Is Development of Pressure Ulcers a Blame of Nurses and Their Quality of Care or the Health Care System as a Whole - Literature review Example

Clinical Observation and Literature Review By {Student’s name} Code+ course name Professor’s name University name City, State Date Clinical Observation and Literature Review Introduction Prevention of pressure ulcers has been the concern of nursing practice for many years. While some clinicians believe that the development of pressure ulcers is not the fault of the quality of nursing care, but the failure of the health care system as a whole, nurses play an important role in the prevention of pressure ulcers (White & Winstanley 2010, p. 151). White and Winstanley (2010, p. 151) also claims that majority of occurrences of pressure ulcers happen during the early stages of the admission process and for patients admitted in hospitals, they occur during their first two weeks. Tannen et al. (2010, 1511) adds that there is a connection between development of pressure ulcers and skin care. According to Tannen et al. (2010, p. 1511), there is a relationship between nursing experience and quality patient health outcomes. White and Winstanley (2010, p. 151) states that the more years of experience a nurse has, the fewer the occurrences of pressure ulcers in the patients to which he or she is attending. Transitional registered nurses, therefore, lack the expertise of assessing, preventing and managing the developments of pressure ulcers as compared to experienced nurses. This paper reviews the relevance of development of pressure ulcers to contemporary nursing practice and transitional registered nurses. The paper finally looks at the role of nurses in prevention and management of the pressure ulcers and some of the leadership characteristics that nurses can use to facilitate change in the health care environment. Relevance of clinical issue Hospital acquired pressure ulcers are closely related to the quality of care and nursing practice within the hospital. Pressure injuries are caused by sustained pressure on certain parts of the body. Tanner et al. (2009, p. 240) defines a pressure injury as the damage done to the skin and its underlying tissues, due to constant pressure or friction. There is a great prevalence of pressure ulcers in Australian hospitals of acute care ranging from 4.5% to 27%, which poses a significant problem to contemporary nursing practice and transitional registered nurses (Tanner et al. 2009, p. 244). According to White and Winstanley (2010, p. 153), the management of wounds and skin is a high priority in the course of daily activities in the surgical intensive care unit. Some of the patients, especially in the ICU are either critically ill or injured, making them too unstable to tolerate the change of positions. Some of the clinical practices offered to such patients may be vasoactive medications, to give the patient support during exposure to excessive moisture, a status of impaired nutrition upon admission, and the state of low perfusion (White & Winstanley 2010, p. 161). Furthermore, some forms of treatment involve the use of devices and equipments, including rigid cervical collars, tracheotomy flanges and splints that increase the risk of skin breakdown and pressure ulcers (Tanner et al. 2009, p. 244). The relationship between hospital acquired pressure ulcers and nursing workforce is a recognized nursing sensitive indicator. Patients who have undergone surgeries due to cerebrovascular injuries are at a high risk of acquiring pressure ulcers. This is due to long periods spent on the operating tables and the long periods of restricted mobility in bed during postoperative periods (Tannen et al. 2010, p. 1511). Offering contemporary nursing practice for such patients can be challenging for nurses, especially the transitional registered nurses who lack a hands on experience. A nurse’s years of experience in nursing plays a critical role in the prevention and management of pressure ulcers. A nurse with multiple experiences of carrying out assessments and process measures in prevention and management of pressure ulcers is more accurate in observing cues, and recognizing patterns that may lead to the development of pressure ulcers (Tannen et al. (2010, p. 1517). As opposed to a transitional registered nurse, who will need to review procedures and policies to act in certain ways, an experienced nurse will act in specific ways due to their mature knowledge caused by years of experience, leading to high levels of clinical performance (White & Winstanley 2010, p. 167). Literature review According to Moore, Cowman and Conroy (2011, p. 2633), Florence Nightingale clearly stated that, if a patient has a bed sore, it is not the fault of the disease, but that of nursing. McInnes et al. (2011, p. 4) claims that other people view pressure ulcers as signifying the visible mark of the sin of the caregiver. Moore, Cowman and Conroy (2011, p. 2635) adds that skin integrity has been used a measure for quality of nursing care. Ludwick and Doucette (2009, p. 24) and McInnes et al. (2011, p. 4) however, claim that despite being a measure of nursing quality, pressure ulcers has been recognized as a major health problem. According to Ludwick and Doucette (2009, p. 24) most of the patients admitted to acute care hospitals are older, therefore, they have multiple risk factors of development of pressure ulcers. Nurses are required to have skills that help them identify the individuals who are prone to developing pressure ulcers early (James et al. 2010, p. 147). McInnes et al. (2011, p. 4), and Ludwick and Doucette (2009, p. 23) agree that it is the duty of nurses and other health care professionals to take preventative measures, even though there are no outward signs of pressure ulcers. According to James et al. (2010, p. 147), nurses have to conduct skin inspections regularly because they provide important information for assessment and prevention of pressure ulcers. Quality nursing practice in this case involves individualized assessments of the vulnerable risk areas (Moore, Cowman & Conroy 2011, p. 2635). According to Grol et al. (2013, p. 1), transitional registered nurses have struggled with the process of transitioning to clinical environments, which are practice oriented in the world of nursing, from the protected academia environment which is protected, since the start of the 1990s. The transitional registered nurses are required to harbour the ability of critical thinking, and the capability of making independent decisions that ensure safety of patients at all times and prevention of development of pressure ulcers (Cichowitz, Pan & Ashton 2009, p. 424). There are, however, discrepancies between what nurses learn from tertiary education and the health care service realities. Grol et al. (2013, p. 1) agrees that due to lack of hospital based training, there are less clinical placements leading to minimal clinical exposure that the nurses