Evidence-Based Practice for Pressure Ulcers - Report Example

Research and Evidence-Based Practice for Pressure Ulcers Customer Inserts His/her Name Customer Inserts Grade Course Customer Inserts Tutor’s Name 07, 09, 2010 Outline Appendix: Evidence Underpinning Practice. Part 1: Description of patient and clinical Question based on PICO format. Part 2: Search for results and resources used. Part 3: The Body and summary. Part 1 Description of patient I worked as an intern at The Royal Prince Alfred Hospital in the orthopaedic ward. I routinely took care for a HIV/AIDS patient who had developed pressure ulcers. This was a result of being bedridden for a substantial length of time. The patient experienced decreased sensory perception, decreased mobility and urinary incontinence. Tissues over the Ischia, sacrum, external malleoli and heels were mainly affected along with muscles and bones (Schultz 2005). Pressure ulcer also known as bedsore is an ischemic ulceration and necrosis of tissues which covers the bony are subject to extra pressure. (Bickley 2003). Both internal and external factors hasten the occurrence of pressure ulcers. Internal factors include pain loss and strain sensations that normally prompt the patient to change position and lessen the pressure. The most significant external causes is pressure, its magnitude and length directly determine the degree of the ulcer. Severe pressure can cause impairment of the local circulation within hours of an immobilized patient. This causes local tissue anoxia that advances to necrosis of the skin and subcutaneous tissues (Beyea & Slattery 2006). Today, pressure ulcers present a key health care problem for immobilized patients. Earlier predictions and prevention of bedsores should be a main concern in the health care field. Healthcare personnel in all patient care settings must pursue knowledge by taking time to evaluate research and discuss with teammates the consequences of not putting into practice new knowledge. I always try to investigate whether a patient's outcome is improved if tradition or common sense is substituted with clinical based evidence. PICO format which is based on Clinical questions. P HIV/AIDS patient with pressure ulcers I Evidence based clinical care. C Tradition or common sense O Reduced incidence of pressure ulcers Question Does evidence based clinical care reduce the incidence of infection and improve wound healing in patients suffering from pressure ulcers? Part 2: Search for research For this research, I used several books to find information about evidence-based practice for pressure ulcers. All of the books and journals used in this analysis are nursing materials relevant in patient administration. These books and journals were useful in providing information on the type of nursing interventions used for individuals suffering from pressure ulcers and risk assessments for all patients, one of the libraries visited is High beam (http:www.highbeam.com) to get articles and other resources that provided information about evidence-based practice of pressure ulcers. Reliable web resources offer health care experts with links to evidence-based education. I also used a variety of web-based sources, I good example of a website used is the University of York Centre for evidence-based nursing (Koretz 2008). These resources were of great use since they were readily available and essentially published articles encoded into computers for simple access to readers. The search results were made easy by use of key words which produced variety of options to choose from. This helped in offering high levels of information on clinical practice guidelines and convenient research articles on pressure ulcers. These resources were helpful in providing information on nursing interventions used for patients and risk assessments. The main parameters used in the search for resources was by use of search engines such as Google search, online books and browsing the internet using key words and related features. Part 3: The Body and summary Evidence based research is a result of examining and evaluating information from thoroughly repeated and assembled data instead of relying on regulations and single observations. It is the thorough, precise, and well judged use of modern best evidence in decision making. It encompasses integrating the clinical expertise of the nurse with the best available external evidence from systematic research and personal patient preferences. Bickley (2003) states that patients' outcomes are at least 29% improved when clinical care is based on evidence rather than common sense or tradition. Some of the health care practices and interventions on pressure ulcers used in health care settings today are discussed below. The most important feature of nursing care is the protection of skin integrity. Regular skin care interventions are vital in ensuring high quality of care (Kozier 2004). Medical personnel monitor their patient's skin for impairments or breaks. Impaired skin integrity occurs from irritation, prolonged pressure on the skin or immobility leading to the occurrence of bedsores. Nursing care interventions aimed at the assessment, treatment and prevention of bedsores should be based on evidence-based practice or research (Pearson 2007). Even though the handling and prevention of pressure ulcers is not exclusively a nursing responsibility, nurses have the opportunity to play a significant role in solving this problem. This is because they have adequate knowledge, think critically, make use of referrals as needed on pressure ulcers and more so value its prevention. A number of clinical instruments have been developed for evaluating patients with high risk of emerging pressure ulcers. However, individuals who have little risk of developing pressure ulcers are spared the precautionary treatments which are not necessary and sometimes very costly (Larrabee 2008). This also reduces risk related problem. The occurrence of pressure ulcers in a capacity of need is an essential pointer of quality of care. Evidence has it that a prevention