...Abstract: In this assignment, I will discuss how pressure ulcers are essentially a severe problem with in healthcare setting and how prevention is accountable in the development in pressure ulcers. I will also address several ways to prevent pressure ulcers, reducing the risk factors, the responsibility of the duty of care of patients and the use of risk assessment tools. We must remove the risk to prevent pressure ulcers. Methods used is researched and reviewed articles discussing the responsibility of the healthcare staff. Pressure Ulcer Sores Pressure ulcers also known as pressure sores bedsores and decubitus ulcers, are confined damaged to the skin and/or underlying tissue that usually occur over bony prominence because of pressure in combination with shear and/or friction. These sores affect 9% of patients admitted to hospital and 23% of those admitted to nursing homes. Early detection and treatment accelerates recovery and reduces complications....
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...-Based Practice September 6, 2015 PRESSURE ULCERS An essential part of nursing care of hospitalized patients is skin integrity maintenance. As markers of the values or products of care most affected by the assessment and interventions delivered by nurses, the rate of PUs is being screened thoroughly now than ever before (Manning, 2015). Pressure ulcers (PUs) are preventable, but PU rates persist to increase disturbingly fast, according to an article by Gary and Hampton published in 2015, the incidence of PUs has increased in the US between 1995 and 2008. The purpose of this paper is to review the incidence of PUs and how to prevent its occurrence and nurses’ responsibility. Practice Setting Problem Pressure ulcer occurs when part of the skin and the tissues underneath are impaired as a result of being placed under enough pressure to impair blood supply. Immobility-related pressure ulcers are defined as localized areas of tissue damage that develops when soft tissue is compressed between a bony prominence and an external surface for a prolonged time. The most common sites were the sacrum, the heel, the ischium and the trochanter. Pressure is where the weight of the body squeezes the tissues between a bony prominence (such as heel, elbow, sacrum or ischials etc) and a hard surface (such as bed, chair or, in the case of heels, the floor). There are four critical factors contributing to the development of pressure ulcers: pressure; shearing forces; friction and moisture...
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...Pressure Ulcers Donna Long Grand Canyon University NRS 433V Introduction to Nursing Research February 11, 2012 Shahin E. S. M., Dassen T., & Halfens R. J. G. (2009). Incidence, prevention and treatment of pressure ulcers in intensive care patients: A longitudinal study. International Journal of Nursing Studies 46: 413–421 Introduction Pressure ulcers refer to damage that occurs to the skin of a patient. Pressure, shear and friction are among the known causes (Shahin, Dassen & Halfens, 2009). Pressure ulcers mostly affect the lower part of the body, the elderly and patients with spinal injuries (Shahin et al, 2009). They are expensive to treat, require long periods of time and numerous treatments to heal. As a result, the cost incurred is very high and ranks among one of the most expensive ailments in the world to treat (Shahin et al, 2009). Background of the Study It is estimated that around 13% of patients in the ICU develop pressure ulcers (Shahin et al, 2009). “Pressure ulcers are the third most expensive disorder after cancer and cardiovascular diseases” (Shahin et al, 2009, p.414). This study looks into the prevalence of pressure ulcers in ICU patients, the factors related to it, and the treatment measures. Overcoming the problem of pressure ulcers is vital especially among critically ill patients who are at the most risk of developing pressure ulcers (Shahin et al, 2009). Educating nurses can reduce the occurrence of pressure ulcers...
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...Summary and Ethical Considerations Introduction "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." (National Pressure Ulcer Advisory Panel, 2007). It is essential to give education to the patients, family, care givers and health care providers to decrease the pressure ulcer rate. Multiple study about pressure ulcer revealed that pressure ulcer causes significant harm to the patients by increasing the length of stay in the hospital due to frequent pain, discomfort, infection and poor healing. The infection and sepsis occur from pressure ulcer can even lead to death. However, pressure ulcers are preventable. Identifying the high risk patients and constantly implementing measures to prevent pressure ulcer in these patients are two major steps to prevent pressure ulcer. "This study aimed at describing contributing factors for the progression or regression of pressure ulcers in the care trajectory as they are understood by nurses working in hospitals or community care." (Athlin et al. 2010) Background of study Nurses play an important role in the prevention of pressure ulcer. Educational programs in the hospital provide good knowledge to nurses about the preventive and treatment methods of pressure ulcer. But some studies pointed that nurses need more updated knowledge about pressure ulcer and due to unorganized systems or shortage of time they...
