The Effectiveness of a Nursing Protocol for the Treatment of Pressure Ulcers - Essay Example

The effectiveness of a nursing protocol for the treatment of pressure ulcers Part 1e Executive Summary The effectiveness of a nursing protocol for the treatment of pressure ulcers Student’s name: One of the greatest priority areas for health professionals across the globe has been the treatment of pressure ulcers. However, to be able to achieve this, hospitals through their administrations have had to identify nursing protocols that have been used towards the treatment of pressure ulcers. According to the US Agency for Healthcare Research and Quality (2007) report on the comparativeness of the effectiveness of the pressure ulcer treatment strategies, nearly over 3 million American citizens are affected by the pressure ulcers; thus, causing mortality, morbidity rates to rise, as well as the healthcare costs. These perceived problems of pressure ulcers are quite common even in the UK hence, necessitating the need for an effective nursing protocol. Subsequently, the nursing protocol adopted in the UK hospitals needs improvement due to the fact that most nurses have developed behaviours and attitudes that are not conducive towards the prevention of pressure ulcer; thus, failing to attain the best conceivable outcomes to the patients. In order as to accomplish the above objectives, the study employed the use of survey interviews in which short questions were asked to the category of shareholders with the intent of collecting relevant data on the user adaptability and functionality of the nursing protocols that are being used by the hospital administration. Subsequently, this method of interviews was chosen due to the fact that it easily allowed for the conversion of projects requirements from the first-hand information obtained from the primary source. Interviews are also good when used to collect data owing to the fact that they allow for the probing of further information form the respondents. As such, the likelihood was for interviews in this case to have been monitored and doctored through extensive probing so as to enable the researcher obtain a true or near truthful reflection of the effectiveness of nursing protocols in the treatment of pressure ulcers patients. However, the interviews were also structured depending on the interviewee, and the nature of data that was being sought for from them in relation to the effectiveness of the nursing protocols. The outcomes of this study disclose that hospital managements are usually uninformed 100% on the functionality requirements that are usually needed to enhance the effectiveness of nursing protocols. For instance, the hospital supervisors in the facility attended were not well informed on what needed to be completed so as to augment the effectiveness of the protocols. Subsequently, as Buttery & Phillips (2009) note, it is essential that audits as a protocol in themselves be conducted in the various health facilities so as to help in determining and highlighting the essential gaps that are being noted in the delivery of the preventive care to pressure ulcer patients. Besides this, the nursing protocols as adopted in combination by the hospital management have also been attributed to the increase rates of recovery among the pressure ulcer patients. Particularly, those patients who were extensively subjected to such protocols like therapies recorded impressive change effects in their health standards with a reduced severity rate. The likely expectation in such a scenario was rare at the beginning of the experiment period but, towards the end, dramatic changes were noted and recorded. However, there were challenges realised with the protocols especially in relation to the non-responsiveness of the therapies in the lives of some patients. Although no causal factor could be linked with the same, the general assumption was that of slowness in responding to body therapy changes. Additionally, the medical practitioners who were tasked with the implementation of the protocols were in some cases unskilled or uninformed about the functionality of the said protocols. As such, it necessitated the introduction of training sessions to nurses first before they could be allowed to practice the same on their patients. According to Samuriwo (2012) the ultimate prevention and treatment of pressure ulcers based on the hospital specific protocols calls for the understanding of the intended use of the packages thus, ensured sustainability in usage over an extensive time period, as well as, the effectiveness in the delivery of services. Part 1a This study will seek to establish the value that nurses have placed on the prevention of pressure ulcers through protocols such as the staging system. Several other means can be used to curtail the spread of ulcers by the nurses on their patients. Some of these prevention methods or protocols that have been adopted by the hospital facility include a mixture of procedures such as the use of ultrasound treatment, therapy of hyperbaric oxygen, dressing of the wounds, vacuum assisted closure of the wounds, topical applications, and electric stimulation among other measures. These measures when combined are mostly applied by the