Foundations of Professional Nursing Assignment 1: Written Essay 1500-2000 words Topic:“Pressure ulcers are debilitating for the client and yet they are largely preventable”. Word count from Introduction to Conclusion: 1520 ? Abstract This paper will discuss how pressure ulcers are essentially a serious problem within healthcare settings and how prevention is accountable in the development in pressure ulcers. The paper explores various 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. In order to prevent pressure ulcers, remove the risk.
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Evidence for this paper was gathered from seven peer reviewed journal articles from the online database CINAHL, a government website QLD Health and from various books. Table of Contents Abstract2 Introduction4 General Disscussion5 Conclusion10 Reference11 Apendix12 Introduction Pressure ulcers are serious problems for patients and healthcare settings and are responsible for high treatment costs and even death. With the increase in the aging population and fewer resources, the intensity of pressure ulcers in patients in healthcare settings will only increase without the appropriate prevention techniques to prevent these risks from occurring.
This paper will look at the risk factors that contribute to pressure ulcers such as the intrinsic and extrinsic factors, and how to prevent these factors from occurring. The final part of this paper will then examine the use of risk assessment tools to discover what degree a person is at risk of developing a pressure ulcer and some examples of risk assessment tools that are available and best suited to the situation. General Discussion
Pressure ulcers can be very distressing and become a real problem for patients and health care facilities. According to Nelson (2003) the inconvenience of a developed pressure ulcer in hospital includes inconvenience to patients with longer hospital stays, pain, discomfort, negative body image, reduced quality of life, fall outs in relationships with carers, loss of mobility, loss of independence, social isolation, financial strain and in some cases even death (Crowe & Brockbank 2009).
This also affects healthcare facilities because it produces: less hospital beds (Nelson 2003), increased financial treatment (Nelson2003), fewer resources (Benbow 2009), increased workloads for doctors and nurses (Sayar et al 2008) and the high risk of client litigation (Nelson 2003). Mortality rates caused by pressure ulcers in Australia are low, but still occur as primary and secondary causes of death in 1,293 circumstances between the years of 1997 and 2000 (Nelson 2003).
Crowe and Brockbank (2009, p. 92) state that there are estimated to be 95,695 new pressure ulcers diagnosed each year in Australian public hospitals, acquiring a cost of $285 million. To avoid the problems caused by these ulcers, a strategy has been adopted, which includes: the ability to identify a person at risk, use of a risk assessment tool to help identify and highlight problem areas, to rectification or prevention of the pressure ulcer from occurring (Ayello & Braden 2002).
To identify someone at risk of developing a pressure ulcer, there are specific factors that can make a person vulnerable. These factors are becoming focus points and aspirations in healthcare settings in today’s society (Belton 2010). Hampton (2008) discusses these specific main factors as pressure over time and tissue tolerance. Pressure over time is when the particular point of the body causes weight on a surface over a period of ime (Benbow 2009a), particularly on the heels, sacrum, elbows, greater trochanter and ischial tuberosities (Crisp & Taylor 2009). This includes immobile, bedridden, wheelchair bound or sedated people (Beldon 2010). Sedation or decreased feeling perception contributed to the ulcer forming because people were unable to feel the need to change position to alleviate the pressure and return an oxygen rich blood supply to the affected area on bony points of their body (Sayer et al. 2008).
Tissue tolerance from extrinsic and intrinsic factors are also claimed to be main factors in pressure ulcer development (Australian Wound Management Association 2001). Extrinsic factors such as moisture produced from excessive perspiration, not drying properly after showering, and urinary or faecal incontinence can increase moisture and make the skin more prone to friction (Beldon 2010). Friction and shearing from poor patient manual handling techniques can result in further pressure ulcer development issues (Benbow 2009b).
Crowe and Brockbank (2009) point out that intrinsic factors such as nutrition, skin temperature, illness, oxygen delivery, skin conditions and medications all can have significant effects on the development process of pressure ulcers, and identifying people with these risk factors can be made easier with the use of a risk assessment tool. A risk assessment tool is a tool that is used to identify someone at risk of developing a pressure ulcer; it then gathers information and suggests problem areas to help prompt the assessor to the correct care or interventions in the prevention of pressure ulcers (Sayar et al. 008). Studies have shown that with the use of a risk assessment tool the occurrence of pressure ulcer development has dropped by sixty percent (Ayello & Brandon 2002). Crisp and Taylor (2009, p. 1338) explain the three main assessment tools used by nurses are the Norton Scale, Braden Scale and the Waterlow Scale. The use of a particular assessment tool is the decision of the assessor and factors that need to be considered include what is most suited to the situation; the reliability (consistency) and the validity (accuracy) of the tool must also be taken into account (Ayello & Braden 2002).
This can be seen in the research undertaken by Sayer et al. (2008). It was decided to use the Waterlow scale as they found it fitted their expectation for sensitivity and specificity across different patient groups and it was fundamental to their study. However, Ayello & Brandon (2002) decided to focus their article on the Branden Scale because it was most appropriate for their study.
