Along with the advancement in diverse spheres of healthcare that guarantees high-quality care in hospitals, many unavoidable issues might cause complications upon treatment. One of the main problems among such is the development of pressure ulcers in bedridden patients. Immobile patients who stay at a hospital for an extended period face a risk of obtaining skin injuries that provoke some severe threats to their health condition.
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The research proposal aims at a discussion of the scope of pressure ulcer incidents investigation and their outcomes for patients’ health. It presents a concise critical overview of the available studies that contribute to the scholarly research of the problem and provide insight into predictors, possible ways of care, and outcomes of pressure ulcers. The research proposal introduces a formulated implementation plan of the specially designed in-hospital interventions aimed at the reduction of bedsores incidents and their aftermath. Finally, the paper overviews the possible contribution the research is potent of, as well as its influence on patients care outcomes.
The Spirit of Inquiry Ignited
Hospital-acquired pressure ulcers are a severe medical problem that a large number of bedridden patients have, and it needs thorough addressing from the specialists’ side. As defined by Mallah, Nassar, and Badr (2015), a pressure ulcer is an “injury to the skin and/or underlying tissue … as a result of pressure, or pressure in combination with shear” (p. 106). The wounds an immobile patient might acquire during hospitalization impose a variety of adverse outcomes ranging from pain and suffering to infections that lead to longer hospitalization, high morbidity, and even mortality (Mallah et al., 2015).
From an epidemiological point of view, bedsores are a frequent occurrence in nursing care that constitutes a severe threat to patients’ quality of health and longevity. The prevalence rates of pressure ulcers in intensive care units range around 20% and show an overall need for patients’ precise examination and treatment (Berlowitz, 2014). It appears to be a problem that is difficult to avoid in severely injured patients.
However, the development of pressure ulcers is a timely process that undergoes several stages. According to Kottner and Raeder (2014), there are four main phases of pressure ulcer acquisition, including “non-branch able erythema,” “partial thickness,” “full-thickness skin loss, and “full-thickness tissue loss” (pp. 50-51). Accordingly, the nursing staff has enough time to stop the detected issue of an ulcer developing during the initial stages of the illness.
Moreover, patients exposed to immobile hospitalization should be specifically treated with more attention as ones subjected to bedsores development because usual treatment would not be sufficient for them. That is why it is vital to utilize proper nursing documentation and pressure ulcer protocols to examine and evaluate patients’ skin predisposition to bedsores on the third day of hospitalization (Li, 2016). Such a nursing intervention should be combined with general care to provide necessary treatment for patients who show high rates of ulcer predisposition.
The PICOT Question Formulated
The general analysis of the available data on the issue of pressure ulcers acquired in hospitals allows for formulating a PICOT question. In patients that are identified as having a high risk for developing a pressure ulcer (P), does the implementation of a pressure ulcer protocol initiated in the emergency department (I) as compared to patients who receive usual care (C), reduce the incidence of hospital-acquired pressure ulcers (O) on day 3 of hospitalization (T)?
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Search Strategy Conducted
The evidence search was conducted with the help of many databases providing a scope of the literature devoted to pressuring ulcers prevention and treatment. CINAHL was used as the first resource for the search and produced 132 results with such keywords as a pressure ulcer, pressure ulcer protocol, hospital-acquired pressure ulcer, and emergency department. The same keywords search was implemented on such databases as PubMed (102 results), an advanced search engine Cochrane Library (35 results), National Guidelines Clearinghouse (40 results), and TRIP Database that provided 20 results of specifically detected articles. In consequence, five major articles were chosen as the evidence basis for the research. The articles comprise level II, III, and VI evidence showing the main ways of pressure ulcer prevention and treatment.
Critical Appraisal of the Evidence Performed
Each study found on the available databases was exposed to critical appraisal and evidence analysis and synthesis. O’Toole et al. (2017) conducted quantitative comparative research aimed at the analysis of standard tracheostomy care’s possibility to prevent and cure pressure ulcers. The introduced quality improvement protocol showed its effectiveness as the results of the study identified diminished occurrences of hospital-acquired bedsores (O’Toole et al., 2017).
The investigation was carried out in a single office with a relatively poor description of the procedures which constitute the limitations of the study. Another research employed a multidisciplinary data analysis available from previous researches to determine the benefits of multi-faceted interventions on the basis of nursing documentation (Mallah et al., 2015). The study addressed the interventions in 19 units, which increase the validity rate of the findings.
A quantitative prospective study conducted by Lam et al. (2018) embraced the population of approximately 10,000 patients and examined the specifically developed program application to pressure ulcers elimination. The findings of the research showed the overall positive outcomes of the interventions based on the addressing of different risk degrees and including the influential factors in treatment procedures (Lam et al., 2018).
The current study presents a scientific interest due to its acute relevance to the current situation in healthcare units. Santamaria et al. (2015) carried out a randomized controlled trial of special silicone foam dressing for emergency department patients to determine pressure ulcer prevention. The study results implied the overall positive outcomes of special dressing for critically ill patients as an aid in targeted nursing interventions specifically aimed at the elimination of the issue (Santamaria et al., 2015). The primary research weakness lies in its narrow applicability to severely injured patients and does not provide enough data for less critically ill hospitalized individuals.
