may help healthcare workers to avoid the development of bedsores in their patients. In particular, scholars suggest that since pressure ulcers develop in three days upon admission, it is necessary to pay thorough attention to the patients during these three days. So far, there is not enough evidence on the productivity of this method, but the current project aims at evaluating the benefits of such protocols for patients.

Literature Review

Pressure ulcers (also referred to as bedsores) denote the damage of skin due to friction or prolonged pressure (Lam et al., 2018). The condition mainly occurs among patients at the acute care unit since they are immobile. The possibility of developing pressure ulcers is reliant more on the condition of the patient than the attitude of nurses. The prevalence of pressure ulcers in the US is approximately 38% in intensive care units. In writing the literature review, the databases used were Google and online libraries such as EBSCOhost and Emerald.

Decreasing preventable pressure ulcers is the major goal of public health sectors worldwide. Bedsores have a negative impact on the health and welfare of patients (Harrison, 2013). Reducing pressure ulcers through successful management is intricate and of fundamental significance to patient safety and quality of care.

The effects of pressure ulcers are detrimental to the patient, the legal system, and the already overstrained medical field. The impact varies reliant on the severity of tissue damage, treatment practice, and the general condition of the individual (Spear, 2013). Increased knowledge by health professionals concerning the underlying problem enhances their understanding of the implementation of effective prevention practices with the people at risk.

Pressure ulcers are linked to a high death rate, morbidity, and medical costs. Moreover, the condition has been established to cause poor quality of life, intense pain, affliction, prolonged hospitalization, and in worst cases, death (Mallah, Nassar, & KurdahiBadr, 2015). Though there are numerous nursing interventions regarding pressure ulcers, there is a scarcity of studies on the most effective nursing approach.

While mulling over the best intervention for pressure ulcer reduction and prevention, it is vital to understand that the implementation of a successful practice at the bedside is an exceedingly difficult task. The factor that makes pressure ulcer prevention complex is it’s being multidisciplinary; that is, nurses, doctors, dieticians, and members of the patient’s family are among those who require being an investment (Preventing pressure ulcers in hospitals, 2014). Furthermore, the prevention of bedsores should be customized since every patient is different. Thus, care has to tackle their distinctive needs.

Prevention approaches for pressure ulcers start with the recognition of high-risk people. Most of the interventions include numerous support surfaces (for instance, mattresses, incorporated bed systems, and cushions, to mention a few), nutrition, and skincare (Qaseem, Mir, Starkey, & Denberg, 2015). Health professionals should arrive at individualized decisions anchored in risk assessment on whether to employ a single or multi-component strategy to prevent bedsores in patients.

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Developing hospital-acquired pressure ulcers (HAPUs) has been connected to immobilization and lengthy stays in hospitals. In their study, Lam et al. (2018) sought to assess effective measures of reducing hospital-acquired pressure ulcers. Some of the preventive approaches for bedsores encompass pressure-decreasing beds, facilitated nutritional support, compulsory two-hour alteration of posture, examination by wound care nurses, and education to healthcare professionals. Such approaches as the provision of specialized equipment and educational approaches were associated with a considerable reduction in the prevalence rates of hospital-acquired pressure ulcers.

The likelihood of developing pressure ulcers depends more on the condition of the patient than the attitude of caregivers. Bedsores present an overwhelming burden to the healthcare system and the economy at large. One of the most effective approaches to preventing the condition is enhanced risk assessment. The management of pressure ulcers calls for individualized practice and education of caregivers.

Discussion

The topic of pressure ulcers appears to be highly relevant in the scientific community in the health care sphere. Many professionals and intellectuals burden themselves with identifying reasons for the development of bedsores. One of the major discoveries pertinent to the current research is that a patient’s condition serves as a more reliable predictor of pressure ulcers than the amount of provided nursing care (Mallah et al., 2015). Such knowledge allows nurses, physicians, and other health care professionals to focus on their efforts with higher effectiveness and to address the matter adequately. In particular, high-risk patient groups might be identified, and their health condition could be managed with specific attention paid to pressure ulcers.

The literature review has also revealed an overwhelming prevalence of this detrimental aliment as well as its negative economic and legal consequences. In light of this, it appears to be paramount to use interventions that target groups of patients prone to the development of this condition in order to reduce the risks of financial losses. Otherwise, pressure ulcers would continue to draw resources from clinics preventing their effective functioning (Banks, Graves, Bauer, & Ash, 2013).

