Pressure Ulcer Prevention n the Community - Essay Example

Pressure Ulcer Prevention In the Community Introduction Local health communities should review their existing service provision for pressure ulcer risk assessment and prevention - including the use of pressure-relieving devices (beds, mattresses and overlays) for the prevention of pressure ulcers in primary and secondary care - as they develop their Local Delivery Plans. The review should consider the resources required to implement the recommendations, the people and processes involved, and the timeline over which full implementation is envisaged. It is in the interests of patients that the implementation timeline is as rapid as possible. This is important in the realm of health care, especially when the human aspect is involved in the context of nursing staff. The approach towards management of pressure ulcers is of utmost importance, as this is one of those medical conditions wherein the treatment circumstances greatly impact the final course of healing. This topic hence entails immense significance and needs to be understood in the context of real-time problems that exist within the treatment mechanism. Statement of the Problem The research goes upfront with the hypothesis that the nursing care system can play a vital role in treatment of patients with pressure ulcers. This can largely be speculated due to the fact that it is both an internal and an external condition. Though the internal condition can be taken care of by medicines, the external one largely depends upon the physical environment that is available over there. This is important as this acts as a vector for the study, and gives it the needed direction on order to answer the research question. The said topic was chosen because it gives a very nice converging point for a multitude of study areas, namely internal medicine, external health care, ancillary health services, nursing health care practices and physical atmospheric comforts in healthcare. An all-encompassing issue, this can give an overview about the issue and finally as to what can and is to be doe in the future on this subject. To investigate in detail the aforementioned reason, a number of recent researches on the topic were studied, to evaluate how is this issue being dealt with in real-time. Search engines of the Med-Line and BMJ were consulted for an all encompassing and international perspective on the issue, and the researches subsequently present a very thorough and diverse standing on the subject. Listing of Relevant Literature Following researches conducted on the said topic in the last decade are of significant mention: "Pressure ulcers were once viewed as an inevitable consequence of being infirm and bed-ridden. As it has been recognized that this is not the case, pressure ulcers have come to be seen much more as an indicator of the quality of care provided, and are consequently high on the political and health agenda. This article provides an overview of the key aspects of pressure ulcer risk assessment and prevention drawn from a variety of national policy documents" (Stephen-Haynes, 2004). "To study prevalence of pressure ulcers among functionally impaired patients in the community and evaluate risk factors associated with the development of pressure ulcers in these patients. Design. Cross-sectional, observational study. Community dwellers served by the Primary Health Care Area of Rincon de la Victoria in Malaga.Participants. All patients included in the Impaired Patient Programme (n=178). Prevalence of pressure ulcers in our Basic Health Area was 12.9%. The most important sociodemographic characteristic associated with the presence of pressure ulcers in these patients was the educational attainment of the caregiver. Health variables of the patient were also associated with the risk of developing ulcers. Results indicate the need of diagnostic protocols with standardised instruments and prevention plans to reduce pressure ulcers in the community. Longitudinal studies are needed to evaluate interventions in this area" (Galvez et al, 2002). "This study aims to provide an insight into wheelchair users' preventative health behaviours with respect to pressure-relief behaviour, perceived risk and attribution of responsibility for preventative health measures. Wheelchair users who are dependent upon a wheelchair for their indoor and outdoor mobility have a long-term risk of developing a pressure ulcer. Of those who responded, 20.8% moved only once an hour and a further 54.7% moved less often than once an hour. This study is part of a wider study investigating the preventative health behaviours of wheelchair users" (Stockton and Parker, 2002). "Research regarding pressure area care and management in nursing extends back many years, but remains relevant and cited today. With relevant knowledge, midwives can help prevent the development of pressure sores in the maternity setting. Improvements in the appropriate prevention and subsequent treatment and management of pressure sores will benefit women and help save the NHS hundreds of thousands of pounds in treatment and litigation costs" (Prior, 2002). "Pressure ulcers are a