Abstract
Many patients experience extended stays in nursing homes where a significant number are bedridden. The special attention needed by such clients may take a toll on the nurses due to the constant care needed. Additionally, elderly patients face a particularly challenging time because their health and well-being are affected by age. Pressure ulcers are a serious concern for bedridden nursing home residents as their skin and certain tissues are exposed to extended pressure. Current practices may involve repositioning clients after every two hours. However, the high incidences of pressure ulcers indicate that there need better resolutions.
Current literature has explored several issues related to this health issue, including such interventions as training nurses to improve their knowledge and attitude. However, to address the broader difficulties related to pressure ulcers in nursing home residents, a complete approach is required. The recommended solution is comprehensive risk management that comprises such mitigation efforts as prevention, training, and interventions.
Introduction
Healthcare facilities have a duty to take ultimate care of their patients and to address all their needs. However, some clients present unique challenges that require healthcare personnel to evolve and adapt their practices as a response to emerging issues. The development of ulcers in immobile people is one such issue. For example, due to physical changes associated with aging, elderly people’s skins are more fragile, putting them at risk for pressure ulcers. Because this is a growing problem in the United States, the goal of this project is to explore nursing practices that can be implemented to prevent pressure ulcers among bedridden patients.
Problem
The problem entails the significant risk of pressure ulcers developing among bedridden patients and efforts to mitigate the risk. Nurses are in charge of caring for patients, which can be difficult when they are unable to move on their own. Pressure ulcers are localized injuries of the skin and tissue adjacent to some caused by shear and pressure (Lee et al., 2021). For normal populations, pressure ulcers should not be a challenge because the individuals would not subject their skins and tissues to extreme pressure. However, bedridden residents of nursing homes are different because they cannot move by themselves. Therefore, long lying hours without adequate movements becomes a risk factor. The facilities have to adapt their care practices because special attention is needed to such patients.
The challenges emanating from this condition include poor quality of life of patients. Ulcers cause pain and open up wounds, which could then increase the rate of infections. In extreme cases, fatalities can result from ulcers wounds. For the facilities, new health emergencies from pressure ulcers could become a major cost issue, especially if the healthcare institutions are to be held responsible. Patients may be subjected to new expenses as medication for ulcers become a necessity. Therefore, the right approach to pressure ulcers is prevention, which will help improve patient safety and help mitigate the underlying risks.
Literature Review
Many studies have been conducted to explore the issues arising from pressure ulcers and to help develop the necessary interventions. However, a consensus across the scholarly works is that ulcers are a serious issue facing the healthcare systems across the world. According to Lung et al. (2020), In the United States, the Netherlands, and Europe, the prevalence of pressure ulcers was found to be 15%, 23%, and 23%, respectively.
Further statistics indicate that the prevalence of pressure ulcers among bedridden residents in these areas was 36.8%. Despite the fact that each country’s data may differ, these findings show that pressure ulcers are a substantial health risk for all healthcare facilities with bedridden patients. Additionally, nursing home residents have been regarded as particularly vulnerable because they are exposed to many losses and different forms of abuse (Lee et al., 2021). As a result, some of the significant health challenges that these communities face must be addressed.
Many academic studies have looked into the many risk factors for pressure ulcers. According to Lee et al. (2021), the three primary domains are perfusion, skin/PU status, and mobility/activity. Other frameworks that have been researched include Defloor’s model that comprises four elements: shear forces, compressive stresses, tissue oxygen tolerance, and tissue pressure tolerance. The elements in Defloor’s model denote the key predictors of the likelihood of pressure ulcer incidents among the elderly. As defined earlier, pressure ulcers develop due to the pressure on the skin and tissues close the bones. The types of pressure are compressive and shearing forces where the tolerance of the skin to both the pressure and oxygen also play a vital role. This knowledge proves helpful for the nurses handling the patients because factoring in these elements will help develop an ideal preventive measure.
Considering that pressure ulcers occur due to pressure on the skin and tissue, nurses need to establish the risk parts of the body so that extra caution can be taken. Such scholars as Kohara et al. (2021) have expressed the need to study skin characteristics at common sites of pressure ulcers because this is an area largely ignored by past studies. These scholars have presented an interesting insight into the subject and nurses can learn where to expect ulcers and how to treat them. The elderly are targeted by such scholars as Kohara et al. (2021) because aging causes various physiological changes in the skin that raise the risk of pressure ulcers.
