The main focus of this project is the identification and prevention of Hospital-Acquired Pressure Ulcers. Pressure Ulcers are a condition that is more efficient and safer for the patient to prevent rather than treat after development. Even though most hospitals treat patients at risk of developing Pressure Ulcers and utilize prevention strategies, not much is known about their actual effectiveness. More experimentation is required in the sphere of Pressure Ulcer prevention to develop reliable recommendations. This project proposes a particular intervention based on existing data and, more importantly, conscious of the gaps in the literature.
The body of literature on Pressure Ulcers is mainly divided into two categories. The first includes the publications on the condition itself, its characteristics, outcomes, comorbidities, and incidence. The second encompasses the publications on treatment, management, and prevention strategies. An example of the first would be an article written by Gardiner, Reed, Bonner, Haggerty, and Hale (2016), which studies the associations between Pressure Ulcer incidence and other factors such as age, race, BMI, and others.
Another example used in this paper is a paper by Agrawal and Chauhan (2012), which describes the condition in detail, as well as its risk factors, classification, and history. An example of the second category would be the paper by Mervis and Phillips (2019), which describes and evaluates prevention and treatment strategies. There are also exceptions, such as Aslan and van Giersbergen (2016), which relate specifically to nursing practice, training, and attitude. These articles and more will serve as the theoretical base for the intervention.
The intervention was designed around the assumption that hospitals and nurses may provide inadequate care due to irregular repositioning and the lack of additional treatments, such as nutrition management and skin assessment. The specific intervention proposed in the PICOT statement is “the strategy of regular repositioning and turning targeted at preventing pressure ulcers development alongside with providing proper nutrition, skin assessment, and incontinent care.”
The intervention relies heavily on both nurses’ and patients’ compliance and a personal bond between the patient and the nurse. The nurses contribute the most towards Pressure Ulcer prevention, and, conversely, their inaction may lead to a higher incidence of the condition (Aslan & van Giersbergen, 2016). The outcome of the intervention will be measured by comparing pre-intervention and post-intervention Pressure Ulcer incidence in the hospital, as well as the patients’ evaluation of the nursing care. The intervention is expected to produce a tangible effect on the target population within 120 days.
Potential barriers to the implementation of the strategy include patient non-compliance, nurse non-compliance, and the intervention’s lack of positive effect. The patient’s non-compliance may arise due to their personal preference. The modern evidence-based models make an emphasis on incorporating patient preference in the decision-making process (Iowa Model Collaborative, 2017). The patient or their representative may object to being regularly examined or repositioned. A possible counter-measure should include a personal and empathetic dialogue that explains the reasons for the interventions and possible adverse outcomes that may result from inaction.
Nurse non-compliance is a more likely and more dangerous barrier. Research shows that the majority of nurses think that Pressure Ulcer is important and that training improves their attitude towards the condition further (Aslan & van Giersbergen, 2016). Thus, yearly training and the adoption of current evidence-based practices is the best available solution. Finally, the intervention’s lack of positive effect can only be measured after implementation. To combat that complication, regular data collection must be implemented, and the approach needs to be regularly reviewed and fine-tuned to produce the best possible results.
References
Agrawal, K., & Chauhan, N. (2012). Pressure ulcers: Back to the basics. Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India, 45(2), 244-254.
Aslan, A., & van Giersbergen, M. Y. (2016). Nurses’ attitudes towards pressure ulcer prevention in Turkey. Journal of Tissue Viability, 25(1), 66-73.
Gardiner, J. C., Reed, P. L., Bonner, J. D., Haggerty, D. K., & Hale, D. G. (2016). Incidence of hospital‐acquired pressure ulcers – A population‐based cohort study. International Wound Journal, 13(5), 809-820.
Iowa Model Collaborative (2017). Iowa Model of Evidence-Based Practice: Revisions and Validation. Worldviews on Evidence-Based Nursing, 14(3), 175–182.
Mervis, J. S., & Phillips, T. J. (2019). Pressure ulcers: Prevention and management. Journal of the American Academy of Dermatology, 81(4), 893-902.