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...
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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
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
The length of the stay of patients diagnosed with pressure ulcers noticeably increased by about five times. The risk of death is increased about 4.5 times compared to the patients without this condition. This is the main reason this issue is being studied. ICU patients require constant monitoring and invasive procedures performed by the multidisciplinary team. Patients admitted to the ICU are considered critical and hemodynamic unstable. These patients may be sedated, provided with mechanical ventilation, and placed on bed rest for long periods of time. The most difficult challenge regarding pressure ulcers is to maintain skin intact. To ensure optimal pressure ulcer treatment and prevention is used, a multidisciplinary approach, in which nurses play a vital role. Risk assessments, hands-on care, daily skin care, and providing an environment, which will help patients attain optimal health are among these responsibilities. Due to the patients’ inability to turn themselves, critically ill patients have to be repositioned by caregivers frequently. It has to be done by professionals who know about the complications and risk factors because improper repositioning may cause shearing and friction, which will lead to pressure
An example of evidence based practice would be to find relevant studies for a specific topic area being researched. For example, to find the research paper titled ‘The efficiency of cotton cover gowns in reducing infection in nursing Neutropenic patients,’ the journal in which the article was published in this case, The International Journal of Nursing, would need to be found. Medline, an online database would be one method of finding this. A list of relevant search terms would then need to be researched by using the PICO Framework, this limits the search to only relevant items and ensures that a well built clinical question will then be formulated (Drummond,1998).
Evidence based practice is the basis for needed change in practice and function. It is a sound method for scientific, fact-based change. Changes which have no evidence to support them are fragile, unscientific, and subjective. These changes don’t effect real change over time, as they aren’t able to be proven to a more general population.
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.
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)
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
Quality improvement issues in healthcare focus on the care that patients receive and the outcomes that patients experience. Nurses play a major advocacy role for ensuring safe and quality care to all patients. Also, nurses share the responsibility in leading the efforts in improving patient care in all settings (Berwick, 2002). One of the ongoing problems plaguing hospitals and nursing homes is the development of new pressure ulcers in patients after admission. A pressure ulcer can be defined as a localized area of necrotic tissue that is likely to occur after soft tissue is compressed between a bony prominence and a surface for prolonged periods of time (Andrychuk, 1998). According to the Centers for Medicare and Medicaid, patients should never develop pressure ulcers while under the supervision of any medical institution because they are totally preventable (Berwick, 2002). The purpose of this paper is to discuss the problems associated with pressure ulcers, examine the progress on improving this specific issue, and explain the Plan, Do, Study, Act cycle that I would use to improve patient care in this area.
What are the best ways of achieving this in the reality of the modern NHS? To conclude, Evidence Based Practice is a process of building up accurate information from medical research which has been correlated and assessed. From this, the nurse is capable of advising the best plan of care. For nursing standards to improve, it is vitally important that the nurse is given the time to research and the trust to start off the process of change for better care. References Cullum, N., Ciliska, D. and R. Haynes, Marks (2008).
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
The outcome of interest in adoption of these two actions of intervention is to help to decrease chances of occurrence of pressure ulcer and also will help to prevent pressure ulcer. A nursing assessment and plan can help to determine the patient’s essential need for treatment. Many different studies have been done which is evident based research, which shows the positive effect of implementing all these interventions including nutrition and high protein diet (Soban et al., 2011). Therefore, implementing this intervention can significantly decrease occurrence of pressure ulcer within two weeks or up to six months. The ideal PICOT statement for this study subject can be "in acute care centers, does pressure mattresses compared to regular turning of patients, reduce the pressure ulcers occurrences among the adult patients within two weeks or up to six
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
Our approach in managing wounds was far from being optimal in our own setting. After having read the article of Sibbald et al (1) and assisting to presentations during the first residential week-end, our approach at St. Mary 's Hospital Center 's Family Medicine Clinic must change. We were not classifying wounds as healable, maintenance or non-healable. We were always considering the wounds in our practice as healable despite considering the system 's restraints or the patients ' preferences. In the following lines, I will define and summarize the methods one should use in order to initial management of wounds and how to integrate it better to our site. The first goal we need to set is to determine its ability to heal. In order to ascertain if a wound is healable, maintenance or a non-healable wound.