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...Intro: What are Pressure Ulcers? Cayuga Medical Center’s Initiative Ideally, in modern medicine patients with wounds are bought to treatment facilities and when they leave they are healthier than when they came in. However, one problem threatens to change this. Pressure Ulcers, which form because of skin pressure reducing blood flow to an area of the body, have a habit of forming in patients with a variety of long-term problems as they are cared for in hospitals and nursing homes. The result of this is that in addition to whatever other problems a patient may have, the ulcer causes the skin and the tissue beneath the skin to die, and if the dead tissue is not quickly removed it can cause additional problems and pain for the patient. There are several factors that put one at risk of pressure ulcers, and these conditions are often difficult or impossible to treat. A typical pressure ulcer patient: suffers from mobility problems, is an older adult, has a spine or brain injury or disease such as multiple sclerosis, has a disease or condition that affect ones mental status, has fragile skin, has urinary incontinence or bowel incontinence or does not get enough nutrition. As most of these conditions are symptoms of old age or mental illness, these people will always be at risk of pressure ulcers, meaning the pressure ulcer prevention is there best chance of living comfortably. Pressure Ulcers can be treated but they are painful and if untreated they can result in death. They are...
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...loved ones as well, to ensure quality patient care. In this particular case, had the 2 nurse understood the reasoning and data behind the Pressure Ulcer Rate and Restraint indicators, and communicated the necessity to report any pertinent findings the CNA may discover in the nurse’s absence, the CNA would not have dismissed the reddened area over the patient’s lower spine and would have immediately informed the nurse of the finding. Upon returning the patient to bed, the CNA would have also known not to place the patient back in bed on his back and reapply the restraints. Instead, would have had the patient lay to one side and stressed the importance, to the patient and family member, of frequent turning, to reduce the chance of pressure ulcers. Quality patient care can only be achieved with teamwork and open communication. The discussion of pressure ulcers in hospitalized patients has become an increasing issue with more attention to the prevention of such since the early to mid-1990’s. The Centers for Medicare and Medicaid Services (CMS) state that stage III and stage IV pressure ulcers occurring during admission are considered preventable (Zaratkiewicz et al., 2010). While the gentleman in our case scenario represented what would be considered a stage 1 pressure ulcer, with proper quality care and training, even this stage 1 ulcer could have been prevented or at the very least, the progression...
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...Nurses towards Pressure Ulcers in Long Term Care Facilities that Hinders Prevention & Treatment Takoya Walker College of Costal Georgia Introduction and Background Pressure ulcers (PUs) have post a problem to healthcare for thousands of years. Since at least the 1980s, pressure ulcers have been considered a result of poor quality of care (Lyder & Ayello, 2012). In response to the Institute of Medicine’s landmark report To Err is Human: Building a Safer Health System, the National Quality Forum designated hospital-acquired Stage III or Stage IV PUs as “never events” (considered avoidable health care incidents) (Agency for Healthcare Research and Quality [AHRQ], 2012). Since 2008, the Centers for Medicare & Medicaid Services no longer reimburse providers for treatment of facility acquired Stage III or Stage IV PUs. Populations at risk for PU development include older adults, patients with dementia, and any person with conditions of immobility (Ratliff, Tomaselli, & The Guideline Task Force, 2010). Because an older adult is more likely than a younger person to have impaired mobility and co-morbid health conditions, elders are especially vulnerable for PU development. This is of particular concern given the large population of these individuals in our nursing home facilities. In 1992, the AHRQ developed early guidelines for preventing pressure ulcers. In general, prevention guidelines focus on reducing the amount and time of pressure and shear through...
