New Technologies to Improve Quality of Life - Dissertation Example

New Technologies to Improve Quality of Life The Background: The Issue Long term conditions like stroke, paralyze, Femoral and hip fractures etc., normally lead to further health problems such as pressure ulcers. The new technologies can be applied as the evidence based medicine to improve the quality of life of the patients. Many researches are carrying out with an objective to enable the patient to manage their condition. The treatment of pressure ulcers is time consuming and financially and emotionally costly to the patient. The clinical side of the treatment needs to address the complexity of the problem. The study about the pressure ulcers have stated that 60 % of the total pressure ulcers is hospital acquired. The NHS estimates that $ 400 - 1,000 million is the annual cost of the hospital acquired pressure ulcers. During the period of globalization and technological advancement the invention and scientific technologies are in the process of advancement and development. Day by day new technological advancement is drifting the changes in the world. As a result of this technological advancement the effectiveness and quality of health care is easily improved by adopting the new technologies. The evidence based medicine is nothing but the updating of knowledge and information on the field of health care field. Encouraging people to use the technology based treatment can reduce the risk of pressure ulcers and other related health problems. Recently a personalized self management system has developed by the RAT group at the University of Sheffield. This technology is a result of the work done by the multidisciplinary team is effective in the treatment process of people with stroke, chronic pain or congestive heart failure. The study comparing the efficacy of two alternating cell mattress and cushion combinations in the treatment of pressure ulcers in hospital patients also showed success result. It has shown improvement in the non heel ulcer patients. The objective of the review is to find out the effectiveness of the use of cell mattresses in the treatment of the pressure born ulcers. Two type of mattresses were used in the research. The research also carried out to find out if there is any difference in the two mattresses’. The evidence Based medicine is carried out by evaluating and analising the entire treatment plan. The advantages and Disadvantages of the treatment method is find out before applying the treatment procedure. The treatment plan is executed after making sure that it will bring only benefit to the patient. The skin in the human body is an important organ in the body since it is the largest organ in the body. “Actual or potential impairment of skin integrity has important implications for a person’s well being because loss of tissue integrity compromises skin function.” (Maklebust & Sieggreen 2001, P.1). The human skin is high sensitive to the external factors. The cells of the skin are always in the process of growing. There fore the long term hospitalization can easily lead to the pressure ulcers. The wound are very difficult to cure because of the multiple health problems. “According to the Department of Health there are 15.4 million people living with a long-term condition in England, and this number is expected to rise due to an ageing population and unhealthy lifestyle choices. Long-term conditions also account for 70% of the NHS budget.” (New technologies to improve quality of life, 2010). “the estimated cost of healing one pressure ulcer including long term care and hospital cost was $2,731. a single pressure ulcer can lengthen a patient’s hospital stay by a factor of 3.5 to 5.” (Maklebust & Sieggreen 2001, P.14). The emotional domain of the nursing staffs also affect in providing care to the patient. There are many reasons for it. For example the dressing of the patient is to be changed frequently. It is very difficult also. Another problem of nursing care is the time. Most of the pressure ulcers need a longer time schedule treatment. Each patient require time consuming care. If a patient does not get proper and timed care the ulcer will become more difficult to treat. Besides all the difficulties the ulcers create a feeling of great anxiety and pain to the patient, the family and to the nursing staffs. The pressure sore are frightening and stark in observing. Some time the born can be seen out and it will reflect our images as a mirror. The literature about the pressure ulcers can provide many effective practices to the health care professionals. Most of the information about the pressure ulcers is derived from the research findings and experience. The Agency for Health care Research and Quality in the US has been working in order to improve the quality of health care and cost of health care. it aims at formalizing guidelines to support health professionals. The practitioners form effective treatment guideline with the help of results from the research finings. “The guide lines for preventing and treating pressure ulcers provide practitioners with current practice parameters based on a synthesis of research findings and expert opinion.” (Maklebust & Sieggreen 2001, p.17). The evidence based Medical treatment based on the guidelines showed significant impact on the treatment process. Care Objectives: The pressure ulcers are formed as a result of any other diseases such as stroke or multiple fractures of hip and other bones. The technologies used to prevent the pressure ulcers are high of cost. In the