As an ICU nurse I constantly watch how patients develop pressure ulcers, a pressure ulcer is an area of skin that breaks down due to having constant friction and pressure, also from having limited movement and being in the same position over a prolonged period of time. Pressure Ulcers commonly occur in the buttocks, elbows, knees, back, shoulders, hips, heels, back of head, ankles and any other area with bony prominences. According to Cox, J. (2011) “Pressure ulcers are one of the most underrated conditions in critically ill patients. Despite the introduction of clinical practice guidelines and advances in medical technology, the prevalence of pressure ulcers in hospitalized patients continues to escalate” (p. 364). Patients with critical conditions have many factors that affect their mobility and therefore predispose them to developing pressure ulcers. This issue is significant to the nursing practice because nurses are the main care givers of these patients and are the ones responsible for the prevention of pressure ulcers in patients. Nurses should be aware of the tools and resources available and know the different techniques in providing care for the prevention of such. The purpose of this paper is to identify possible research questions that relate to the development of pressure ulcers in ICU patients and in the end generate a research question using the PICO model. “The PICO framework and its variations were developed to answer health related questions” (Davies, K., 2011). Five Researchable Questions and Analisis For the process of formulating a PICO question I have narrowed down to five questions pertaining to the factors in the development of pressure ulcers. The first question is what role does the environment play i... ... middle of paper ... ...re, 20 (5) : 364-374. Doi: http://dx.doi.org/10.4037/ajcc2011934 Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75–80. Retrieved from https://ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/9741/8144 Ford, S. (2013). List of 12 Priorities for Pressure Ulcer Study Identified by UK Researchers. Retrieved from: http://www.nursingtimes.net/nursing-practice/clinical-zones/wound-care/priorities-for-pressure-ulcer-research-identified/5058364.article Sayar S.,Turgut, S., Dogan, H., Ekici, A., Yurtsever, S., Dermirkan, F., Doruk, N., Tsdelen, B. (2009) Incidence of pressure ulcers in intensive care unit patients at risk according to the Waterlow scale and factors influencing the development of pressure ulcers. Journal of Clinical Nursing 18, 765-774.
The Braden risk assessment tool was deemed to be appropriate due to the patient’s comorbidity’s of peripheral vascular disease and lymphoedema with the addition of an arterio-venous leg ulcer of the right leg. This scale is universally accepted as a tool to help identify those most at risk with a goal of allowing health care providers to use their experience and judgement to consistently reduce the risk or to ensure preventive care is appropriately prescribed (Guy, 2012). Pressure ulcers are a risk factor for those who suffer from
Willock et al, (2007) developed a detailed questionnaire based on a paediatric and adult pressure ulcer literature. A survey of 265 in patients in a paediatric hospital in the UK was conducted so detailed data could be obtained. The study found anaemia emerged as being a highly significant aspect of determining pressure ulcers. As a result of this study, the Glamorgan scale was
According to ASHA Evidence Based Practice is the combination of clinical expertise opinion, data, and patient’s perspectives, with the goal of providing high-quality services (2013). The process of evidence-based practice consists of formulating a research question, collecting evidence, including views, and then evaluating the entire process. This project introduces the research topic I’ve chosen, which identifies a researchable problem, and formulates an answerable question that is relevant to nursing and evidence-based practice.
With noticeable increase in chronic diseases, trauma, and increasing number of aging population, nurses are required to be in the position of providing pressure ulcer care and prevention. Immobility, advanced age, incontinence, prolonged pressure or friction, inadequate nutrition, dehydration, anemia, hypoxemia, multiple comorbidities, sensory deficiency, thin skin, prominent bony prominences, circulatory abnormalities, pain, and smoking are important risk factors. The barriers in the implementation of preventive measures are staff shortage, shortage of pressure relieving devices (e.g., foam or air mattresses), excessive workload, and uncooperative patients. The Centers for Medicare and Medicaid Services has classified the pressure ulcers as a preventable Hospital Acquired Conditions and stopped reimbursing for such hospital acquired conditions. In the United States, the cost of an individual patient care per pressure ulcer includes skin cleanser, moisturizer, dressings, wound debridgement, antibiotics, analgesics, turning sheet and support surfaces, nursing time for risk assessment, monitoring, and repositioning. It is the second most common claim after wrongful death and greater than falls or emotional distress. No matter what causes the pressure ulcers, the presence or absence of pressure ulcers is generally regarded as a performance measure of quality nursing care and overall patient health. Pressure ulcers can be avoided by applying simple interventions like factor assessment scales and regular turning of the patient. Proper hydration, a balanced diet, activity, wound care, and keeping patient’s skin and body dry are treatment, as well as, preventive measures of this problem. A thorough physical assessment, risk assessment (using a risk assessment tool like Barden scale), repositioning, patient and caretaker education, effective communication, and
Specific refers to this author’s SMART goal being focused on obtaining certification as a Wound, Ostomy, Continence Nurse (WOCN), and work as part of an interdisciplinary team in a hospital setting. The process for this goal will begin after completion of the BSN program. The accomplishment of this goal will encourage professional growth and an opportunity to help develop a more cohesive working relationship with other disciplines.