administration of hospitals as interventionist programmes that will enhance the prevention from further spread and the healing of the ulcers. If appropriately used, these mechanisms or protocols will be effective in the prevention and aiding of healing of the wounds of patients having pressure ulcers (Sampson, Gerhadt & Mandelbaum, 2008.p.165-174). However, in ensuring the successful adoption and adaptation to the listed protocols above, there needs to be an engagement from the relevant medical stakeholders. Nurses, while performing their duties of taking care of patients suffering from ulcer conditions need to be in continuous communication with the other therapeutic professionals who work with them in the same facility so as to enhance their knowledge in the management or prevention of the ulcers. As a part of the nursing strategies or interventions put forth, there should be a regular reassessment interval between when the conditions of the patient changes. Doing this will help with the nurses acquaint themselves with matters relating to the particular strain of ulcer affecting each patient. Subsequently, the tool that is used for reassessment should be ensured to be reliable and standardized. The stakeholders involved in the running of these protocols include the nurses themselves who will be the ones to carry out the care exercises on the patients, the hospital administrations who will ensure that adequate equipment is provided to aid the nurse perform their duties upon the patients, the medical professionals; these will include the professional doctors who are employed in the facility, and who are tasked with the provision of appropriate diagnosis to the patients. Subsequently, it is these doctors who will also recommend the appropriate treatment and care protocols for the patients based on each patient’s specific needs for therapy (Hampton & Collins, 2009.p.6-12). Finally, there are likely chances that certain problems might arise with the implementation of the ulcer prevention techniques. Such may include the inability of the nurse to adequately administer the programmes to the patients. Additionally, the facility may not be equipped with the required apparatus for the enhancement of the protocols towards the prevention of ulcers. As such, such protocols may be regarded as having not been effective in the prevention process of ulcers among the sick patients with the pressure ulcers. Part 1b Having considered the need for a protocol that can be used in the prevention of ulcers among affected person in the society, as well as taking into consideration the need for a reassessment of the programme to ensure its efficiency and effectiveness towards prevention of ulcers, it is imperative to conduct meetings with the identified stakeholders. These meetings are essential in the sense that they are intended to enlighten the stakeholders of the role each needs to play in order to ensure the success of the care programmes adopted. In an ideal sense, the main purpose of this programme is to ensure effectiveness in the use of nursing protocols that are being used by nurse in the treatment of and care for the pressure ulcer patients. Specifically, this program aims to achieve quality health care as provided by the nurses and other medical professionals, particularly in relation to the treatment of pressure ulcers. Additionally, this study or adoption of a nursing programme seeks at minimising patient population for those suffering from pressure ulcers. To ensure that the programme is efficiently operating and protocols are adequately observed, a baseline survey needed to be conducted. As such, interviews with the respective member stakeholders were conducted with the aim of obtaining illustrative discussions on how best the nursing protocols for treating pressure ulcers were being observed and whether they were effective. The main aim of this short survey was to determine the structure of the hospital’s medical practitioners in respond to the plight of the pressure ulcers patients. To the hospital management, it was essential to determine whether the equipment that were in use were of quality standards and met the minimum standardized requirements. Subsequently, information was sought from them in relation to the adaptability of the medical practitioners to the nursing protocols that had been introduced specifically for the purpose of treating pressure ulcers among patients. With the nurses, the short interview sought to determine their perception of the available protocols, and whether they would suggest the introduction of a new protocol to aid in the treatment of pressure ulcers. Particularly, the survey questions addressed to them would be in the sense that the nurses idealize the processes that needed to be monitored in the enhancement of treatment to the patients of pressure ulcers. Ultimately, the study also sought to know the perception of the nurses with regard to the procedures that are contemporarily being applied by the hospitals in the preclusion and management of pressure ulcers. For the medical practitioners such as doctors, the survey done sought to determine the relationship they had with the care providers (nurses) in terms of the support they offered them in the determination of