The Waterlow Risk Assessment tool, as cited on the QLD Health website (2003) (see appendix 1), is commonly used within Queensland hospitals as it is promptly available as a laminated pocket sized card for a quick reference (Australian Wound Management Association 2001). It encompasses several categories such as: continence, build/height, skin integrity, gender/age, appetite, mobility, and special risks such as: tissue malnutrition, neurological deficit, surgery or trauma and medication. Each category is assessed and the appropriate score is achieved. The total score is added up and the higher the score the greater the risk. 0+ is “high risk” and 20+ is “very high risk” (Carville 2005). Once a particular sensitivity score is achieved, clinical and professional judgement is used by the nurse to accurately decide what preventable actions are required to prevent the development of a pressure ulcer (Benbow 2009a). It is also beneficial to have the person assessed with the risk assessment tool on regular basis (Australian Wound Management Association 2001). A risk assessment is a preventative measure, therefore the person must be assessed regularly and the appropriate action taken to accurately pin point the appropriate prevention.
It is suggested that risk assessments should take place on the first day of care, after any change in the person’s condition, at regular intervals and prior/during and after any prolonged procedure where mobility is compromised (Australian Wound Management Association 2001). There is evidence to suggest pressure ulcers are preventable (Beldon 2010). Development of a pressure ulcer in a health care facility is neglect and a sign of a breach in the duty of care in that facility, and could result in a litigation case presented against them (Nelson 2003).
A case study presented by Nelson (2003, p. 184) describes the incident involving a patient in 1983, who suffered extreme muscle loss when she developed a pressure ulcer in a Sydney Hospital. The patient sued the hospital staff and resulted in an excessive payout of $630,000. Thus, prevention is an important and it is the nurse’s responsibility to deliver the highest clinical and professional standards and duty of care (Benbow 2009 b) . Evidence suggests that prevention of pressure ulcers can easily be achieved with the removal of the risk (Hampton 2008).
Anyone who has been identified as being at risk should have a management plan and documentation put in place that includes a regular skin assessment to discover any changes in skin integrity (Benbow 2009a), protection from extrinsic factors such protecting the skin from moisture using a barrier creams or absorbing pads, pressure reducing devices and the importance of mobility (Crisp & Taylor 2009). Others include the expensive pressure relief devices such as the use of mattress overlays, speciality beds, alternating pressure devices, pillows and padding or real sheepskin (Australian Wound Management Association 2001).
Hampton (2008. p. 588) explains the importance of nurses having a basic education to be able to recognise and make the right decisions in pressure ulcer prevention. With the appropriate early intervention with the use of the risk assessment tools prevention of pressure ulcers can be evident. Conclusion Pressure ulcers are preventable and is the healthcare worker’s responsibility to ensure a duty of care to any vulnerable person of the age of eighteen in a healthcare setting is not to come to harm.
It is essential that the appropriate elimination and education of the risk factors with the use of risk assessment tools and the implantation in the appropriate action is constantly taking place and documented according to health care settings protocols. It has been suggested that regular skin assessment is vital for the first signs of pressure ulcers to be diagnosed and treated, the idea of regularly turning of a patient and mobility for the release on pressure on the skin to enable blood to return to the area, and the use of pressure relief devises are all essential issues in the prevention of pressure ulcers.
If these issues are being addressed then future pressure ulcers will be avoided and the person will then be safe from theses debilitating unnecessary wounds. Reference Benbow, M 2009 a, ‘Principles of pressure ulcer prevention’, Practice Nursing, vol. 20, no. 10, pp. 504-509 (online Cinahl). Beldon, P 2010, ‘Using risk assessment to prevent pressure ulcers’, Nursing & Residential Care, vol. 12, no. 1, pp. 28-31, (online CINAHL). Ayello, EA & Branden, B 2002, ‘How and why to do pressure ulcer risk assessment’, Advance s in Skin & Wound Care, vol. 5, no. 3, pp. 125-129, (online CINAHL). Sayar, S, Tugut, S, Dogan, H, Ekici, A, Yurtsever, S, Demirkan, F, Doruk, N & Tasdelen, B 2008, ‘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, vol. 18, no. 12, pp. 765-774, (online CINAHL). Hampton, S 2008, ‘Pressure care, part one; preventing pressure ulcers’, Nursing & Residential Care, vol. 10, no. 12, pp. 85-590, (online CINAHL). Benbow, M 2009 b, ‘Quality of life and pressure ulcers’, Journal of Community Nursing, vol. 23, no. 12, pp. 14-18, (online CINAHL). Crowe, T & Brockbank, C 2009, ‘Nutrition therapy in the prevention and treatment of pressure ulcers’, Journal of The Australian Wound Management Association, vol. 17, no. 4, pp. 90-99. Nelson, T 2003, ‘Pressure ulcers in Australia; patterns of litigation and risk management’, The Australian Journal of Wound Management, vol. 11, no. 4, pp. 183-187.
Australian Wound Management Association 2001, Clinical practice guidelines for the prediction & prevention of pressure ulcers, Cambridge Publishing, Australia. Crisp &Taylor, C 2009, ‘Potter & Perry’s fundamentals of nursing 3e’, Elsevier, Australia. QLD Department Of Health, Waterlow Pressure Ulcer Risk Assessment Tool, viewed 22 April 2010, http://www. health. qld. gov. au/patientsaftey/pupp/documents/waterlow. pdf. Carville, K 2005, ‘Wound care manual 5e’, Silver Chain Foundation, Australia. Appendix (Appendix 1)