I have done a research project in fulfillment of the Bachelors of Science in nursing at Rufaida College of nursing, Hamdard University, New Delhi, India. The project was, ‘A study to determine the prevalence of pressure ulcer in spinal cord injury patients and its possible underlying factors in a selected Government hospital of New Delhi in India'.
The objectives of the study were, to determine the prevalence of pressure ulcer in spinal cord injury patients and find out the possible underlying factors for the development of pressure sore in spinal cord injury patients.
The conceptual framework offered for the study based on the epidemiological concept of interaction between the agent, host and environment. The research approach adopted for the study was descriptive survey method. The tools for the data collection were an observation checklist, an interview schedule and a questionnaire. The observation checklist, used to determine the prevalence of pressure ulcer in spinal injury patients. The investigators used the interview schedule for the spinal cord injury patients, and the questionnaire for nursing staff to find out the possible underlying factors. Five experts from health care profession validated the tool. Purposive sampling technique adopted to select the sample. The sample consists of 54 spinal cord injury patients and 20 nursing staff from the spinal cord injury unit of Safdarjung Hospital, New Delhi, India. The information collected over a period of two weeks.
The data analyzed to find out the prevalence of pressure ulcer, their distribution by affected bony prominence and the stages of pressure sore by computing frequency and percentage. The data collected from spinal cord injury patients analyzed under host, agent and environmental factors by computing mean percentages.
The significant findings of the study were as follows:-
1. There was a high prevalence (66.67%), of pressure ulcer in spinal cord injury patients.
2. The most affected bony prominence was sacrum (44.44%) and least affected area were ischial tuberosity, lateral malleolus, and toes (2.78%).
3. In most of the patients (47.22%), the pressure ulcers were in the 1st stage.
4. The key factors for the development for pressure ulcer in spinal cord injury patients were the lack of comfort devices (96%), and inadequate nurse- patient ratio (94%).
5. As reported by the nursing staff, the adequate nurse patient ratio (80%), was the dominant factor for the development for pressure ulcer in spinal cord injury patients.
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
Risk assessment scales have been in situ for over 50 years within the adult sector. These scales consist of several categories, which are thought to be associated with the potential occurrence of a pressure ulcer. Factors such as mobility and incontinence etc. are considered. Each category of the assessment is added up to give a total. The score then suggests whether a patient is at low, medium or high risk of developing a pressure ulcer. Higher-risk patients are therefore more susceptible to develop pressure ulcers and interventions are implemented such as, Air mattresses or nutritional support which is hoped to reduce the occurrence of pressure
...ssure ulcers can be preventable if there is a systemic and multi-professional approach to their prevention and continuing assessment of skin integrity. Mary was determined and worked well with the physiotherapist; she was up and on her feet within a week of returning. Staff had to prompt her to move around the ward, which at times was hard for her due to her anxiety. Mary was deemed high risk for falls, so was put on a prevention of falls chart in conjunction with the pressure area chart and repositioning chart.
Hinkle, J., Cheever, K., & , (2012). Textbook of medical-surgical nursing. (13 ed., pp. 586-588). Philadelphia: Wolters Kluwer Health
These risk assessments include, pressure injury assessment, nutritional status, fluid balance charts, falls risks assessment, and double checking of the right medication. These are all a set of examinations that are done throughout every day of the patients stay and depending on the individual it may be assessed every 20-30 minutes or every other hour. For Mr Azikiwe, each of these assessments must be made throughout the day as his flu-like symptoms are worsening, he lacks energy and does not feel like eating. With his lack of energy and weakening body it may lead Mr Azikiwe to be dehydrated, malnourished and have pressure injury sores from lack of movement. Through the help of these risk assessments, it can be determined exactly where Mr Azikiwe is with his health and come up with possible ways to improve it. A pressure injury assessment would be crucial because at this age his skin is more prone to pressure sores, and due to his lack of energy, he will need to be checked on and turned at least every 2 hours. Other things that may reduce his chances of getting pressures injuries are by keeping the skin clean and dry, protecting the skin by applying talcum powder or cushioning at friction points. Due to the fact that Mr Azikiwe does not feel like eating much, his nutritional status and fluid balance will need to be assessed daily. By keeping track on these, it will help in achieving a healthy nutritional status and fluid balance chart so that he may regain his energy. In addition, because of Mr Azikiwe’s condition, a set of falls risks assessment must be made each time before leaving the room to ensure there is no chance of him accidentally falling in the absence of a nurse. Along with this, it is crucial that he receives
Shekelle, P. (2013). Nurse-patient ratios as a patient safety strategy. 158, 404-409. Retrieved from http://eds.b.ebscohost.com
warm) in the left upper and lower extremities; decreased strength and movement of the right upper and lower extremities and of the left abdominal muscles; lack of triceps and biceps reflexes in the right upper extremity; atypical response of patellar, Achilles (hyper) reflexes in the right lower extremity; abnormal cremasteric reflex in the right groin; fracture in cervical vertebrae #7; and significant swelling in the C7-T12 region of the spinal canal (Signs and symptoms, n.d.). The objective complaint of a severe headache could also be consistent with a spinal cord injury (Headache, nausea, and vomiting,
..., Ducker, T.B., ….. Young, W. (1997). International Standards for Neurological and Functional Classification of Spinal Cord Injury: International Medical Society of Paraplegia, 35, 266 – 274.
In this section the researchers explain the complications that can occur based on non-adherence to a proper self-catheterization regimen. A spinal cord injury can cause an interruption in neural pathways which affect the function of the bladder causing urinary incontinence, urinary retention, urinary reflux, and recurrent urinary tract infections. These problems can ultimately lead to an increase in renal morbidity and mortality (Shaw & Logan, 2013) Later, in the discussion section of the article, the authors focus on the importance of nursing education to teach patients proper methods to perform and cope with ISC in order to eliminate these common occurrences in patients suffering from SCIs (Shaw & Logan, 2013). The perception of performing this task may vary from patient to patient. This research helps identify various educational approaches that could be taken to accommodate all patients. Therefore, the research is significant to nursing due to the fact that nurses are considered the primary educators and are expected to address practical issues with patients performing ISC and help them manage the psychological issues that are faced with this
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.
Registered Nurses Association of Ontario (RNAO). (2005). Best practice guideline (BPG): Risk assessment and prevention of ulcers. Retrieved from http:// www.rnao.org
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...
In patients with diabetic foot ulcers, how does the use of negative pressure wound therapy compared to moist wound therapy influence wound healing in a shorter period of
Davenport, Joan M., Stacy Estridge, and Dolores M. Zygmont. Medical-surgical nursing. 2nd ed. Upper Saddle River, N.J.: Pearson Prentice Hall, 2008, 66-88.
Brunner, L.S. & Suddarth, D. S Textbook of Medical- Surgical Nursing, 1988 6th ed. J. B. Lippincott Company, Philadelphia