the effective protocols to follow in the treatment of the pressure ulcer patients. Subsequently, the doctors being the ones who prescribed medication to patients and the programmes to be followed by the nurses, the interview with them sought to get clarifications on the criteria they used in the determination of the appropriate treatment programme for the patients. Subjectively, this analysis through an interview, therefore, determines the division of labour among the hospital care teams. As shown above, the management will be concerned with the procuring of appropriate and adequate pressure ulcer treatment equipment and medicine which are then used by the doctors and nurses to provide treatment and carry out the treatment exercises, respectively. To be able to undertake the objectives of this programme, it is identifiable that the hospital care providers work as a team so as to be able to complement each other in the treatment processes. In considering the mix of staff that are needed and skills that are needed, the management felt that due to the low doctor patient ratio in the hospital, nurses would be fit to handle the nursing protocols of offering treatment and curative methods to patients with pressure ulcers. However, the nurse on their side when asked about their perception and considerable staff mix opted that the doctors accompany and assist the nurses in the treatment procedures so as to enable the doctors, as well, assess the condition of the patient and recommend appropriate measures to be taken (Ward, 2010.p.22-27). On their part, the doctors had no complete utter objection to the point given by the nurses except that there would be likelihood to spend much time in the wards attending to the patients than in addressing other pertinent issues that could arise in the hospital. As such, they suggested that more doctors be employed by the management to help in providing medical support to the nurses. Actually, the doctors supported the employment of the medical interns to assist the nurses, a move that was objected by the management given that the interns were not fully qualified to be entrusted with the management of health conditions such as pressure ulcers (Corcoran & Woodward, 2013.p.450-457). Taking a critical look into these divergent views, it is eminent that all the stakeholders supported the concept of a new treatment protocol but, were divergent on the implementation criteria of the programme, especially in relation to division of labour, formation of teams, and the managerial span of control to be adopted. While the respondents agreed to the human resource management, improvement of quality and the efficient management of information as the keys to the attainment of the goals of the programme, it was evident that the management was the biggest hindrance to the adoption and implementation of the nursing programme. However, studied from a different perspective, it can be noted that the stance taken by the management currently was as well contributing to the achievement of the goals of the programme, although at a slower pace. Thus, credit could be accorded to them in this regard, particularly in the determination of the combinational matrix applied by nurses in the management of pressure ulcer patients’ conditions (Hampton & Collins, 2009.p.6-12). Part 1c The current literature on the emerging modality for treatment is as presented below. According to Scevola, Nicoletti, Brenta, Isernia, Maestri & Faga (2010) no consensus is currently considered for the unanimous use of the platelet gel in the curing of the chronic pressure ulcers. With the aim being to determine the effectiveness of the platelet gel in the treatment of pressure ulcers, a randomized controlled trial in which ulcer was considered as the experimental unit is developed. The platelet gel, when used as a nursing protocol strategy, is considered as an effective tool in the treatment of pressure ulcer only for the first 2 weeks. However, with a prolonged or extended treatment plan, thus nursing protocol becomes inefficient thus; it does not offer any substantial advantage in the treatment of pressure ulcers as compared to the current nursing protocols that are in use (Scevola et al, 2010). In another more related study by Sampson, Gerhadt & Mandelbaum (2008), the aim was to establish whether the platelets in the body plasma was effective enough to facilitate the healing process of pressure ulcers in a number of applications. Thus, as a protocol, the study recognizes the abundance in enthusiasm towards the use of concentrated levels of the platelets. Essentially, this article only functions to introduce readers to the PRP therapy but, provides a very promising alternative for treating pressure ulcers without opting for surgery. Thus, this protocol appears to be safer as it promises natural healing. However, the study employed randomized trials in which the sample sizes were as well small thus, limited the generalisation for its findings. Chen, Tsai & Burnouf (2010) in their study that sought after the evaluation of a new technique’s efficacy and safety in their experiment combined allogeneic single donor PG together with the fibrin glue to determine the take for the enhancement of the skin graft in offering