difficult and complex problem, frequently resulting in poor patient outcomes and significantly increased cost of care. This project evolved from a desire to improve the management and subsequent outcomes for persons with spinal cord injury (SCI) who experience pressure ulcers acquired in the community. The vast body of work related to pressure ulcers has focused on risk assessment and prevention. A number of issues are identified that relate to funding, diet, attitudes, consistency of care, and low levels of staff interest in pressure ulcer management. This work provides baseline data from which current management practices can be reviewed, revised, and empirically evaluated" (Wellard, 2001). "In 1998, 89 health care institutions (hospitals, nursing homes, residential homes, and community care institutions) participated in the first Dutch National Pressure Ulcer Prevalence Study. It is concluded that participating in the first national prevalence study was a positive experience for the institutions, because agenda-setting took place and most started to plan or implement activities to improve the prevention and treatment of pressure ulcers" (Halfens et al, 2001). "Drug errors, hospital-acquired pressure injuries, and patient falls top the list of hospitals most frequent adverse events. Following a serious medical error in 1995, University Community Hospital in Tampa built a data-driven patient-safety program that has led to reductions in all three categories of error" (Journal of Clinical Resource Management, 2000). "Good nutrition is essential throughout life and often patients have a poor understanding of what a balanced diet comprises. Nurses need to have a good comprehension of malnutrition. Where malnutrition is evident it can be resolved by working with the patient to encourage a healthy diet. One way to improve patient nutrition is by a nutrition audit of patient food. A solution to this problem is to use nutritional tools to highlight nutritional deficiency in a patient's diet not only in hospitals but also in the community and in nursing homes" (Russell, 2000). "To identify predictors of pressure ulcers in men with spinal cord injury over a 3-year period. Interviews, questionnaires, and physical examinations were completed in two phases, 3 years apart. Information obtained included demographic and spinal cord injury characteristics; ulcer history; health beliefs and practices; measures of impairment, disability, and handicap; and skin integrity. Phase 1 predictors of ulcer presence at Phase 2 examination were similar to predictors for self-reported ulcers. Individuals with the identified predictive characteristics are at greater risk for developing pressure ulcers. These individuals should receive additional interventions to reduce that risk. Potential interventions include more systematic and frequent follow-up, frequent review of pressure ulcer prevention and management strategies, and provision of needed personal assistance and relevant equipment" (Garber et al , 2000). "A pressure ulcer is an area of localized tissue destruction directly related to prolonged pressure. Once the individual develops an ulcer, assessment of healing is critical to determine the appropriate treatment. Successful treatment depends on the principles of debridement, cleansing, bacterial control, wound dressing, and occasionally, surgical intervention" (Ratliff and Rodeheaver, 1999). "A large proportion of home care patients present with pressure ulcers, and many more patients are at risk. Home care nurses have an opportunity to manipulate favorably certain environmental factors that can prevent pressure ulcers from forming and to develop effective treatment plans for ulcers once they occur. This article discusses the current practice for pressure ulcer prevention. Next month, a companion article will explore treatment strategies for these wounds" (Macklebust, 1999). "A questionnaire mailed to all 2,295 members of the Eastern Paralyzed Veterans Association measured 45 potential risk factors for pressure ulcers. Logistic-regression analysis and Cox proportional-hazards analyses were used to identify the variables that were independently associated with pressure ulcers. It appears to be a more accurate method of predicting pressure ulcers than currently used risk assessment scales" (Salzberg et al, 1998). "Pressure sores remain a significant problem in hospitals and domestic settings, affecting people of all ages, social class and race. Associated complications may be life threatening, e.g. sepsis and osteomyelitis. Other less dangerous, but nevertheless compromising outcomes such as pain, discomfort and low self-esteem and body image can cause personal suffering, and may add extra demand for limited resources. Pressure sore risk assessment and classification are discussed, and an overview of nutrition, moving a handling, selecting support surfaces, principles of wound management, and skin care are considered" (Culley, 1998). "As the population ages and becomes more frail, pressure ulcer prevalence and incidence within specific care settings are being evaluated through outcomes review. This article summarizes the process and