...Literature Search Wound Care is very important topic in modern medical field. Pressure ulcers are the major problem in the long term facilities. Having an understanding of the exact cause of pressure ulcers helps place the role of repositioning into context. Demographic and epidemiological data suggest that health-care demand will increase considerably in the future as a result of an ageing population and a rise in the prevalence of chronic diseases such as diabetes. This phenomenon has come to be referred to as the ‘health care time bomb’ in the popular press and political discourse. The authors seek to look beyond the headlines and political rhetoric to clarify the extent to which they reflect the likely future reality with a specific focus on wound management. The present-day burden that wounds and current wound management practices place upon the health-care system are detailed and clarified, and the potential future implications of increasing wound prevalence on the current picture are explored. Possible opportunities to enhance current wound management practice as identified in the analysis are discussed. Declaration of interest: Alistair Biel by is a contractor for Smith & Nephew. Richard Searle is and employee of Smith & Nephew. This project was supported by an unrestricted grant from Smith & Nephew. As such, a pressure ulcer is defined as localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure or pressure in combination...
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...The Significance of Having a Multidisciplinary Team 3 Abstract The growing prevalence and hospital acquired pressure ulcers is an immediate concern. The major challenge is the A major challenge is the lack of knowledge and skills in wound identification, management, treatment and prevention. This, along with other factors, creates poor patient care and vast costs to the pertinent facilities. The solution is to have interprofessional collaboration. The utilization of current advanced practice nursing staff as a resource for floor nurses and other involved healthcare workers is a must. This would obtain certification in wound care and be responsible for the ongoing continued education for wound prevention, monitoring and maintenance. The staff will be educated and trained at quarterly intervals on wound identification, staging, prevention, maintenance and monitoring. Key words: wound care, evaluation, pressure ulcers, multidisciplinary, specialist, evidence The Significance of Having a Multidisciplinary Team 4 Problem Identified The Centers for Medicare & Medicaid Services (CMS) declared in October of 2008 that it will no longer provide reimbursement for hospital acquired pressure ulcers (HAPUs) because it is a preventable occurrence (CMS, 2014). Even though the percentages of occurrences have declined since then, HAPUs continue to cause financial strain on institutions (estimated $9.1- $11.6 billion dollars loss annually)...
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...World Wide Wounds Negative Pressure Wound Therapy Augusta Ogwu Chamberlain College of Nursing Foreword: Negative Pressure Wound Therapy better known as Topical Negative Pressure (TNP), stands to be a vacuum assisted procedure for the treatment of ulcer by employing a negative pressure of 60-125 mm Hg on the bed of the wound. The procedure has been employed ever since the year 1995 for the treatment of surgical wounds, severe wounds and more rarely for the ulcers that are hard to heal. Treatment with TNP is employed within the departments of high technology like the department of cardiothoracic surgery, wherein the procedure has been widely assessed for mediastintis post heart surgery (Sjögren J. Vacuum, 2005). The experiences of patients of treatment with TNP for mediastintis has been elucidated in one Swedish doctoral thesis (Swenne C.L., 2006). Plurality of research rest upon the V.A.C. therapy, that was brought forth in the American market in the year 1995 and in Europe in the year 1997(Argenta L.C, Morykwas M.J. Vacuum, 1997). The objective of this research was to assess if the negative pressure would be a clinically feasible alternative for the management of wound in primary care, when taking into consideration the time for the healing of ulcer (gauged in weeks), change in the size of the ulcer (measured in cm² using a digital planimeter) and formulation of the granulation tissue (examined by visual observation). Albeit the calculation costs was...
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...Wounds are injuries that break the skin or other body tissues. They include cuts, scrapes, scratches, and punctured skin. The skin of the elderly may degenerate on its own and sometimes even without the presence of an injury. Elderly wound care is a significant and important part of the duties for 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...
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...Study Knowledge Pressure Ulcer Prevention among Nursing Professionals Jeamol Joseph Grand Canyon University NRS-433= Introduction to Nursing Research 24 July, 2011 Quantitative Research Study Nursing research is a process which helps to improve the patient outcomes through a thorough analysis of data collected and making new contributions to the healthcare field. Evidence based nursing is the process by which nurses make clinical decisions using the best available. In quantitative studies researchers identify the problem and collect relevant data from subjects. The researchers plan in advance the steps to be taken and collect data in numerical form. In qualitative studies, researchers collect narrative descriptions. Data is collected and progression takes place as the research is continuing. Nursing research is systematic search to develop evidence on problems of nursing profession. Now days hospitals deliver higher quality care to critical patients .In hospital settings these patients are more susceptible to hospital acquired infections and injuries. All the institutions have used effective strategies to avoid complications that keep their patient’s safety at risk. Quality improving programs and patient safety committees are available in all hospitals to promote patient safety. Pressure ulcer or bed sores are important problem in hospitals and nursing homes. Pressure ulcers prolong the hospital stay of hospital. They increase the cost of patient care. The article “knowledge...
