Role of Assessment Tools in the Prevention and Management of Pressure Ulcers - Research Paper Example

Role of Assessment Tools in the Prevention and Management of Pressure Ulcers of the APA format Role of Assessment Tools in the Prevention and Management of Pressure Ulcers Introduction Immobility occurs due to several conditions and can lead to many consequences, one of which is pressure ulcers. Often, clinicians have researched strategies to prevent these consequences. For effective practice, application of research information is very important. According to Polit and Hunger (1999; cited in Melnyk et al, 2000), "research utilization is the use of some portion of research in practice that is similar to the manner in which it was used in the original study.” Research has shown that following certain strategies to prevent and manage pressure ulcers helps in controlling mortality and morbidity related to them. One such strategy is use of assessment tools for evaluation. In this essay, the role of assessment tools in the prevention and management of pressure ulcers effectively will be discussed through review of appropriate research articles for evidence-based information. Research question The research question for this essay is "Do assessment tools help in the prevention and management of pressure ulcers?" Purpose Pressure ulcers are a common source of distress in any health care setting. They contribute to morbidity and mortality and are a significant source of healthcare cost. It is often difficult to treat pressure ulcers because of lack of proper understanding of the complexities involved in the causes of breakdown of skin (Riordan and Voegeli, 2009). This research is intended to evaluate and ascertain the benefits of using assessment tools in the prevention and management of pressure ulcers and in total decrease the incidence and prevalence of pressure ulcers in any health care setting. Research article-1: Riordan, J., and Voegeli, D. (2009). Prevention and treatment of pressure ulcers. British Journal of Nursing, 18, S20- 27. Purpose of the article The article by Riordan and Voegeli discusses about the prevention and treatment of pressure ulcers. Relation to the question The article begins with the prevalence of the pressure ulcers in Europe and the impact they have on the patient, community and society. This is followed by the definition of pressure ulcer. According to the authors, pressure ulcers are "areas of localized damage to the skin and underlying tissue caused by exposure to pressure, shear or friction, or a combination of these." While most of the pressure ulcers affect only the skin, severe forms of ulcers involve other structures like muscle, bone and tendons. Pressure ulcers develop because of sustained high pressure in an area of the body, mostly over the prominences of bones. Due to the raised pressure, the capillaries supplying blood supply to a particular region get compressed resulting in ischemia of the tissue. Other than ischemia, thrombosis of the venous system and occlusion of the lymphatic vessels of the area also are affected because of pressure. All these eventually lead to increased permeability of the capillaries, interstitial edema and tissue death. The article provides an understanding of various causes of pressure ulcers and this is presented in a table form. This information is followed strategies for prevention of ulcers. Under this section, the importance of risk assessment is elaborated and various tools used to assess the risk of development of pressure ulcers is discussed. The articles stresses the impment within 6 hours of admission to any setting with frequent updates as early as every week. Grading of the ulcers has be elaborated according to the European Pressure Ulcer Advisory Panel Grading System in a table form. Once pressure ulcer risks are evaluated strategies to relieve pressures are to be taken and this is discussed after risk assessment. According to the authors, "pressure-relieving strategies form the cornerstone of prevention and treatment." These strategies have been discussed along with education of the patient. the next section addressed is the treatment strategies under which various methods to treat the wounds of pressure ulcers have been discussed. the authors stress on the fact that "treatment should be directed towards improving the overall condition of the patient and providing an optimum wound environment for healing." The management of wounds include strategies to reduce pressure, friction and shear through proper positioning, appropriate nutrition and wound care. There is a crisp conclusion at the end of the article. Major findings in the article 1. Risk assessment tools are very important to prevent pressure ulcers and detect them in early stages. 2. Risk assessment must be performed as early as possible immediately after admission and reviewed frequently. 3. The most commonly employed risk assessment tools are Norton, Waterlow and Braden. However, none of these tools have good predictability of development of the disease. 4. Pressures can be relieved by proper positioning and by using pressure relieving devices. 5. Besides reduction of pressure, friction and shearing must also be tackled as even they contribute to the development of ulcers. 