outcomes of an ongoing prevalence study at a 300-bed acute care community hospital. After implementation of the Total Quality Management model at our Institution, the prevalence of patients with nosocomial pressure ulcers was reduced by 83%" (Drew and Sacharok, 1998). "The need for effective pressure support systems is often overlooked in the community. Through patient assessment is required for the selection of pressure-reducing aids. Patients should be involved in the selection process, and any equipment chosen must be suitable for the home environment" (Cowan, 1996). "The purpose of this study was to identify factors that resulted in severe pressure ulcers in a community-based sample of 23 persons with spinal cord injury (SCI). A correlational design was used. Twenty men and three women, 57% with tetraplegia and 43% with paraplegia, participated. Adult participants with an ulcer of 12 weeks' duration or less were recruited from the plastic surgery clinic of a regional SCI center. The findings suggest that educational programs should emphasize more strongly immediate visits to a physician upon detection of an ulcer. Furthermore, such educational models should be assessed for their effectiveness in reducing ulcers and preventing progression in severity once persons with SCI return to the community" (Garber et al, 1996). "The purpose of this investigation was to render a more complete understanding of subjective perceptions of pressure ulcers from the perspective of family dyads, and to study the effect of these subjective experiences on preventive behaviors and pressure ulcer outcomes. Shared care was a pattern of interaction used successfully by family members to prevent pressure ulcers in patients at risk" (Sebern, 1996). "This article reviews the etiology, pathology, description, risk factors, prevention, medical and surgical management, and complications of pressure ulcers. Pressure ulcers, which develop primarily from pressure and shear, are also known as decubitus ulcers, bed sores, and pressure sores. Areas of ongoing research such as electrical stimulation and growth factors are discussed" (Yarkony, 1994). "The prevention and management of pressure ulcers often creates challenging situations requiring specialized knowledge and expert, consistent nursing care. In order to promote pressure ulcer prevention and control costs at a 350-bed community hospital, a "Pressure Ulcer Prevention Program" was developed. An overall decrease in pressure ulcer incidence was found and the documentation of pressure ulcer prevention was improved" (Jones, 1993). "135 patients developed pressure ulcers during four weeks after admission. The weekly incidence of patients with pressure ulcers was 6.2% (95% confidence interval 5.2% to 7.2%). Although risk assessment scales predict the occurrence of pressure ulcers to some extent, routine use of these scales leads to inefficient use of preventive measures. An accurate risk assessment scale based on prospectively gathered data should be developed" (Schoonhoven et al, 2002). "Several fundamental issues around the use of pressure risk scales are highlighted by the article by Schoonhoven et al. These scales are poor predictors of pressure ulcer development, but nurses are encouraged to use them to meet the clinical governance agenda. With changes in demography, earlier discharge from hospital, the threat of litigation, and an ever higher reliance on community services, nurses and clinicians will need more potent evidence to support their management of patients at risk of pressure ulcer development" (Franks et al, 2003). "Although risk assessment scales for pressure ulcers predict the occurrence of pressure ulcers to an extent, strict application leads to inefficient use of preventive measures. Schoonhoven and colleagues used the Norton, Braden, and Waterlow scales to predict the development of pressure ulcers in hospital patients. In a group of 1229 patients studied over 2190 patient weeks none of the scales satisfactorily predicted the development of pressure ulcers. Most risk assessment scales are based on expert opinion or literature review and have not been evaluated" (British Medical Journal, 2002). "Gerben ter Riet and colleagues report a double blind randomised trial of ultrasound treatment and placebo in 88 patients with pressure ulcers; they found no significant differences between the treatments. They stated: In designing the double-blind study, it was anticipated that ultrasound would double the healing rate of pressure sores. For such a common condition what is needed is a large, pragmatic multicentre (multinational) double blind trial comparing ultrasound treatment (as practised for pressure ulcers by the individual centres) with placebo. Large pragmatic trials are now common in cancer and other diseases.3 They are the only means to answer important questions such as those posed here" (Machin, 1995). "Pressure ulcers can have a devastating impact on health and care provision, ranging from patient discomfort and increased healthcare costs to a potential reflection on the quality of care. To evaluate the outcomes of prevention education and skin integrity interventions on