Therefore, nursing practitioners can learn to identify the most vulnerable populations. Lastly, some scholars have explored training programs that can be offered to nursing home nurses to help them handle pressure ulcers. The study by Ibrahiem and El-Maksoud (2021) also focuses on the elderly and several aspects of training have been recommended to nurses. Examples include knowledge and attitudes of the nurses, as well as responsible practices.
Resolution
The key concern for a nursing home is to avoid pressure ulcers from developing among their patients. Therefore, the facilities can build an environment where nurses are aware of the possibility of pressure ulcers and have been trained to intervene accordingly. While simple training and development programs can help resolve the issue, it is important to acknowledge that the problems that arise from ulcer development are massive and would need a better alternative (Ibrahiem & El-Maksoud, 2021). A risk management framework is proposed as a key resolution because it serves a broader scope covering both prevention and intervention as the basic forms of risk mitigation.
It is important to acknowledge that training and development will be crucial elements of the risk management framework because they allow facilities to develop the necessary knowledge and attitudes among the nurses. Most importantly, the framework will comprise plans for identifying the vulnerable patients, assessing the level of risk, and developing the most ideal intervention. Risk management allows the facilities to predict incidences and prevent them from occurring. Additionally, reporting cases are incorporated in the plan to help address the incidence as early as possible as a form of preventing greater harm to the patients who have already developed pressure ulcers.
Monitor and Analyze Outcome Data
Implementing a risk management framework will require continuous monitoring and analysis of outcome data. An approach similar to that adopted by Ibrahiem and El-Maksoud (2021) in examining the outcomes of the training program can be adopted. In this case, the focus should be on how well the nurses respond to the practices and how their attitudes and behaviors affect the implementation. The design of the risk management framework allows the facilities to predict incidences and mitigate them accordingly. Additionally, the training programs are embedded into this framework, which presents various aspects to monitor and analyze.
First, the knowledge of the nurses on matters of pressure ulcers can be monitored and measured using the appropriate scales. Continuous monitoring can also be used to measure the progress in their learning and the analysis can help make critical decisions regarding the effectiveness of the training practices. Second, the checklist contained in the risk management plan can also be monitored in terms of how many actions are undertaken and their frequency. This data can be analyzed to help identify what aspects of the framework are implemented and to what extent.
Evaluation and Dissemination
Evaluation of the risk management framework targets the achievement of the overall objectives and goals set out during implementation. I this case, the ultimate objective is to reduce or eliminate the incidences of pressure ulcers among bedridden nursing home residents. The evaluation focuses on the effectiveness of such aspects as reporting, interventions, and the training program. In terms of reporting, nurses are required to identify and record all cases of pressure ulcers based on the symptoms that they can examine. According to Lee et al. (2021), new technologies involving machine learning have been developed to help identify cases of pressure ulcers.
Implementation of these innovations alongside the risk management framework should make it easier for nurses to discover and report. The interventions are evaluated based on how effective they help with early warning signs and the statistics showing the reduction in pressure ulcers cases. Lastly, the training program is evaluated in terms of its role in facilitating the achievements of the risk management objectives. The dissemination of the evaluation findings involves periodical presentations to nurses and the management team, which highlight the overall progress.
Summary
Pressure ulcers are a severe condition that affects nursing home residents. The difficulties result in a low quality of life and a risk to patient safety in the institutions. The literature indicates that the healthcare systems across the world face this issue and solutions are subject to considerable scholarly work. The recommended resolution is a risk management framework that integrates training programs to educate nurses on the problem and help in the development of interventions. The risk management approach is selected because it offers a possibility of prevention as opposed to only treating those cases that have already emerged.
References
Ibrahiem, D., & El-Maksoud, M. (2021). Training program for caregivers to prevent pressure ulcers among elderly residents at geriatric homes. Frontiers in Nursing, 8(3), 249-259. Web.
Kohara, H., Ikeda, M., Yokotani, K., Okawa, M., & Nishimoto, S. (2021). Skin characteristics of sites predisposed to pressure ulcers among bedridden elderly patients in Japan. Open Journal of Nursing, 11, 497-512. Web.
Lee, S., Shin, J., Ahn, J., Lee, J., & jang, D. (2021). Identifying the risk factors associated with nursing home residents’ pressure ulcers using machine learning method. International Journal of Environmental Research and Public Health, 18(6), 1-8. Web.
Lung, C., Jan, Y., Lu., J., Chen, C., Kuo, F., & Liau, B. (2020). Evaluation of mechanical properties of soft tissue on pressure ulcers among bedridden elderly patients. In R. Goonetilleke, & W. Karwowski, Advances in Physical Ergonomics and Human Factors. (pp. 360-368). Springer AG.