program guided by risk assessment can be used to reduce the established occurrence of pressure ulcers by as much as 87% and cut off the cost of prevention (Boswell & Cannon 2009). Evidence-based practice further shows that there is need for health care facilities and hospitals to improve on prediction and prevention approaches. This can be done by introducing risk scales to record patients at high risks hence prompt the plan care to reduce risk factors. Once patients are admitted to nursing homes and other health care facilities, they should pass through thorough examination for risk of developing pressure ulcers. Based on evidence practice, it has been shown that long stays in hospitals trigger the risk of developing pressure ulcers. The care givers should therefore remain observant to such patients; this can be easily achieved by practicing daily skin examination and individualized skin care observation program. Nurses should ensure that their patients rest on surfaces that relieve them from too much pressure. They can also use scales to assess risk procedures, these scales are important because they distinguish between patients at high risk and those at low risks of developing bedsores (Houser 2008).             Evidence-based nursing practice also shows that when patients are subjected to nutritional consultation, the occurrence of pressure ulcers is minimized. Once a patient is subscripted to nutritional consultation, the entire staff is notified for a possible occurrence of a bedsore in the patient. The care givers then intervene to reduce the ulcers by assessing and determining how the individuals respond to treatment and whether they meet their targets. This is achieved by examining the patient’s effectiveness and response on the medication provided. This approach entirely puts focus on teamwork, critical thinking and communication to ensure that staff control improves patient care and outcomes. The outcomes are to avoid injury to the skin and the tissues beneath (Levin 2006). Nutrition is usually related to pressure ulcers. Though nutrition is normally overlooked by nurses while caring for pressure ulcers patients, it is known to play a major part in prevention of bedsores and treatment. Nutrition and sufficient hydration are both very important in maintaining tissue integrity. Malnourished patients are more likely to develop bedsores as compared to well-nourished patients. Thus, care givers and dietitians should work as a team in assessing the patient's nutritional and hydration condition and make sure that these issues are dealt with in the patient's care plan.            Regardless of the origin of pressure ulcers, the patient’s outcome is always negative. These outcomes may include longer stays in hospitals, excessive pain, additional treatments, scarring and disfigurement, increased morbidity; and higher costs. Although these negative outcomes are a cause for concern, pressure ulcers acquired in hospitals results in patient dissatisfaction with the care, increased hospital costs, and sometimes controversial situations (Gogos 2002). Even with increased focus on evidence-based practice in current years, information is lacking in countryside areas about utilization of research findings for evidence-based practice among nurses. Studies on research utilization have been conducted in urban settings in the past. Nursing as a medical practice must not remain within hospitals found in urban areas but should also include nursing practice in every physical location. However, there is little proof of evidence-based practice used in the cure for bedsores. Therefore, strategies are needed to help these nurses to incorporate evidence-based guidelines in their work (DiScenso 2005). When appropriate, clinical practices should followed as it can help prevent diseases that are painful and take time to heal especially pressure ulcers. Medical measurers need to be taken in advance to help patients that are at risk to overcome this disease. Clinical nurses should also specialize on pressure ulcers in order to be in a position to identify the disease in patients and be in a position to administer medication. There is enough evidence to suggest that the rates of pressure ulcers significantly lower when evidence-based practice is used. In order to provide quality care for the patient, each nurse is challenged to stay up to date with new information concerning health care practice. References Beyea, CS & Slattery, JM 2006, Evidence-based practice in nursing: a guide to successful implementation, HCPro, Marblehead. Bickley, L & Szilagyi, P 2003, Bates' Guide to Physical Examination and History Taking, 8th edn, Lippincott Williams and Wilkins, Ambler, P.A. Boswell, C & Cannon, S 2009, Introduction to Nursing Research: Incorporating evidence based practice, 2nd edn, Jones & Bartlett, Sydney. DiCenso, A, Guyatt, G & Ciliska, D 2005, Evidence based nursing: a guide to clinical practice, Elsivier Health Sciences, Missouri. Gogos, D 2002, ‘Prevention program reduces incidence of pressure ulcers by up to 87%, Dermatology nursing journal,vol.5,no.2, pp 30 viewed 07 September 2010, Janettis publication, Michigan. Houser, J 2008, Nursing research: reading, using and creating evidence, Jones & Bartlett Learning, Sydney. Koretz, B & Eslami, M 2008, Pressure Ulcers, Clinics in Geriatric Medicine, 13(2), 543-52. Kozier, B & Erb, G 2004, Fundamentals of Nursing: Concepts, Process, and Practice, 7th edn, Pearson Education Inc, Carlton. Larrabee, HJ 2008, Nurse to nurse Evidence-Based practice, McGraw-Hill Professional, West Virginia. Levin, FR & Feldman, RH 2006, Teaching evidence based practice in nursing: a guide for academic and clinical settings, Springer publishing company, New York. Pearson, A, Field, J &Jordan, Z 2007, Evidence-based clinical practice in nursing and health care, Wiley-Blackwell, Adelaide. Schultz, A 2005, ‘Predicting and Preventing Pressure ulcers in Surgical Patients’, AORN Journal, vol.12, no.6,pp 23-25,viewed 07 September 2010,Highbeam Research, http://www.highbeam.com/doc/1G1-132841327.html. Read More