In addition, the improper management of this matter could take a severe toll on the image of a health care institution as well as the professionals employed there. On the level of the health care system, the problem of bedsores may incur serious losses of taxpayers’ money, which undermines effective budget management.

Elimination or, at least, decreasing the losses that the issue currently inflicts could help officials to channel funds into more relevant and pressing matters. However, resources are needed to tackle bedsores, and their guided use will define the success of any initiative in this area (Spetz, Brown, Aydin, & Donaldson, 2013). In particular, managerial and professional interventions will be among the critical elements that can assist clinics in the reduction of pressure ulcer incidence. As indicated in the literature review, organizational efforts and immobilized patient care seem to be the areas in which researchers found the greatest number of flaws. In this regard, the search for the most effective field interventions proposed in the thesis appears to be warranted.

As for the actions proposed by the intellectuals, there are a number of cost-effective and evidence-based solutions to the bedsore issue. Thus, hospital-acquired pressure ulcers can be managed more effectively through the usage of pressure-decreasing beds (Lam et al., 2018). This solution will likely increase the expenses of hospitals in the short term yet, ultimately reduce the economic burden of the institution by decreasing the number of legal pursuits. In addition, less frequent application of health care procedures aimed at mitigation of the bedsore consequences could help the clinics to reduce their spending.

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Educational initiatives mentioned in the literature may also be effective at reducing the incidence of pressure ulcers. The introduction of specific guidelines for nurses on how to manage at-risk patients may decrease the number of bedsore cases (Qaseem et al., 2015). This intervention appears to be less costly than the ones that require specific equipment yet also have a limited effect. In regard to protocols being the most effective prevention measure, the literature review revealed no specific comprehensive action plans. Instead, it identified a list of measures that, if combined, can become a part of a pressure ulcer protocol, such as finding at-risk patients, attention to specific condition markers, and employment of modern screening techniques.

References

Banks, M. D., Graves, N., Bauer, J. D., & Ash, S. (2013). Cost effectiveness of nutrition support in the prevention of pressure ulcer in hospitals. European Journal of Clinical Nutrition, 67(1), 42-46.

Harrison, T. (2013). Preventing pressure ulcers: How to implement a change package to improve pressure ulcer management. Web.

Lam, C., Elkbuli, A., Benson, B., Young, E., Morejon, O., Boneva, D.,… McKenney, M. (2018). Implementing a novel guideline to prevent hospital-acquired pressure ulcers in a trauma population: A patient-safety approach. Journal of the American College of Surgeons, 226(6), 1122-1127.

Mallah, Z., Nassar, N., & Kurdahi Badr, L. (2015). The effectiveness of a pressure ulcer intervention program on the prevalence of hospital acquired pressure ulcers: Controlled before and after study. Applied Nursing Research, 28(2), 106-113.

Preventing pressure ulcers in hospitals. (2014). Web.

Qaseem, A., Mir, T. P., Starkey, M., & Denberg, T. D. (2015). Risk assessment and prevention of pressure ulcers: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 162(5), 359-369.

Spear, M. (2013). Pressure ulcers: What are the implications? Plastic Surgical Nursing, 33(3), 147-149.

Spetz, J., Brown, D. S., Aydin, C., & Donaldson, N. (2013). The value of reducing hospital-acquired pressure ulcer prevalence: An illustrative analysis. Journal of Nursing Administration, 43(4), 235-241.

Annotated Bibliography

Harrison, T. (2013). Preventing pressure ulcers: How to implement a change package to improve pressure ulcer management. Web.

The study conducted within the Medway NHS Foundation Trust concerns some modern measures and organizational tools targeting the reduction of the adverse outcomes of pressure ulcers in immobile patients. The targeted audience of the article is the medical workers, nurses, and scholars in the field of healthcare who need informational and educational assistance. Acknowledging the danger of the problem to hospital patients, the scholars utilized Root Cause Analysis to search for possible ways to prevent and treat the traumas of skin acquired in medical facilities. The division of the threats to avoidable and unavoidable presents an opportunity to develop specific measures and action plans necessary for particular types of patients. Thus, the article is a compulsory source for the investigation of the modern ways of resolution of ulcer-related problems, their evaluation, and possible improvement during the following analysis.

