Pressure Ulcers and Recommended Care Techniques

Introduction to the Problem

• Bedsores are frequent in long-term care
• Continuous pressure on the skin
• Problems related to proper blood circulation
• Sepsis and bacterial infections (cellulitis)
• A review of PU aversion methods
• PU protocols to be improved

Pressure ulcers (PU) belong to the most common wounds associated with long-term hospital treatment. As is clear from the term, they develop due to continuous pressure on some body parts and obstructions of proper blood flow. Since this problem leads to dangerous complications, approaches to PU aversion should be reviewed thoroughly to facilitate the development of more effective prevention protocols.

Analytical Perspectives

• Level 1 and 2 scientific inquiries
• Current achievements in hospital PU prevention
• PU prevention and treatment: financial burden
• PU and the analysis of epidemics
• Different groups’ vulnerability to PU
• Organized by the levels of request

This paper explores the multifaceted issue with reference to both level one and two research questions. The problem is studied with attention to research findings peculiar to PU prevalence, treatment, and financial considerations linked to this type of wounds. Also, attention is paid to the risks of bedsores in different social/demographic groups, and presentation is structured based on the levels of request.

Level 1 Questions

• PU prevention and treatment: mathematical/analytical aspects
• PU rates in emergency clinics: 2.6% (Gardiner, Reed, Bonner, Haggerty, & Hale, 2016)
• Related factors: BMI, age, race, sex
• Reductions in PU rates (2014-2015) (O’Toole et al., 2017)
• Consideration groups in healthcare facilities
• Potential of quality improvement conventions

Level one questions guiding the process of inquiry are focused on scientific facts. Based on modern research, in 2009 and 2010, more than two percent of patients in emergency facilities developed PUs (Gardner et al., 2016). Interestingly, with the development of up-to-date prevention techniques, PU incidence rates tend to decrease, probably due to the implementation of institutionalized group efforts, as well as conventions on quality improvement (O’Toole et al., 2017).

• PU and disease transmission: current situation
• USA: 1.000.000-3.000.000 patients develop PU annually (Lam et al., 2018)
• Crisis care facilities: 2.500.000 cases (Lam et al., 2018)
• 60 thousand people develop PU complications (Lam et al., 2018)
• Disease transmission studies are strongly recommended
• Support surfaces, repositioning techniques, regular examinations (Lam et al., 2018)

In the United States, there are between one and three million cases of this condition every year, the majority of which take place in crisis care (Lam et al., 2018). The long-term effects and complications of PU also affect thousands of people annually. Along with the timely use of evidence-based PU prevention guidelines, the studies of disease transmission can improve the situation.

Level 2 Questions

• Financial aspects of treatment and prevention
• PU care involves significant expenses (Demarré et al., 2015)
• Prevention costs are up to €240.000.000 (Demarré et al., 2015)
• Up to €7.980 per patient (Demarré et al., 2015)
• PUs’ budgetary impact should be reduced
• Both treatment and aversion are costly

Level two questions touch upon the financial impact of PU aversion and treatment. According to Demarré et al. (2015), PU prevention is associated with large expenses varying depending on the country and particular strategies. From modern statistics, it follows that the ways to deal with the risks of bedsores should balance between effectiveness and economic rationalization.

• PU occurrence and related risk factors
• Vulnerability is tied to demographic variables
• Older adults face increased health risks (Coleman et al., 2013)
• Stability of condition should be considered
• Risk factors: portability, mobility, skin condition (Coleman et al., 2013)
• PU improvement: blood analysis, dampness (Coleman et al., 2013)

The next portion of questions is linked to the risks of bedsores related to socio-demographic variables. Patients’ advanced age and instability are among the factors that are positively associated with PU incidence rates (Coleman et al., 2013). Other factors to be taken into account are individuals’ movement ability, portability, and skin issues. The indicators of PU improvement include hematological test results and assessments of skin moisture.