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...of the blood vessels. Affecting about 8.5 million people in the United States of America, PVD is more prevalent in older adults, smokers, diabetics, and people with high blood pressure. Individuals who have a family history of Coronary Heart Disease (CHD), high blood pressure, high cholesterol, and stroke are also at increased risk. In diabetics and older adults, PVD is the leading cause of disability. Although PVD can be asymptomatic, there are a few different tests which can diagnose it. There are many misconceptions about PVD. Most people, especially older adults, believe the pain associated with PVD is a sign of normal aging. Many people believe, after being diagnosed with PVD, the only treatment option involves surgery and amputation. Even though surgery is a treatment option, the use of medications and other medical...
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...2011 Abstract Historically, the United States has been sickness oriented. But in the last twenty years, a new model has surfaced. The new model lays emphasis on wellness rather than sickness. As a result in this change in focus, health promotion is now a fundamental part of nursing profession. This article will review recent literature from three professional sources relative to nursing profession and health promotion. This paper will examine; (a) Definition of health promotion. (b) Purpose of health promotion in nursing practice. (c) Evolving nursing roles and responsibilities in health promotion. (d) Explain the implementation methods for health promotion. (e) Compare the three levels of health promotion prevention. Health promotion is defined as “the science and art of helping people change their lifestyle to move toward a state of optimal health.” (Edelman & Mandle, 2010). The purpose of health promotion in nursing practice is to enable people make healthy choices. According Smeltzer & Bare (2006), the purpose of health promotion is to focus on a person’s potential for wellness and to encourage him/her to change her personal habits, lifestyle and environment in a way that it will reduce risk and improve health and wellbeing. Nursing roles and responsibilities have gradually evolved due to changes in the society. Special importance is now attached to preventive, community-based care...
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...the development of pressure ulcers. Objective: Identify risk factors related to complications secondary to immobility such as pressure ulcers on the integumentary system. Immobility also leads to other adverse effects affecting cardiovascular system, respiratory system, and musculoskeletal system as well. The assessment is performed on admission data, then once a week. The risk assessment scale used was the Risk Assessment Pressure Sore (RAPS) scale, which includes the following variables; general physical condition, activity, mobility, moisture, food intake, fluid intake, sensory perception, friction and shear, and body temperature (Lindgren & Unosson, 2004). Results: 25 % of patients developed pressure ulcers. Non-blanchable erythema was the most common pressure ulcer noted among these patients. The majority of these patients were significantly older, and hospitalized for a longer period of time. In the analysis using variables included in the RAPS scale, immobility emerged as a major risk factor. Conclusion: Immobility is the main cause of pressure ulcer development among adult hospitalized patients. Part II: After reviewing patient’s charts and documentation in 4 west, it is concluded that: 37% charts with mobility documented. 63% charts with no mobility documented. Problem statement: After carefully reviewing patients charts, baseline data was gathered on 4West step down unit revealing that that only 37% of patients with orders for early ambulation were...
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...nursing staff. Bedsores, ulcers and other types of wounds require lots of treatment and attention, which is a major responsibility for licensed nursing staff (Bock, M. (2003). However, there are instances when improper elderly wound care can result in further health complications or even early death. There are a number of types of chronic wounds that may require to be treated in a nursing facility. The different types of wounds are lacerations, abrasions, contusions, and avulsions. There are a lot of factors that determines wound closure, the type of wound, size, the location of wound, how long-standing the wound is, condition of the patient, whether infection is present, and urgency of closure. Pressure ulcers often occur because of limited mobility and confining physical structures such as wheelchairs and bed rails. With elimination of pressure, a good blood supply, and adequate nutrition, the pressure ulcers will generally heal. With our aging population, chronic diseases that compromise skin integrity such as diabetes, peripheral vascular disease (venous hypertension, arterial insufficiency) are becoming increasingly common. Skin breakdown with ulcer and chronic wound formation is a frequent consequence of these diseases. Types of ulcers include pressure ulcers, vascular ulcers (arterial and venous hypertension), and neuropathic ulcers. Valid and reliable pressure ulcer risk assessment tools are seriously underused. Evidence-based pressure ulcer prevention and treatment rules...