research for treating the pressure ulcer patient’s two equipments are tested consecutively. Two cell mattresses were given to the patients in the clinical setting and analyzed the effectiveness of both. The significance difference between the two equipments needs to be analyzed whether there was any significant difference between the both. A total of 141 patients in a care of the elderly unit were assessed. “The nutritional management, the body positions, the body posture schedules, the support surfaces, skin care and monitoring changes in risk status” are the important areas that to be noticed in the care. (Maklebust & Sieggreen 2001, p.59). The surface area or the supportive surface is an important factor in the treatment care. The effectiveness of the technical aspects of the supportive surface is to be examined. It is because the patient is always in contact to the supportive surface. The pressure created when the supportive surface to the body can easily create risk of the ulcer or can increase the pressure ulcer into a more complex issue. Hence the effectiveness is highly ensured when using a pressure relieving equipment is used. Huge array of equipments are available in the market. Hence the effectiveness of the selected equipment is to be ensured before it is providing to the patients. The equipment is cost effective also. Hence the failure of the effectiveness of the product may result the total failure of the treatment system. The providers always try to use the less cost product with high efficacy. In the treatment process assessing for pressure ulcers and its risk is an important factor in the treatment process. The assessment process includes the assessment of the nutritional deficit and the incontinence and the moisture problems. The skin should be protected from the fecal and urinary waists. “The body positioning techniques can be important tools to help minimize pressure on vulnerable soft tissue over bony prominences.” (Maklebust & Sieggreen 2001). The reposition in frequent times may decrease pressure duration. Provide a foam postitioner or a mattress to balance the body weight. Avoid. All these are monitored with the help of flow charts. The desire of the patient is taken account as the needs of the patient. Facet Analysis of the Question: Research question: “The effectiveness of adaptation of the new technologies in the treatment of pressure ulcer patient.” The research question is the assistive technologies are used to reduce the pressure to make the patient free to the risk of pressure ulcers. The study is about comparing the efficacy of the mattresses in treating the pressure ulcer patients as a pressure relieving equipment. The patients who are at high risk of the pressure ulcers are randomly selected using the Watelow score. The significant issue is the prevention of pressure born ulcers. The effectiveness of different systems is the important thing in the providers’ health care. Two alternate cell mattress and cushion combinations in the treatment process are to be tested through the research. The research review question is “the effectiveness of adaptation of the new technologies in the treatment of pressure ulcer patient”. The effectiveness means the usefulness and the purposefulness, the adaptation means the use of a certain method or object in the clinical care, the new technology means the updated knowledge and the new inventions based on the updated knowledge, pressure ulcer is the ulcer formed as the result of the long term medical treatment. Type study: The study is carried out by randomized controlled trials of two pressure – relieving systems. The study tries to compare the efficacy of two alternating cell mattress and cushion combination in the treatment of pressure ulcers in hospital patients. Populations: The study population of the research was 141. 70 were nursed using Huntleigh Nimbus 3 in conjunction with the Aura cushion this is formed as the group A. the remaining were using the Pegasus Cairwave Therapy System in conjunction with the Proactive 2 Seating cushion it is formed as the group B. Critical appraisal of the research article: Summary of the research review: Most of the pressure ulcers are hospital acquired and millions and millions of money is spending for the treatment of pressure ulcer. It is estimated that fifty percent of the patients admitted in the hospital are at the risk of developing the disease due to inadequate quality of the care rendering in the hospital. This could be considered as one of the indicators to assess the quality of the care given each hospital. There is equipment to prevent pressure ulcer in the hospitals but the problem with the inadequacy is because of the expensive nature of the equipment and there is no sufficient supply of the equipment. Some of the hospitals develop evidence based pressure ulcer prevention policy to prevent such incidents in the hospital which has become a major problem among the inpatients. Even though there are equipments in the market which are pressure relieving, it is very difficult to assess statistically the benefits and efficacy of the equipments. Since there is no substantial evidence to support the expensive equipment, the people hospital practitioners find it very difficult to select the equipment out of many products. In this context, in order to assess the utility and efficacy of the pressure reliving equipments, the researchers tested two alternating-cell mattress systems. Methods: In this study the patients who were admitted in the hospital from 17th August to 31st December 