the incidence of pressure ulcers, a multiphase project was initiated in an urban 154-bed regional referral community hospital in Ontario, Canada that provides care to an urban and rural population. The results suggest that education and the implementation of appropriate skin care products and procedures and pressure ulcer prevention protocols may reduce the incidence of hospital-acquired pressure ulcers" (Cole and Nesbitt, 2004). Research Evaluation According to Nine Point Plan of Evaluating Research The specimen research considered here entails, "The aim of this research was to establish whether the attitudes and expectations of senior nursing staff might adversely affect patient outcomes in the prevention of pressure ulcers. The hypothesis was that nursing locus of control affects clinical outcomes in patients. In particular, it affects departmental prevalence of pressure damage. A population of nurses (n = 439) in an acute and community NHS trust were surveyed to test knowledge, control beliefs and value of pressure ulcer prevention relative to prevalence. The research was designed to provide different data against which to test the hypothesis: first, to assess acceptability of nurses' knowledge of prevention and appropriate use of risk assessment and equipment; second, to calculate a mean departmental pressure ulcer prevalence; and third, to measure locus of control and value, which is the focus of this article. There were strong associations between departmental prevalence of pressure ulcers and attitudes of senior nursing staff. For example, the more that ward sisters believed they could control pressure ulcer prevention, the higher the prevalence of ulcers in their department. The more that sisters believed that they could not control prevalence, the lower the prevalence of ulcers. The study shows that failure to account for beliefs, values and expectations of staff could lead to patient harm. It is suggested that it might be counterproductive to put great effort into developing clinical guidelines and refinement of risk assessment methods. The findings have important implications for nursing, and challenge the assumption that nurse leaders are universally beneficial to patients" (Maylor, 2001). 1) Aims of the study The aim was to establish whether the senior nursing staff's attitude may affect the treatment of pressure ulcer patients adversely. The topic was tackled appropriately. 2.) The study and the research design It started with the hypothesis that the nursing locus can affect clinical care because of its sheer proximity to the situation at hand. The hypothesis was exploratory in nature, whereby the result or impact of a particular independent variable (nursing behavior) was sought out on a dependent variable (pressure ulcer treatment). 3.) Sample in the study A population of nurses (n = 439) in an acute and community NHS trust were surveyed to validate the said hypothesis. 4.) How were the terms defined The research was designed to provide different data against which to test the hypothesis: first, to assess adequacy of nurses' awareness of prevention and appropriate use of risk assessment and equipment; second, to evaluate an average departmental pressure ulcer incidence; and finally, to measure area of control and impact of the nursing staff. 5.) What counted as data The accounts, evaluations and retrospective opinionated accounts of the nurses counted as the data. It was largely qualitative in nature and hence subjective in essence. 6) What questions were asked/not asked The ward nurses were asked evaluative, clinical based and profession related questions pertaining to the treatment and care of pressure ulcer patients. 7) Who did the research A health care professional, Maylor, of the School of Care Sciences, University of Glamorgan, Pontypridd, Mid Glamorgan conducted the research. 8) What was the theoretical framework Primarily implicit in nature, the theoretical nature based upon deductive reasoning, and evolved an answer based upon the analysis of the environmental stimuli around the topic statement. 9) How were ethics observed or not observed Extensive emphasis was not highlighted with regards to ethics, largely because the sample was voluntary, and asked for opinionated responses. Summary In light of the aforementioned literature review,. It can be assumed with the help of scientific evidence that nursing care, and overall health care methodologies in general within a community can play a vital role in the treatment of patients with pressure ulcer. They demand specialized care in the context of the medication, as well as the physical environment. Precautionary measures are also essential; it generates a mutual relationship between the health care provider and the patient with that 'extra' bit that goes into patient care. This goes on to elucidate that idea that leaders are in effect very important of the health care system. As they develop those successful strategies and processes, which are ultimately beneficial for the cause of the human race. Though a variety of researches from all over the world done in the past one year were reviewed, they more or less culminated at the very same