treatment to recalcitrant ulcers. By enrolling 17 ulcer patients with different etiologies into the programme, the results of the study show that most grafts took well with no recurrence of ulcers for a period between 3 to 18 months when the follow up study was conducted. Thus, the programme provides skin grafting advantages that can explain the effectiveness of this protocol in the treatment of recalcitrant ulcers. Buttery & Phillips (2009) in their study seeks to show that the audits of pressure ulcers requires great dynamism or vitality and time from all that are involved in the process. As such, the study through the analysis of longitudinal results seeks to show that the current audit processes being conducted as nursing protocols do not effectively improve the quality of the programmmes. Thus, the study notes that there needs to be a reversal of the same in order to be able to expand on the results of patients and benefits from the use of such programmes. With an aim of exploring the implementation guidelines especially with regard to the timeliness of the assessement of the risk and the appropriateness of the associated outcomes, the study by sampling 30,000 patients annually found that the rates of the pressure ulcers stagnated while the severity and number of facility acquired pressure ulcers remained constant. In concluding, the study notes that pressure ulcer audit programmes should have given higher priorities owing to the implementation of preventive care against standard protocol and not by simple description of the adversity of the events resulting from the use of the programme. Samuriwo (2012) conducted a study in which he sought to review the findings of a Straussian theory that is grounded. Therefore, he ascertained the value placed on the prevention of pressure ulcer by the nurses plus, the role played by the multidisciplinary team of health experts in maintaining the integrity of the skin. Conclusively, he noted that there should be proactivity amongst the nurses so as to facilitate them to provide efficient treatment services. Ward (2010) records a study whose main aim was the determination of the effectiveness of the systematic evaluation value. Through the conduct of systematic prospective investigations, conducted on a new PRM for 5 months, with a sample of 60 participants, effectiveness studies such as randomized control tests are difficult to maintain. Part 1d In the conduct of this study and through the review of the most current and relevant literature as shown above, it can be seen that certain aspects are missing which could only be enhanced with the making of recommendations based on the reviewed literature. In ensuring the effectiveness of a nursing protocol, it is essential that the adopted programme becomes easily adaptable to the prevailing medical conditions of the patients. Thus, the need for improvement in various sections of the nursing protocol as suggested in this study. Based on the studies as presented above, each has an application of a nursing protocol that is being applied in the management and treatment of pressure ulcers. However, the challenge arises when the particular protocol fails to efficiently live to its functionality and is thus, considered by the health workers as a failed perspective. In some instances, it is the health works whom themselves refuse to adapt to the functionality requirements of the new protocols that are brought hence, mostly applying old strategies in caring for the sick pressure ulcers patients. To this end, a likely recommendation I would make is to have all nursing professionals attend prior training seminars in which they would be taught on the functionality of newly adopted protocols and on how to accurately apply them so as to enhance their effectiveness. References Buttery, J., & Phillips, L. (2009). Pressure ulcer audit highlights important gaps in the delivery of preventative care in England and Wales 2005-2008. EWMA Journal, 9(3), 27-31. Chen, T. M., Tsai, J.-C. and Burnouf, T. (2010), A Novel Technique Combining Platelet Gel, Skin Graft, and Fibrin Glue for Healing Recalcitrant Lower Extremity Ulcers. Dermatologic Surgery, 36: 453–460. doi: 10.1111/j.1524-4725.2010.01480.x Corcoran, E., & Woodward, S. (2013). Incontinence-associated dermatitis in the elderly: treatment options. British Journal of Nursing, 22(8), 450-457 Hampton, S., & Collins, F. (2009). Reducing pressure ulcer incidence in a long-term setting. British Journal of Nursing, 14(15), S6-S12. Evidence Level II: RCT. Sampson, S., Gerhadt, M., & Mandelbaum, B. (2008). Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Current Reviews in Musculoskeletal Medicine, 1(3-4), 165-174. Samuriwo, R. (2012). Pressure ulcer prevention: the role of the multidisciplinary team. British Journal of Nursing, 21(3), 4-13. Scevola, S., Nicoletti, G., Brenta, F., Isernia, P., Maestri, M. And Faga, A. (2010), Allogenic platelet gel in the treatment of pressure sores: a pilot study. International Wound Journal, 7: 184–190. doi: 10.1111/j.1742-481X.2010.00671.x Ward, C. (2010). The value of systematic evaluation in determining the effectiveness and practical utility of a pressure-redistributing support surface. Journal of Tissue Viability, 19(1), 22-27. Read More