Pressure ulcer wound management

Answer

Pressure Ulcers

The Problem

                Pressure ulcers are major problems that continue to influence the life quality, health status and health care costs of Americans across various health care settings. Despite new findings revealing causes and treatment approaches of the disorder, these wounds continue to occur across states in the US.  According to Bhattacharya and Mishra (2015), pressure ulcers have doubled forcing Americans to spend much money daily to prevent and treat this disorder. Moreover, as the population of the elderly continues to grow, pressure ulcers are expected to grow. As such, patients, as well as, other healthcare institutions design appropriate practice guidelines to control the spread and occurrence of preventable wounds. In the US, many hospitals incorporate stringent prevention measures while others only focus on treating the problem once it occurs, putting much effort on prevention. In these institutions, patients who are at risk hardly get needed preventive care and as a result, their wounds continue to spread instead of healing (Osuala, 2014). Therefore, this paper discuses pressure ulcer wounds, its impacts on patients, significance and possible solutions.

Practice Setting of the Problem

                Pressure ulcer is the disintegration of the skin that usually appears over a bony prominence where blood circulation is stopped due to friction, shearing, pressure or both. It can be caused by the patients’ extrinsic and intrinsic factors or combination of both. Boyko, Longaker and Yang (2018) Pressure ulcer wounds occur when a patient of any age is confined for a longer duration to a bed or unable to move. In such a situation, the blood is blocked from flowing to various parts of the skin and the body thus limiting the supply of blood rich in oxygen and nutrients from such areas leading to cell death and ischemia.

 A report by Sari et al. (2019) revealed that most healthcare professionals in the US hospitals are only concerned with skin breakdown when determining whether a patient suffers from pressure ulcers. They do not adopt any prevention approach for patients who are at risk of developing the disease unless such patients manifest ulcers, where the skin breakdown is clear. These institutions lack appropriate lifting devices that can be used to minimize friction during transfer and repositioning (Tsaras et al., 2016). Unfortunately, in most healthcare settings, patients’ heels are usually subjected to friction and pressure. The healthcare practitioners in these facilities do not raise patients’ heels by putting them on the folded blankets.

Impact of the Problem

            Some of the effects of pressure ulcers on patients include poor health status, low quality of life and increased costs incurred during hospitalization. Other effects of the disease include dermatologic complications, pain, infection, and bleeding. Pressure ulcers also contribute to high mortality rates among the elderly. Reports indicate that about 60% of the older people suffering from pressure ulcers die within one year once they are released from hospitals (Etafa, Argaw, Gemechu, & Melese, 2018). Besides death, pressure ulcers are a significant predictor of mortality (Repić & Ivanović, 2014). Bhattacharya and Mishra (2015) note that the occurrence of skin breakdown post-surgery makes the elderly to experience functional impairment during post-surgical procedure. Pressure ulcers also lead to hefty financial burden to patients and governments. Essentially, van Leen, Schols,  Hovius and Halfens (2017) noted that costs involved in treating pressure ulcer wounds is relatively high and varies according to included or excluded from the economic model.

Significance of the Problem

                The main aim of any nursing is to protect patients from disorders such as including pressure ulcers. In nursing practice, preventing pressure ulcer wounds denotes a quality care. The disease is critical nurse-sensitive patient outcome thus nursing practice plays a critical role on the growth, prevention and treatment of pressure ulcers. When pressure ulcer wounds develop, every nurse tries to ensure that the disease is eliminated or prevented from spreading further. Thus, addressing pressure ulcer wounds helps improve health status and quality of patients. Similarly, adopting appropriate preventing and treatment approaches will ensure that elderly receive quality care and necessary support leading to decrease in the cases of falls as nurses will be able to conduct comprehensive health assessment on the patients. Every healthcare practitioner ensures that patients receive quality care and prevent further infections (Repić & Ivanović, 2014). Therefore, offering a solution to pressure ulcer wounds will ensure that nurses implement appropriate strategies to manage and treat pressure ulcer wounds thus improving patient outcomes.

Proposed Solution

                Protection is the most appropriate solution to pressure ulcer wounds. Patients who are at higher risk of developing pressure ulcer wounds should have their skins carefully assessed for any redness or damage twice a day. The wound should be kept clean and dry and any pressure causing the damage to the skin or wound should be eradicated immediately (Bhattacharya & Mishra, 2015). To achieve this, the professionals should use special mattresses, cushions, and other protective devices that can relieve extrinsic pressure on the wounds. Moreover, healthcare professionals should reposition patients’ at least twice after two hours. In particular, they should ensure that patients are supported in a 30-degree lateral position and not a 90-degree angle to avoid excess pressure of the wounds (Bhattacharya & Mishra, 2015). Similarly, while transferring and repositioning patients, Gorecki, Nixon, Madill, Firth and Brown (2012) noted that the practitioners should use appropriate lifting tools to prevent friction.

                 A key element of wound management involves wound bed preparation, and using suitable dressings. Notably, applying dressing without debriding do not heal the wound but instead wastes effort and time. Thus, initial debridement must be followed through maintenance.

Conclusion

                Pressure ulcers are considered the most severe form of wound common among hospital patients. Despite new strategies developed to prevent and manage these wounds, many cases of pressure ulcers continue to be reported. Thus, healthcare professionals should relief pressure ulcers using devices such as lift sheets among others.

Clinical Problem the Organization Is Facing and Nursing Implications

                As already explained, most patients at XYZ hospital do not get appropriate preventive care and those patients who have existing wounds usually get infected and rather than healing, their conditions decline (Sari et al., 2019). One clinical problem that the institution faces is nurse shortage. Due to this shortage, the nurses and assistive personnel at the institution do not extend a helping hand to their incontinent patients for longer periods. Therefore, the nursing implication of this problem is that nurses often work for many hours under stressful conditions leading to injury, fatigue and job dissatisfaction (Matozinhos et al., 2017). These nurses are prone making committing mistakes, as well as, medical errors. The next nursing implication for nurse shortage is that nurses are not alert about inadequate nutrition and its effect on pressure ulcers.

                The major issue for the organization in addressing the stated problem is the treatment and prevention guidelines for pressure ulcers. Regarding prevention, conducting a comprehensive head to toe skin assessment on admission and when the condition of the patient changes is an area that the organization should take seriously (Osuala, 2014). The organization should use risk identification scale particularly Braden Scale to establish patients who are at risk of developing the disease. Given that nutritional status is a risk factor, nurses should conduct nutritional assessment when the patient is admitted to the facility. The first step in addressing and resolving pressure ulcers is to address the nutritional aspect. Here, more nurses should be hired to keenly monitor the nutrition aspect of every patient admitted.