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...Wound Care Education Abstract The purpose of this paper is to identify a patient health issue that would benefit from patient education. During the clinical rotation at Jackson South the group identified a need in wound care especially for patients with other underlying health issues such as diabetes. A large percentage of patients had wounds that would require patients to properly care for them once discharged. The group identified a lack of patient knowledge on how to care for these wounds and decided to develop a patient education pamphlet to teach patients how to care for wounds while not in a hospital setting. The group identified one particular patient that had insufficient knowledge in self-care. Wound Care J.G. is a 65-year-old male patient with a history of a cerebrovascular accident, hypertension, diabetes and multiple pressure ulcers. The patient was admitted to Jackson South Community Hospital with multiple wounds for suspected infection. He currently has two pressure ulcers present. One is a stage IV ulcer located at his right hip and the other is a stage III ulcer located on the heel of his right foot. He is scheduled for a CAT scan to rule out any collections in the hip and medical management of the wounds will be continued. Factors that contributed to the development of these ulcers were his lack of sensation due to his diabetes and being bed bound. He is alert and oriented and is in no acute distress. He currently lives with his only daughter, who will...
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...Design for Change in Practice The increasing prevalence of Hospital Acquired Pressure Ulcers (HAPU) is a problem that is plaguing hospital’s across the nation. The estimated added expense in managing a single full thickness pressure ulcer can be as high as $70,000.00, and the total cost to hospitals across the nation could be as high as $11 billion/year (Lynch & Vickery, 2010). Initial identification of at risk patients has been one of the keys to successfully reducing stage 3 and 4 reported pressure ulcers. The Braden scale for predicting pressure sore risk is a universally accepted tool used to help nurses identify patients who are at risk of developing pressure ulcers. The scale evaluates each patient in the following six areas exposure to moisture, sensory perception, activity, and ability to change positions, nutrition, and exposure to shear (Rosenfeld, 2010). The identification of unit specific champions is a key strategy for the continued reduction of the prevalence of pressure ulcers. These leaders on the units serve as the educators for the remaining staff on the unit. These champions would be part of a multidisciplinary team, which reviews all new research, assistive devices, and evidence-based practice concerning the treatment and prevention of pressure ulcers. The multidisciplinary team would focus on key points the help take aggressive action against pressure ulcer prevention, some of the key points are education, documentation, setting benchmarks...
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...A pressure ulcer is a wound or sore caused when an area of skin and the tissues below are damaged due to an occlusion of the blood supply (Neilson, 2014). If the lack of blood supply is prolonged the tissue will continue to degrade. This progression is categorized into the four stages of pressure ulcers. I will begin by giving an overview of each stage, and then comparing and contrasting the stages. I will finish with two unconventional options of wound treatment derived from folk medicine. Stage I of a pressure ulcer is when the skin is intact, and has localized redness that does not turn white (blanch) when pressure is applied (The National Pressure Ulcer Advisory Panel [NPUAP], 2015). The site of the pressure ulcer is usually located over a bony area of the body (NPUAP, 2015). The location could have a different temperature or texture than that of the rest of the skin, or be painful (NPUAP, 2015)....
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...Reduction of Nosocomial Wounds Phillip Cook American Sentinel University Hospital acquired wounds or nosocomial wounds have been a problem to the health systems 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...
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...the nursing profession” (Tomajan, 2012, abstract). Nurses have the power to make a difference in their work organization by making positive changes. Changing the staffing matrix to staffing based on acuity and reducing the unit department’s acquired pressure ulcers will greatly contribute to patient safety and patient/nurse satisfaction. Goal 1: Leadership Development A major problem of the health care system today is the heavy workload of the hospital nurses. Nurses are experiencing job dissatisfaction and burnout due to three main reasons: increased patient acuity, inadequate nursing staff, and higher workload. Staffing by patient acuity is safer for patients. It decreases the heavy patient workload and eliminate overtime. It will also increase the nurse’s job satisfaction and create better patient outcome. The article “Safe Staffing Saves Lives” mentions, “insufficient nurse staffing has been linked with poor patient outcomes, longer hospital stays and increased risk of patient mortality” (2011, p. 16, para. 2). The article summarized how the American Nurses Association (ANA) introduced the formal legislation that required “hospitals that participate in Medicare to form committees that compromised of at least 55% direct care nurses” (“Safe Staffing Saves Lives,” 2011, p. 16, para. 2). Now the ANA has proposed a guideline to solve the nurse-staffing crisis. The ANA’s guideline requires hospitals to set nurse staffing based on five changing condition: patient acuity, patient...