1997, were assessed. When they were admitted in the hospital, they were assessed grade two pressure ulcer. The researchers focused on hundred patients from two groups and the recruitment lasted for eighteen months to get sufficient number of patients. They were recruited with their consent and the patients who were not willing to participate in the study were excluded from the research. The two pressure relieving systems which were undergone for the study by the researchers are Huntleigh Nimbus 3 with the Aura cushion which is the A group and the Pegasus Cairwave therapy system with the proactive cushion which is the B group and one month was allotted for the pre trial use in order to make the practitioners familiar with the systems. No other systems used in the patients during the time of trial in order to receive accurate efficacy of each systems. The site, progression and severity of the disease were recorded at the time of admission of the patients on the basis of hospital information system. The site of pressure ulcer were photographed by the medical photographer in every weak and the patients were surveyed after each seven days of the trail by a medical interviewer in order to understand the progress in the patient and the efficacy of the systems. A person who is not in charge of the patient care and equipments was appointed to take statistical monitoring in order to avoid the bias and he was given the responsibility of the randomization of bed allocation. The patients who had not completed the trial were excluded from the research. Result: Even though 186 subjects were recruited for the study altogether in group A and group B, some of them could not complete their trial because of death. Sixteen patients were died from the A group and ten patients were died from the B group. Even though one hundred and twelve were alive until the end of the trial some of them could not complete because of various problems. 41 patients were photographed and among them four have been withdrawn since they could not sleep on the alternated bed and aversion to the photography. Table one in the research review shows the average severity and highest severity of the pressure ulcer patents, number of the subjects who completed the trial including group A and group B and the number of subjects who were died during the study. The second table in the research review presents improvement factors including group A and group B for both who were alive and who were dead. In this study it is found that both mattresses are equally effective to prevent pressure ulcer. There were some difficulties with some of the equipments in the initial month of the trail since they required repair. Because of the education, vigilance and availability of the equipment there observed a noticeable decrease in the pressure ulcer among the inpatients. Discussion: This research aimed at making the patients to stay for eighteen days and the hundred percent occupancy of the equipment even though it could not occupy the systems hundred percent. But some patients who were having severe pressure ulcer were stayed for twenty two days. The researchers did not think that this number of patients would die. Data which were collected from the patients were examined after eleven months in the view that the trial must continue or not. The information observed and assessed was kept secret from the company and the professionals who were in charge of the care of the patients. It is observed and assessed that the equipments resulted in the recovery from sacral ulcers. Although there was minute superiority of group A mattresses in the recovery from ulcers, the improvement was not adequate to state the significance. When the trial was over, it is found that there was no difference between these two mattresses in the improvement of pressure ulcer. Randomization of the bed allocation was not successful since the patients who were mostly affected by pressure ulcer were nursed on a better performing surface. Critical appraisal of the research article: Validity of the research: In order to understand the validity of the research we have to go back to the background in which the research was undertaken. Around fifty percent of the patients in the hospital are inflicted to pressure ulcer. This is because of the equipment using in the hospitals. There are two problems with the equipments and they are this equipment is very costly and shortage in the supply of the equipments. One of the main challenges in using this equipment is that even though there are so many products in the market, the providers do not understand which equipment is more effective in the patients. Therefore this research could be considered as a research at the proper time. The two equipments compared in the research are Huntleigh Nimbus 3 with the Aura cushion which is the A group and the Pegasus Cairwave therapy system with the proactive cushion which is the B group. This research is considered valid internally since it meets some of the factors such as taking the history of the patient in order to understand the severity of the disease, the effects of the various tests, keeping the instruments in proper way and conducting research in the moral way. The history of the subjects was taken according to the procedure of the hospital in which the research was conducted. The sites and severity were recorded in the case history. The medical auditor assessed the situation in each day after the trail. And the sites were photographed by the medical photographer using the advanced digital camera in order to