can apply in assessing, preventing and managing pressure ulcers. Grol et al. (2013, p. 1) states that although there is a good understanding of the patients’ risk factors in developing pressure ulcers, there is poor understanding of the roles nurses and health care organization as a whole contribute to their development. Cichowitz, Pan and Ashton (2009, p. 426) concluded that in some cases, nurses and clinicians fail to listen to patients or their care givers observations about their quality of care and risks. Cichowitz, Pan and Ashton (2009, p. 426) also found out that some nurses and clinicians fail to notice and respond to clear signs of a patient being at the risk of having a pressure ulcer. Moore, Cowman and Conroy (2011, p. 2637) and Ludwick and Doucette (2009, p. 24) also add that nurses fail to address or respond to the repeated appeals of discomfort or pain and patients’ concerns about their well being, for hours or even days. While risk assessments should be taken regularly, some are only taken several days after a patient has been admitted to acute hospital wards (McInnes et al. (2011, p. 4). Impact of leadership on clinical issue Nurses can use various leadership characteristics within their clinical practice to prevent and manage development of pressure ulcers effectively. First, they can perform case studies or background research of their patient’s history, to come up with assumptions on whether the patient is at a risk of developing pressure ulcers (Banks, Bauer, Graves & Ash 2010, p. 181). Background research will help in identifying the risk factors that are not reported or apparent. For example, a nurse can apply their knowledge from literature or clinical experience to note that a patient with a history of diabetes mellitus may have had incidences of neuropathy and may not be aware of their decreasing sensations (Banks, Bauer, Graves & Ash 2010, p. 183). The nurse will, therefore, be able to trigger interventions that will prevent heel PU assuming that such a patient is at a higher risk. Another example would be to assume that a patient being transferred from another health facility may have had restricted mobility earlier, and therefore, the nurse will implement prevention strategies even when there are no outward signs of pressure ulcers. The nurses can use assessment tools such as Braden Scale or Waterloo assessment tool to score the risks of the patients developing pressure ulcers (Banks, Bauer, Graves & Ash 2010, p. 181). Nurses can practice the skill of good communication with their patients, to address their concerns about the quality of health care they are being offered, and the risks of developing pressure ulcers. During nursing practice, a nurse is required to make regular skin inspections and assess and stage a pressure ulcer at every dressing (Banks, Bauer, Graves & Ash 2010, p. 185). A nurse is also required to encourage patients to shift positions whenever possible and report any discomforts, pain and signs of development of pressure ulcers. Transitioning registered nurses need to maintain good communication and professional relationship with experienced nurses so that they can learn from their clinical experiences, and apply them to their practice (Banks, Bauer, Graves & Ash 2010, p. 187). Application of the clinical issue to contemporary nursing practice Applying nursing leadership in the nursing practice and the prevention and management of pressure ulcers has various positive benefits. Firstly, it will reduce human errors that are caused by the complex interactions in a health care environment (Anthony et al. 2010, p. 132). When such errors occur, due to inadequate training or insufficient experience, they are manifested as violations and incompetence (Anthony et al. 2010, p. 133). Applying nursing leadership in the nursing practice will, therefore, enhance human performance and problem solving abilities. Furthermore, there will be increased job satisfaction and increased working conditions that will create the right work environment. Application of nursing leadership during nursing practice will lead to fewer cases of patients developing pressure ulcers due to patient-centred care. Patient-centred care will improve the health care outcomes of patients, and reduce or eliminate most of the disparities, linked to the provision of quality care in preventing development of pressure ulcers (Banks, Graves, Bauer & Ash 2010, p. 132). Team work, good communication and collaboration will also be improved, leading to gathering of important information that can be used in planning prevention measures. Furthermore, the involvement of the patients and their family members increases the health outcome of the patients. Patients whose family members have been involved in their care decisions have better health outcomes as compared to those who lack the involvement of family members (Anthony et al. 2010, p. 133). Application of evidence based practice during nursing practice will increase efficient clinical decision making. Conclusion Some clinicians believe that the development of pressure ulcers is not to be blamed on nurses or their quality of care, but to the health care system as a whole. Nursing practice, however, plays a crucial role in prevention and management of pressure ulcers. There is a great prevalence of development of pressure ulcers in Australian hospitals, which has been problematic to contemporary nursing practice. It is believed that experienced nurses have mature knowledge and clinical experience to handle development of pressure ulcers than transitional registered nurses, therefore, years of experience is a determining factor. Transitional nurses are, therefore, required to maintain good professional relationships with experienced nurses to learn from their experiences. Reference List Anthony, D., Papanikolaou, P., Parboteeah, S., & Saleh, M. (2010). Do risk assessment scales for pressure ulcers work?. Journal of tissue viability, 19(4), 132-136. Banks, M. D., Graves, N., Bauer, J. D., & Ash, S. (2010). The costs arising from pressure ulcers attributable to malnutrition. Clinical Nutrition, 29(2), 180-186. Banks, M., Bauer, J., Graves, N., & Ash, S. (2010). Malnutrition and pressure ulcer risk in adults in Australian health care facilities. Nutrition, 26(9), 896-901. Cichowitz, A., Pan, W. R., & Ashton, M. (2009). The heel: anatomy, blood supply, and the pathophysiology of pressure ulcers. Annals of plastic surgery, 62(4), 423-429. Grol, R., Wensing, M., Eccles, M., & Davis, D. (Eds.). (2013). Improving patient care: the implementation of change in health care. John Wiley & Sons. James, J., Evans, J. A., Young, T., & Clark, M. (2010). Pressure ulcer prevalence across Welsh orthopaedic units and community hospitals: surveys based on the European Pressure Ulcer Advisory Panel minimum data set. International wound journal, 7(3), 147-152. Ludwick, D. A., & Doucette, J. (2009). 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