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...practice. An instrument specifically designed to aid health care workers evaluate the dangers of pressure sores that a patient faces is called the Braden Scale. After assessment, the victim is categorized depending on six aspects: capability of physical activity, hydration and nutrition status, capacity to alter position, the ability to respond after sensing discomfort related to pressure, shearing or exposure of the skin to friction during locomotion, and skin exposure to moisture. If the overall score is lower it means the risk of pressure sore is higher (Changing Practice, Changing Lives: 10 Landmark Nursing Research Studies, n.d). Prior to this Change, Skin assessment was based on non- formalized risk assessment which varies with each clinical practice. 2. Discuss why the current nursing practice needs to be changed Using non-formalized risk assessment in Predicting pressure ulcer resulted in non-uniformity and personal clinical judgement which varies from one person to another. Using Clinical judgement is more effective where the staffs are experienced and their experience assist in appropriate predictability, but with novice staff, the use of clinical judgment is inappropriate. In a multisite trial, Braden scale was tested by clinics bringing together skilled nursing facilities, Veterans Administration or VA medical centers and hospitals providing tertiary care. Of those who took part, none had experienced pressure sores earlier. Nurses evaluated those who took part in the...
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...A venous leg ulcer is a chronic wound as it takes longer than six weeks to heal. It is caused by venous hypertension which is high blood pressure exerted in the veins of the legs which causes damage to the skin. Fluid can leak from the veins and pool under the skin causing swelling and thickening, this then leads to the skin breaking down to form an ulcer. Before a venous ulcer can be treated it is important to rule out peripheral arterial disease being the cause of the ulcer. Symptoms of peripheral arterial disease include pain in limb when exercising or walking, intermittent claudication, skin changes such as hair loss, cold to touch, oedema and ulceration. An arterial leg ulcer is caused by poor blood flow in the arteries and due to the current treatment of venous ulcers which is bandaging. This would reduce blood flow further and cause more damage making the ulcer worse. Having a history of varicose veins and a lack of mobility increases the chance of developing venous leg ulcers . According to SIGN (2010) when assessing a patient for the first time with a venous ulcer it is important to obtain their medical history in case of previous varicose veins and deep vein thrombosis as well as their mobility. Knowing these factors will contribute to managing the patients treatment, care and help with the rate of improvement. The framework model used to assess leg ulcers is the leg ulcer care pathway which is dived up into four stages 1. Patient...
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...today. According to the 2014 National Diabetes Statistics Report, “29.1 million people or 9.3% of the population have diabetes.” One of the many conditions resulting from uncontrolled diabetes is foot ulcers. Foot ulcers can lead to an increase hospitalization stay for wound care treatment. The standardized method for treating foot ulcers consist of saline moisture gauze. The newer technology to promote wound healing is Negative Pressure Wound Therapy (NPWT). One type of NPWT is vacuum-assisted closure device. With the rapid growth of diabetes, there comes an...
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...Education on Wound Care for Diabetic Patients Education on Wound Care for Diabetic Patients Abstract Non-compliance of wound care management has increased the risk of infection and amputations. Diabetes wound care management is an important and fundamental aspect when it comes to diabetes teaching and education. Assessment of the feet daily and at a primary care office will provide information such as noncompliance, risks for neuropathy, peripheral vascular disease, macro-vascular disease, and possible amputation. Education provided by health care practitioners to the diabetic population will promote decrease in risk for further complications and the patient to be involved in their own care. Assessment, treatment, and education on wound care management with the involvement of the patient will increase the patient’s quality of life and be very beneficial to both the practitioner and the patient. Keywords: diabetic wound care management, diabetic ulcer care, outpatient diabetes management, diabetic care management Introduction Working in a primary care setting will involve a multitude of disease processes- diabetes mellitus being one of them. Diabetes is a disease that is characterized by high levels of blood glucose with a defect in insulin secretion and cell resistance. Without proper management, diabetes may lead to other issues in health. Examples of such, would be, delay in wound healing, leading to foot ulcerations, which thus increases the risk for amputations...
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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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