The field of nursing is one that requires much passion, hard work and critical thinking. It is a nurses job to promote the well being of their patients and help the return to normal function. However unfortunate events occur, resulting in patients receiving adverse health conditions as a result of being in a medical facility One of the most prevalent of these nosocomial conditions are pressure ulcers. Not only do the patients suffer from the pain of pressure ulcers but the hospitals and medical facilities are effected as well. A randomized controlled trial conducted by Pickham et al. reported that “ Pressure ulcers are insidious complications that affect approximately 2.5 million patients and account for approximately US$$ 11 billion in annual health care spending each year” (2016). Pressure ulcers not only cause the patient pain but “even contribute to disability and
Pressure ulcer is one of the major health issue found mostly in sub-acute center and in the hospital. Pressure ulcer usually affects adults. There are many preventive measures available for pressure ulcer such as multidisciplinary team role. Nurses play very important roles for pressure ulcer prevention. Per many studies, to advance health care quality by adapting various strategies, problem solving evidence based practice in the nursing practice plays an important role (Melnyk, Gallagher, Long, L. E., & Fineout‐Overholt, 2014). Pressure ulcer usually affects young adults, especially in acute care and hospital setting affects quality of health due to poor mobility. Therefore, this paper will discuss about establishing a PICOT
The aim of the Healthcare Quality Strategy (HQS) is to deliver excellent healthcare to the citizens of Scotland and brand NHS Scotland as a world leading care provider (Scottish Government, 2010). An improvement intervention examined in the HQS is the prevention of pressure ulcers (PUs). Using the Gibbs (1988) framework, this essay will demonstrate how I was involved in this intervention by applying my skills of compassion, person-centred care and teamwork. I have chosen PU prevention as the subject for this reflection; since, the majority of PUs are preventable (Watret and Middler, 2012) and the cost of treating them ranges from £1,214 to £14,108 (Dealey, Posnett and Walker, 2012). Supporting the Nursing and Midwifery Council (NMC) (2011) confidentiality guidelines, the pseudonym “Ruby” has been used.
Fox, C., Wavra, T., Drake, D. A., Mulligan, D., Jones, L., Bennett, Y. P., & ... Bader, M. K. (2015). USE OF A PATIENT HAND HYGIENE PROTOCOL TO REDUCE HOSPITAL-ACQUIRED INFECTIONS AND IMPROVE NURSES ' HAND WASHING. American Journal Of Critical Care, 24(3), 216-224 9p. doi:10.4037/ajcc2015898
Decubitus ulcer is a kind of pressure sore that is caused by unrelieved body pressure to the body which causes the skin to breakdown. Some causes for pressure ulcer are sitting or lying in one position for longs periods of time without rotating of the body. Many elders that are living in nursing rooms develop these ulcers. There are four stages to decubitus ulcers. The fourth stage is the worst stage and is usually incurable; meanwhile, many that develop the fourth stage or pressure sore usually die. The damage to the skin which damages the muscle, bones and tendons is so extensive. When I worked in nursing homes I had a lot of total care patients, which were unable to turn themselves. I would turn them every two hours to prevent pressure sores. This topic is very touching to me because my grandmother died from decubitus ulcer. She was unable to turn herself the staff would not come change her
The reduction of pressure ulcer prevalence rates is a national healthcare goal (Lahmann, Halfens, & Dassen, 2010). Pressure ulcer development causes increased costs to the medical facility and delayed healing in the affected patients (Thomas, 2001). Standards and guidelines developed for pressure ulcer prevention are not always followed by nursing staff. For example, nurses are expected to complete a full assessment on new patients within 24 hours at most acute-care hospitals and nursing homes (Lahmann et al., 2010). A recent study on the causes of pressure ulcer de...
Evaluation of the wound related to the nutritional aspect. The best coverage to be used is then chosen.
When caring for patients it is fundamentally important to have a good selection of up to date evidence Based Practice clinical articles to support research strategies, this allows professionals to assemble the most resent and accurate information known which enables them to make decisions tailored to the individual’s plan of care. It is essential to have clinical expertise and have the involvement from the individual patient, they must have full engagement and incorporation in order to have the accurate evaluation.
Due to the high risk that pressure ulcers impose on the health of patients, nurses play a vital role in the prevention and treatment. “A pressure ulcer is a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure or pressure in combination with shear and/or friction”, (Gulanick & Myers, 2014). All patients, no matter what age, ...
When a wound is determined as non-healable, as described by Sibbald et al (1), it should not be treated with a moist treatment and should be kept dry in order to reduce the risk of infection that would compromise the limb. It is also important to consider the patient 's preferences and try to control his pain, his discomfort in activities of daily living and the odour that their wound may produce. In this case, special attention must be given to infection prevention and control. Some charcoal dressing would be interesting in the care of our non-healable wounds at St. Mary 's Hospital.