Cultural/Ethical Aspects

• Multifaceted nature of PU prevention/treatment
• Ethical ramifications of PU care decisions
• Applications of moral considerations to PU
• Existing social standards in PU care
• Moral dimension of research on PU
• PU treatment and social relationships

Apart from statistical data, the results of qualitative research may prove effective for the global outcomes of PU management strategies. Healthcare providers should be able to practice different activities, including the analysis of some actions’ cultural and ethical appropriateness. Therefore, the next portion of research is focused on moral theories and socio-cultural characteristics in PU management.

Ethics-Related Inquiries

• Moral theories apply to PU care
• Vanity runs counter to nursing values
• Thoughtful guidance and proper patient education (Beldon, 2014)
• Medical ethics and patients’ individual needs
• Temperance as a patient care value
• Ethics of moral duty and utility

Despite differences between ethical theories, there are some basic recommendations for healthcare specialists, such as the need to avoid vanity in the workplace and keep patients informed about their health. Thus, temperance is seen as the source of service that meets both patients’ expectations and ethical requirements. The notions of utility and moral duty can also inform the selection of care strategies.

• Examinations must conform to ethical standards
• Patients’ defenselessness requires specific ethical considerations
• Consent to research and treatment
• Reductions in health risks for patients
• Care based on dignity and respect
• Security of sensitive patient data

When caring for patients with bedsores, healthcare specialists are anticipated to align their actions with ethical standards and consider clients’ vulnerable position. Any interventions should be aimed at reducing health risks and providing care with reference to patient dignity. Therefore, it is critical to obtain consent from patients prior to conducting some procedures and exclude any threats to patient privacy.

Culture-Related Inquiries

• Intergenerational differences in attitudes to providers
• Poor compliance with self-care recommendations
• Doctors’ advice and young patients’ individualism
• Role of culture in emotion
• Expression of emotions and PU care
• Reporting of pain and cultural considerations

The question of culture is also critical when it comes to PU management and patients’ compliance with indications. Patients’ attitudes to healthcare specialists are often predicted by their age, with young people being more likely to call doctors’ authority into question. Culture-based perspectives of emotional openness can also affect clients’ willingness to report pain, which should be considered to maximize positive outcomes.

• Models of familial relationships affect treatment
• Women’s decision-making ability in patriarchal cultures
• Guardians and abuse of power
• Culture, family, and healthcare decision-making
• Family’s and individual’s well-being in healthcare (Lin, Pang, & Chen, 2013)
• Study familial relationships in individual cases

The model of ideal relationships in patients’ native cultures should be considered to avoid their limited involvement in decision-making processes and prevent their families from abusing power. With that in mind, the cultural underpinnings of patients’ attitudes to individuality and unity may need to be studied to avert the use of unethical practices.

Conclusion

• Risk assessments based on individual variables
• Institutionalized PU prevention efforts are needed
• Promising measures: examinations, equipment, repositioning
• Patient consent, dignity, and individual needs
• Models of relationships and decision-making power
• Combination of evidence-based strategies improving outcomes

To sum it up, to reduce the number of people suffering from bedsores, recommended care techniques should be combined with the organization of institutionalized efforts and risk identification strategies. All interventions have to follow ethical standards and align with patients’ personal treatment needs. Also, patients’ cultural values need to be analyzed to improve treatment outcomes.

References

Beldon, P. (2014). The role of ethics in the wound care setting. Wounds UK, 10(3), 72-75.

Coleman, S., Gorecki, C., Nelson, E. A., Closs, S. J., Defloor, T., Halfens, R.,… Nixon, J. (2013). Patient risk factors for pressure ulcer development: Systematic review. International Journal of Nursing Studies, 50(7), 974-1003.

Demarré, L., Van Lancker, A., Van Hecke, A., Verhaeghe, S., Grypdonck, M., Lemey, J.,… Beeckman, D. (2015). The cost of prevention and treatment of pressure ulcers: A systematic review. International Journal of Nursing Studies, 52(11), 1754-1774.

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.

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.

Lin, M. L., Pang, M. C. S., & Chen, C. H. (2013). Family as a whole: Elective surgery patients’ perception of the meaning of family involvement in decision making. Journal of Clinical Nursing, 22(1-2), 271-278.

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.