assess the minute improvement in the patient. There was some problem with the equipments in the initial stages but it got repaired and the practice for practitioners also was given. In order to avoid the bias they appointed an outsider to assess the change and randomization of the bed allotting. Nothing has occurred against the ethics of research. People were given maximum freedom to participate in the research according to their will. Subjects were allowed to leave even during the research. Two subjects were not comfortable for exposing to the photograph. They were allowed to be free from the participation of the research. But one thing which affected the research is the unexpected death rate. The researchers knew that the subject would die in between but the death rate was beyond the expectation. The research is valid because they have excluded the passed subjects from the study. This research is externally also valid since it can be generalized its findings to other population and environment also. It was a hospital setting to assess the efficacy of two pressure relieving equipments. There was no external threat since the selection of patients, sampling methods and number of the participants was proper. The response of the participants was also in the desired way. Reliability of the research: The research is reliable since there is no room for bias and for instrumental defects. There was consistency in obtaining the same result over repeated testing and there showed progress in heeling the pressure ulcer. There are three reasons to relay on this research. First one is that the ulcer was graded in order make sure inter observer reliability in the research. Second one is that carrying out of image analysis by way of taking the photography of each site of the ulcer in the body of the patient. Images are taken using high power of digital camera one a week. It would give correct picture of the recovery from ulcer. Third one is that the medical auditor used to visit the patients after the trial in order to check out the progress. And also the researchers had taken steps to avoid bias in the research. Findings of the research: It is observed in the research that both equipments are equally effective in the treatment of pressure ulcer. There was no noticeable difference in the use of both equipments. The non hell ulcer patient has shown subsequent improvement with the adaptation of the mattresses. Ethics of the research: This research was approved and given permission to conduct by the ethical committee and it was very keen to observe and address all the ethical issues related to research. The patients who were chosen in the research participated out of their will and convenience only. Strategy for implementing the evidence in heeling pressure ulcer: From this research it is found that both equipments Huntleigh Nimbus 3 with the Aura cushion and Pegasus Cairwave therapy system with the proactive cushion are equally effective in preventing pressure ulcer. This evidence solves the problem in relation to the treatment of the pressure ulcer. Since there lacks sufficient knowledge about the advanced equipments and its effectiveness this research brings light to various factors of the treatment of pressure ulcer. This could be used in every hospital setting because the improvement in the case of pressure ulcer patient has been shown. Most of the hospitals do not have these equipments since it is very costly and inadequate knowledge. Since the research has shown the efficacy of the equipments, many of the hospitals would come forward to prevent such incidences in the hospitals. The findings can be generalized. The outcome is also relevant to others such as the nursing staffs and the members of the family because it is cost effective and beneficiary in treating the patient with pressure ulcers. The change can be achieved in the clinical setting by providing the entire patient the equipment. The heeling of the pressure ulcer patient is to be managed by providing them with pressure relieving equipment. The use of the specific equipment can be used widely because it is based on the Evidence based medicine. The benefactor of the system has proved good by the randomized controlled trial. The attitude towards the equipment of patient may differ each other. It is important because the comfort feeling of individual is subjective. Another barrier is the age problem. The RCT is carried out only with the aged person when it comes to the younger generation the result may vary. In order to prevent the barriers the research must be updated always. Further researches should be carried out by making the first one as the basement. Another barrier of implementing the strategy is the cost. The product is costly hence the treatment cannot be feasible to many of the patient. No control group was set, there fore there is a chance of the formation of more ulcers in patients using a standard matters. Reference List New technologies to improve quality of life, 2010. [Online] The University of Sheffield. Available at: http://www.shef.ac.uk/research/stories/medandhealth/25.html [Accessed 13 July 2010]. Maklebust, J & Sieggreen, M., 2001. Pressure ulcers: Guidelines for prevention and management. [Online] Lippincott Williams & Wilkins, p.1. Available at: http://books.google.co.in/books?id=nGCH1g6TA28C&printsec=frontcover&dq=Pressure+Ulcers&source=bl&ots=Klvb5gN6c8&sig=EKX7dtXc9jQy4Z9o7ho0lc_CWSs&hl=en&ei=fPg7TPSCNs-1rAeA1PzJCg&sa=X&oi=book_result&ct=result&resnum=4&ved=0CBoQ6AEwAw#v=onepage&q&f=false [Accessed 13 July 2010]. Read More