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...Pressure sores are a burden to patients who live with them, on healthcare providers as well as those who engage to prevent and manage them. These are localized injuries to the tissues of skin and surrounding tissues that happen mostly over a bony body part and are as a result of pressure, friction and shear. Prevention and managing pressure sores is a priority for NHS. According to studies conducted by NHS, “pressure ulcers incidence can be decreased by half annually and the tools to accomplish this are through quality evidence in National Institute for health and Care Excellence (NICE) guidelines”. Pressure sores are common. A research conducted by NIHR program in Leeds suggests that complicated sores are common with estimation occurrence...
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...across America for some time. They can be caused by several factors such as pressure, friction, or shear. In 2008, The Centers for Medicaid and Medicare (CMS) began withholding payment for hospital acquired conditions such as pressure ulcers ("Centers for Medicare," 2012). Hospitals have placed a priority on identifying those patients that are high risk for nosocomial wounds as well as protocols for preventing the wounds. Background of the Project Nosocomial wounds are a possibility for any patient that is admitted to the hospital. Patients are admitted to hospitals in various physical conditions and nosocomial wounds are caused by several factors. According to the Mayo Clinic (Mayo Clinic staff, 2011), nosocomial wounds are a result of pressure on the skin that inhibits the blood flow to skin and underlying tissues. This may come as a result of different problems such as: 1. Sustained pressure from the skim being trapped between a boney prominence and a surface such as a wheelchair or a bed. 2. Friction from moist skin being pulled across a surface 3. Shear from two surfaces moving in the opposite direction such as the bed and the patient. This movement damages the tissue making it more vulnerable to sustained pressure. Add to this the compromised nutritional status of the patients and developing a nosocomial wound becomes a very distinct possibility for many patients. Pressure wounds may develop in many different areas. When a patient is lying supine...
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...Organizational Systems and Quality Leadership RTT Task 1 Nursing-sensitive Indicators Nursing- sensitive indicators are defined as those outcomes that improve in the presence of greater quantity(higher staffing ratios) or quality(educational levels and competence of nursing staff) of nursing care (www.nursingworld.org). These nursing-sensitive measures help healthcare organizations to analyze the quality and quantity of nursing care services. (www.americansentinel.edu )Nursing sensitive-indicators (NSIs) are characterized by measures that are in the realm of nurses to improve and control. According to the website www.nursingworld.org , in 1998, the National Database of Nursing Quality Indicators was established by the ANA so that nurses would have a national benchmark to reach they can compare the outcomes. This has given the profession of nursing a solid core of benchmark capital nursing sensitive indicators that are totally nursing care dependent. This database provides benchmark performance with which the individual healthcare institution can compare its performance to similar institutions across the nation. These nursing sensitive indicators result in patient outcomes that are influenced by nursing care decisions and actions. Research has indicated that patient outcomes improve, complications and mortality are reduced, costs can be reduced, and patient and professional nurse satisfaction can be enhanced with strong performance on nursing-sensitive indicators. These patient...
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...A written assignment that evaluates comprehensive approaches to nursing assessment for an older person with multiple health problems. The account should reflect on how the multidisciplinary team and other agencies including the family, may contribute to these assessment approaches. Particular attention should be paid to national policies in this area and evidence of best practice. The patient that will be discussed within this assignment is a 70 year old male admitted to hospital following a stroke. Pressure ulcer risk assessments and nutritional risk assessments will be discussed within this assignment looking at how they are used in the assessment of an older people with multiple health problems. A stroke occurs when there has been a disturbance or cut off of blood flow within the brain, this disturbance damages or destroys brain cells preventing these cells from doing their job. Damage to the brain causes problems with bodily functions and can also affect mental processes (Stroke Association, 2010). A stroke can cause sudden weakness or paralysis which often only affects one side of the body and is one of the most common symptoms of a stroke. It can also cause swallowing difficulties (dysphagia), speech and language (dysphasia) can be affected also, patient may have difficulty in understanding and basic things such as reading and writing following stroke. Problems with eyesight, perception and interpretation, mental processes, bladder and bowels, mood swings, sensation and...
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