6. Wounds must be covered with suitable wound dressings and proper wound care must be delivered. 7. Patients must be advised about strategies to prevent and manage pressure ulcers. Strengths and weaknesses The article is presented in a lucid and easily understandable manner with appropriate headings and tables. The abstract and conclusion are crisp and to the point. The reader gains an insight into the complexities involved in the development of pressure ulcers and strategies to evaluate, ascertain, prevent and manage them efficiently. Research article-2: Gudell, T.L., Long, P.J., and Edmiston, T. (2009). Hospital Home Health, 26(12), 133- 144. Purpose of the article This article is an executive summary of Indiana initiative which set norms for best practice in the prevention and management of pressure ulcer and eventually led to a drastic decline in the number of pressure ulcers in various nursing homes, hospiotals and other health settings in Indiana. The purpose of the article is to educate clinicians about strategies to prevent and manage pressure ulcers effectively with intentions to decrease morbidity and mortality associated with it. Relation to the question The Indiana initiative stresses on the need to use assessment tools to evaluate for pressure ulcers within 24 hours of admission. The scale recommended is the Braden Scale which can effectively identify the risk to develop pressure ulcers. The initiative recommends that all staff members must be provided with the guidelines to prevent and manage pressure ulcers in a timely manner. The initiative stresses on the need to standardise transfer reports through appropriate communication strategies and give due importance to information and training of aides of the patients. Major findings in the article 1. Aides of the patients play an important role in monitoring for signs and symptoms of pressure ulcers even at early stages, thus, increasing the chances of detecting them in early stages. 2. The most useful tool for risk assessment is Braden Scale 3. In order to have effective evaluation and identification of risk of pressure ulcers as early as possible, all staff members must be aware of the guidelines. 4. The key for effective prevention and management of pressure ulcers is appripriate communication and transfer of information between staff and beteeen aides and staff. 5. Education of the aides and care takers is very important for early detection. Strengths and weaknesses The article provides an overview of one of the most successful initiatives to prevent and manage pressure ulcers effectively. the flow of information is easy to understand and the reader gains insight into the key messages delivered. It would have been more useful if Braden Scale was presented in the article itself. Research article-3: Moore, Z.E.H., and Cowman, S. (2008). Risk assessment tools for the prevention of pressure ulcers. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD006471. DOI: 10.1002/14651858.CD006471.pub2 Purpose of the article This article from cochrane database is a review to determine, evaluate and ascertain the role of risk assessment tools in the reduction of pressure ulcers in any health care setting. Relation to the question The article is a systematic review of various other studies conducted to evaluate the effectiveness of risk assessment tools in the prevention and management of pressure ulcers in various types of health care settings. The systematic review was conducted on randomised controlled trials which are at a high hierarchy level for evidence-based information. Major findings in the article According to the study, there are no estblished randomised controlled trials to ascertain and evaluate the usefulness of structured risk assessment tools in the prevention and management of pressure ulcers when compared to clinical judgement. Strengths and limitations The study by cochrane database provides insight into the meaningfulness of risk assessment in the prevention of management of pressure ulcers as against clinical judgment. Conclusion While assessment tools like Braden Scale are frequently used to prevent and evaluate pressure ulcers in early stages, the Cochrane database argues that there is no evidence-base for such an application in practice since there are no definite and valid randomised controlled trials to prove the role of assessment tools as against clinical judgment. Thus, this research ended with unclear information as to whether assessment tools are useful in the prevention and early management of pressure ulcers. References Gudell, T.L., Long, P.J., and Edmiston, T. (2009). Hospital Home Health, 26(12), 133- 144. Melnyk, B.M., Fineout-Overholt, E., Stone, P., and Ackerman, M. (2000). Evidence-Based Practice: The Past, the Present, and Recommendations for the Millennium. Pediatric Nursing. Retrieved on 25th May, 2010 from http://www.highbeam.com/doc/1G1-59967182.html Moore, Z.E.H., and Cowman, S. (2008). Risk assessment tools for the prevention of pressure ulcers. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD006471. DOI: 10.1002/14651858.CD006471.pub2 Riordan, J., and Voegeli, D. (2009). Prevention and treatment of pressure ulcers. British Journal of Nursing, 18, S20- 27. Read More