Lam, C., Elkbuli, A., Benson, B., Young, E., Morejon, O., Boneva, D.,… McKenney, M. (2018). Implementing a novel guideline to prevent hospital-acquired pressure ulcers in a trauma population: A patient-safety approach. Journal of the American College of Surgeons, 226(6), 1122-1127.

The article by Lam et al. points out the significance of the problem of pressure ulcers in the modern healthcare sector as a threat to the health of patients with immobility complications. The authors present specific ulcer preventive measures carried out during an experiment arguing their ability to minimize hospital-acquired pressure ulcers (HAPUs). A three-year-long review of the bed-bound patients included a series of interventions such as the usage of special beds, controlled nutrition, and change of position every two hours. Also, there was an educational program introduced to patients and nurses aimed at early recognition of ulcer traumas for their timely treatment. The targeted audience of the article is the medical workers, nurses, and scholars involved in the investigation of the progressive approaches to the resolution of the ulcer problem. The positive results of the study allow it to be used for the current research due to its relevance to the discussed problem.

Mallah, Z., Nassar, N., & Kurdahi Badr, L. (2015). The effectiveness of a pressure ulcer intervention program on the prevalence of hospital-acquired pressure ulcers: Controlled before and after study. Applied Nursing Research, 28(2), 106-113.

The research article presents a valuable source of scientific empirical data due to its practical approach to the resolution of the problem of pressure ulcers. The study was carried out in the medical institution in Lebanon and included pre-intervention and post-intervention data collection and analysis to evaluate the effectiveness of the measures. The authors claim that the utilization of the Braden scale and proper skin care helps to prevent the emergence of skin damage in immobile patients. This study is an influential source of data due to its acute concern about the mortality threat presented by ulcers. The further development of practical interventions is possible due to the research conducted by Mallah, Nassar, and Kurdahi Badr. It might be used as a basis for the introduction of a new approach to preventing pressure ulcers.

Preventing pressure ulcers in hospitals. (2014). Web.

The article created by the Agency for Healthcare Research and Quality gives a broad overview of the available practices in U.S. medicine that enable effective prevention and treatment of pressure ulcers. It aims at providing information not only for specialists in the medical field but also for people who need some authoritative opinion about the issue of skin trauma acquired in hospitals. The authors conduct a structural analysis of the modern practices employed by different practitioners around the USA to underline the importance of the unification of the most significant achievements in this field. It is vital to incorporate the measures of comprehensive skin assessment, progressive, evidence-based care, risk assessment, and staff education to achieve positive outcomes. The article is relevant to the topic of investigation and gives a complete and specified overview of the possible areas for improvement.

Qaseem, A., Mir, T. P., Starkey, M., & Denberg, T. D. (2015). Risk assessment and prevention of pressure ulcers: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 162(5), 359-369.

This source is rich in references and literature based on the theoretical background that validates the significance and relevance of the study for the following use in the academic circles. The authors (the representatives of the American College of Physicians) concern primarily the preventive strategies based on the risk management techniques. It is important that upon the conclusion, the scholars give some valuable recommendations aimed at the improvement of the healthcare of the patients who are at risk for pressure ulcers. These recommendations include grading of the level of particular patients’ risk, utilization of special matrasses for the patients who are at the highest level of pressure ulcers risk and restricting of alternate-air matrasses. The study provides a large amount of data for the following usage in the development of measures aimed at reducing the threats of the ulcers.

Spear, M. (2013). Pressure ulcers: What are the implications? Plastic Surgical Nursing, 33(3), 147-149.

In the history of medicine, the problem of pressure ulcers was usually addressed as the responsibility of the nurses. However, with the advancement of the medical field, the ulcer issue remains relevant even at present. The authors present valid background information explaining the reasons and threats of the skin damage acquired in hospitals to underline the necessity of the specifically organized interventions to minimize the danger. The statistical data provided in the article underlines the acuity of the problem. The references to reliable sources guarantee the relevance of the presented data. Spear emphasizes financial, educational, informational, and medical sides of the discussion necessary to be addressed in a complex to make a change. This source applies to the current study due to its scientific accuracy and complexity.

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