A retrospective descriptive correlational study conducted by Li (2016) mainly concentrated on the nursing documentation as a useful tool for prevention, detection, and treatment of pressure ulcers in immobile patients during their stay at a hospital.
The importance of guidance by the particular protocol is evaluated by this study. Thus, the collected evidence emphasizes the positive outcomes of accurate utilization of pressure ulcer protocols in nursing care for decreasing of adverse outcome rate of this hospital-acquired issue. The data collected and evaluated during the search process was a solid basis for the development of an implementation plan for ulcer aversion in immobile patients.
Evidence Integrated with Clinical Expertise and Patient Preferences to Inform a Decision and Practice Change Implemented
Given the health-related threats the developing of hospital-acquired weight pressure ulcers cause and taking into account the collected evidence, it is possible to introduce an effective practice change implementation. It is valid to attract Certified Wound Care Nurses for daily examinations of hospital-acquired pressure ulcers and intensive review of the developing process. The project aims at the targeted population embracing the patients showing high-risk rates of developing bedsores. The planned procedure includes the evaluation of the patients’ skin damages on a daily basis. According to the examination procedure, each nursing staff member will be expected to deliver a chart with the presentation of the wound assessment process at the beginning of each working shift.
The registered nurses would utilize electronic services to report their records. The information collected during each examination procedure will concentrate on the relation of the current state of a patient to his or her earlier condition regarding pressure ulcers developing. According to the frequency of the procedures, it is necessary to implement a hospital server to deliver and store the necessary documentation automatically. By the basic daily examinations, the patients will be evaluated according to the bedsores predisposition rate.
The documentation data will be integrated into daily census reports prepared before the morning meetings of the Certified Wound Care Nurses and hospital staff. During the sessions, a supervisor will bring the most acute cases to the discussion to emphasize the importance of nurses’ precise attention to particular patients. The task of Certified Wound Care Nurses is going to include the revision of the previously presented report and its comparison to the earlier condition of a patient. Such a close examination will make it possible to pay more attention to those patients who are at higher risks of ulcer acquisition and need treatment.
The outcomes of this project address the positive results in a reduction of morbidity and mortality rates caused by pressure ulcers acquired in hospitals. The program will be successful in the case when the number of patients on the high-risk list is reduced. The compulsive daily examination interventions with the following documented reports assessed by a supervisor provide a sufficient basis for patients’ pressure ulcer developing risks and allow for incidents aversion.
The positive project outcomes are a subject for further scholarly discussion and scientific research. The presented evidence evaluation and implementation plan serve as a solid basis for the active version of one of the acutest problems in modern nursing care. The implementation of documentation-based pressure ulcer examination procedures in patients of a high-risk group is applicable in diverse healthcare units and is potent for minimization of morbidity and mortality rates caused by this issue.
To summarize the project presentation, weight pressure ulcers constitute a significant threat to the health quality and longevity of hospitalized immobile patients. Despite overall advancement in the nursing practice field, this issue remains acute due to its severe outcomes resulting in pain and suffering, as well as health complications or even death of a patient. Thus, a significant number of researchers are being conducted to find effective ways of ulcer prevention and treatment.
The evidence search allowed evaluating the importance of specially designed programs, protocols, and procedures detecting different stages of pressure ulcers developing depending on diverse factors. Considering the collected data, a documentation-based implementation plan attracting Certified Wound Care Nurses was introduced to construct a system of procedures aimed at accurate daily assessment of ulcers developing in patients. The project anticipates positive outcomes comprised in the reduction of an ulcer developing immobile patients in hospitals.
Berlowitz, D. (2014). Incidence and prevalence of pressure ulcers. In D. R. Thomas & G. A. Compton (Eds.), Pressure ulcers in the aging population: A guide for clinicians (pp. 19-26). New York, NY: Humana Press.
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Kottner, J., & Raeder, K. (2014). Assessment and documentation of pressure ulcers. In D. R. Thomas & G. A. Compton (Eds.), Pressure ulcers in the aging population: A guide for clinicians (pp. 47-65). New York, NY: Humana Press.
Lam, C., Elkbuli, A., Benson, B., Young, E., Morejon, O., Boneva, D.,… McKenney, M. (2018). Implementing a novel guideline to prevent hospital-acquired pressure ulcers in a trauma population: A patient-safety approach. Journal of the American College of Surgeons, 226(6), 1122-1127.
Li, D. (2016). The relationship among pressure ulcer risk factors, incidence and nursing documentation in hospital‐acquired pressure ulcer patients in intensive care units. Journal of Clinical Nursing, 25(15-16), 2336-2347.
Mallah, Z., Nassar, N., & Badr, L. K. (2015). The effectiveness of a pressure ulcer intervention program on the prevalence of hospital-acquired pressure ulcers: Controlled before and after study. Applied Nursing Research, 28(2), 106-113.
O’Toole, T. R., Jacobs, N., Hondorp, B., Crawford, L., Boudreau, L. R., Jeffe, J.,… LoSavio, P. (2017). Prevention of tracheostomy-related hospital-acquired pressure ulcers. Otolaryngology–Head and Neck Surgery, 156(4), 642-651.
Santamaria, N., Gerdtz, M., Sage, S., McCann, J., Freeman, A., Vassiliou, T.,… Knott, J. (2015). A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: The border trial. International Wound Journal, 12(3), 302-308.