stance, which ultimately goes on to prove the initial hypothesis stated in the research question. The fact of the matter is,. That nursing intervention is crucial to the cure of patients with pressure ulcer. Patients heavily rely upon their respective health care providers for support, education and training into how to take care of their respective disease. Another subsidiary lesson drawn from the study was understanding of the research process. It was observed, that it is imperative for any study to be held valid and reliable, a comprehensive stance upon the issue should be followed. This in turn means, that the steps involved in conducting a research must be religiously adhered to. Conclusion This research believes to have established that there is a strong directly proportional link between the health care provided by the community, vis--vis the treatment of pressure ulcers. Nursing staff, health care providers, ancillary health professionals, and the community at large have to play a major role in the successful dealing of the patients with this disease. This was largely attributable to the fact that this disease has both internal and external determinants; though the internal ones shall be dealt with by medications, the external ones are heavily dependent upon how well are the environment stimuli controlled within the health care system. It was also found that the ever changing variables within a system can greatly induce the results found in a research. Therefore, it is imperative, both for the cause of this research and for the sake of research in general, that a standardized research system should be adopted. References British Medical Journal. (2002). Scales do not assess the risk of pressure ulcers. 3 Jan 2006. . Cole, N. and Nisbett, C. (2004). A three year multiphase pressure ulcer prevalence/incidence study in a regional referral hospital. Journal of Ostomy Wound Management. 3 Jan 2006. . Cowan, T. (1996). Pressure-reducing aids for community use. Journal of Professional Nursing. 3 Jan 2006. . Culley, F. (1998). Nursing aspects of pressure sore prevention and therapy. British Journal of Nursing. 3 Jan 2006. . Drew, J. and Sacharok, C. (1998). Use of a total quality management model to reduce pressure ulcer prevalence in the acute care setting. Journal of Wound Ostomy Continence Nursing. 3 Jan 2006. . Franks, P. et al. (2003). Risk assessment scales poorly predict pressure ulceration. British Medical Journal. 3 Jan 2006. . Galvez, C. et al. (2002). Prevalence and risk factors for pressure ulcers. Aten Primaria. 3 Jan 2006. . Garber, S. et al. (1996). Reported pressure ulcer prevention and management techniques by persons with spinal cord injury. Archives of Physiological Medical Rehabilitation. 3 Jan 2006. . Garber, S. et al. (2000). Pressure ulcer risk in spinal cord injury: predictors of ulcer status over 3 years. Archives of Physiological Medical Rehabilitation. 3 Jan 2006. . Halfens, R. et al. (2001). The impact of assessing the prevalence of pressure ulcers on the willingness of health care institutions to plan and implement activities to reduce the prevalence. Journal of Advanced Nursing. 3 Jan 2006. . Jones, S. et al. (1993). A pressure ulcer prevention program. Journal of Ostomy Wound Management. 3 Jan 2006. . Journal of Clinical Resource Management. (2000). Intensive safety effort cuts falls, ulcers, and drug errors at once-disgraced FL hospital. 3 Jan 2006. . Machin, D. (1995). Ultrasound treatment for pressure ulcers. British Medical Journal. 3 Jan 2006. . Macklebust, J. (1999). Preventing pressure ulcers in home care patients. Journal of Home Healthcare Nursing. 3 Jan 2006. . Maylor, M. (2001). Senior nurses' control expectations and the development of pressure ulcers. Journal of Nursing Standards. 3 Jan 2006. . Prior, J. (2002). The pressure is on: midwives and decubitus ulcers. RCM Midwives Journal. 3 Jan 2006. . Ratliff, C. and Rodeheaver, G. (1999). Pressure ulcer assessment and management. Lippincotts Primary Care Practice. 3 Jana 2006. . Russell, L. (2000). Malnutrition and pressure ulcers: nutritional assessment tools. British Journal of Nursing. 3 Jan 2006. . Salzberg, C. et al. (1998). Predicting and preventing pressure ulcers in adults with paralysis. Journal of Advances Wound Care. 3 Jan 2006. . Schoonhoven, L. et al. (2002). Prospective cohort study of routine use of risk assessment scales for prediction of pressure ulcers. British Medical Journal. 3 Jan 2006. . Sobern, M. (1996). Explication of the construct of shared care and the prevention of pressure ulcers in home health care. Journal of Resident Nursing Health. 3 Jan 2006. . Stephen-Haynes, J. (2004). Pressure ulcer risk assessment and prevention. British Journal of Community Nursing. 3 Jan 2006. . Stockton, L. and Parker, D. (2002). Pressure relief behaviour and the prevention of pressure ulcers in wheelchair users in the community. Journal of Tissue Viability. 3 Jan 2006. . Wellard, S. (2001). An Australian experience of managing pressure ulcers in persons with SCI. SCI Nursing Journal. 3 Jan 2006. . Yarkony, G. (1994). Pressure ulcers: a review. Archives of Physiological Medical Rehabilitation. 3 Jan 2006. . Read More