Pressure Ulcer Prevention Repositioning
Introduction
Pressure ulcers are one of the most common problems health care facilities often face which causes pain and discomfort for the patient, cost effective to manage and impacts negatively on the hospital (Pieper, Langemo, & Cuddigan, 2009; Padula et al., 2011). The development of pressure ulcers occur when there is injury to the skin or tissue usually over bony prominences such as the coccyx, sacrum or heels from the increase of pressure and shear. This injury will compromise blood flow and result in ischemia due to lack of oxygen being delivered (Gyawali et al., 2011). Patients such as those who are critically ill or bed bounded are at high risk of developing pressure ulcers (O'Brien et al., 2014).
Pressure ulcers are considered an adverse event in health care and guidelines are set to help health care professionals prevent this from occurring. Penalties have been placed as an incentive to help prevent hospital-acquired pressure ulcers (Cantrell, 2013). The most common method used to reduce the risk of pressure ulcers are two hourly repositioning (REF). However, there is insufficient evidence regarding the frequency of repositioning and research regarding the purpose of turning is very limited. The following review will discuss the research found for the frequency of repositioning patients and supportive surfaces used to reduce the risk of the development of pressure ulcers.
Methodology
In gathering articles for this review, numerous methods were used to narrow journal articles that were relevant to nursing. A search was conducted on EBSCO HOST for key terms such as ________. This was narrowed down to articles which were between 2009 and 2014, plus articles which had full text...
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...tioning component” and not used in isolation (Moore, Z., Haynes, J., & Callaghan, R. (2014); Bergquist-Beringer, S., Dong, L., He, J., & Dunton, N. (2013).
Conclusion
Pressure ulcers remain a major health problem for patients in all health care setting but may gaps still remain in the understanding and prevention. Studies indicate that comprehensive prevention techniques such as repositioning and pressure relieving aids have slightly reduced incident rates but areas of high skin-bed interface pressures still remain in jeopardy. By preventing pressure ulcers, it would reduce health cost and patient comfort will be increased. Additional research is needed to determine the most appropriate preventative responses, thus, more research should be conducted in regards to the frequency of turning plus the use of pressure releasing equipment. (change and improve outcomes)
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
...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.
A study in Hong Kong also evaluates the use of double-gloving during surgery (Guo, 2012). This study fouses more on nurses instead of surgeons. They also focus more on glove perforation as opposed to sensitivity and dexterity. Guo states that “the purpose of our study was to assess the effectiveness of double-gloving in protecting perioperative nurses from having contact with patients’ blood and body fluids during surgery by comparing the frequency of glove perforation between single-gloving and double-gloving groups” (Guo, 2012).
Hinkle, J., Cheever, K., & , (2012). Textbook of medical-surgical nursing. (13 ed., pp. 586-588). Philadelphia: Wolters Kluwer Health
Utilizing this tool will allow The Restorative Nurse and Wound Nurse to generate a graph based off of the data retrieved from the Center of Medicare and Medicaid Services (CMS) quarterly Quality Measures Report (APPENDIX B). The Wound Nurse and Restorative Nurse will start with the last data reported before the start of the On-Time Project and then graph the data every three months during the On-Time Project for the following areas: falls, weight loss, in- house acquired pressure injuries and nosocomial infection. For that purpose, to monitor the effectiveness of the On- Time Project the Wound Nurse and Restorative Nurse will provide a designated share drive to present to the Director of Nursing and other stakeholders on a quarterly schedule at the quarterly Quality Assurance Improvement Program(QAIP)
LoBiondo-Wood, G., & Haber, J. (2014). Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice (8th ed.). St. Louis, MO: Elsevier, Inc.
The purpose of this report is to compare and contrast two different nursing research articles. The report will critique and evaluate two qualitative studies, one being an original research report and the second being a review paper. The scope of comparison and contrast will include research design, theories or conceptual models, how the research was conducted, analysis and reporting of research data, usefulness of the research, and a conclusion.
To sustained the PSI a clear recognition from senior healthcare staffs such as continence nurse advisers, the nurse specialist and community nurse and support by training, coping and adopting strategy to change is needed (NHS ΙΙΙ 2008). The role of the nurse involves investigating patient, communicating with the other healthcare team members such as community nurses to help ensuring the use of the cover for the catheter stand is an essential element of care, rather than being dismissed or patient isolating them self due to stigma (RCN 2013).
Polit, D. F. & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia: Lippincott.
Nursing research is a systematic enquiry that seeks to add new nursing knowledge to benefit patients, families and communities. It encompasses all aspects of health that are of interest to nursing, including promotion of health, prevention of illness, care of people of all ages during illness and recovery (or) towards a peaceful and dignified death (ICN 2009)
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...
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...
According to Ruth Craven, Constance Hirnle, and Sharon Jensen in Fundamentals of Nursing Human Health and Function a restraint is used to stop a patient from being able to move freely, whether it be physically or assisted with medication. Types of restraints include physical, chemical, nonviolent/self-destructive, violent/self-destructive, and seclusion. Ultimately restraints are used in situations to help keep both the patient and the staff caring for that patient safe. The purpose of this paper is to recognize and explore ways to improve the use of bed restraints and further educate nurses on proper use to enhance patient safety. This is relevant in today’s healthcare setting, because there is still a need to keep patients safe and provide them with quality care, which may include the use of restraints.
Potter, P. A., & Perry, A. G. (2009). Fundamentals of nursing (Seventh ed.). St. Louis, Mo.: Mosby Elsevier.