The problem of pressure ulcers presents a significant challenge to health care delivery, and nurses dealing with it should have the most capacity to address it. Patients who are unable to move develop ulcers, which are areas of necrosis and ulceration that occur from the combination of pressure, moisture, and displacement forces (Agrawal & Chauhan, 2012).
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It is important to understand that early prevention is essential because the further the condition develops, the higher are the risks of dangerous infections developing and presenting significant treatment challenges. Risk factors for pressure development include more senior age, the impaired circulation of blood, malnutrition and immobilization, lower sensitivity, and fecal incontinence (Demarre et al., 2015). The further discussion will focus on identifying a PICOT question intended to develop an intervention to address the issue.
- P (population): the target population of patients suffering injuries and significant impairments in mobility, thus unable to move or forced to rest in bed for prolonged time periods;
- I (intervention): the strategy of regular repositioning and turning targeted at preventing pressure ulcers development alongside providing proper nutrition, skin assessment, and incontinent care;
- C (comparison): compared to occasional turning and skin assessments, which occurs in many instances because of the low quality of care in some institutions;
- O (outcome): the reduction of pressure ulcers occur in the target population:
- T (timeframe): within a 120-day period.
Thus, the PICOT question for the project is the following: In a population (P) of immobile patients and those with low mobility, what is the effect of a regular repositioning intervention (I) combined with proper nutrition, skin assessment, and incontinent care as compared (C) to occasional turning and skin assessments, on the reduction of pressure ulcers (O) occurrence in the target population within a 120-day period (T).
The proposed intervention is an evidence-based solution supported by multiple researchers. For example, Yap, Kennerly, Bergstrom, Hudak, and Horn (2017) concluded that in order to prevent pressure ulcers, nurses had to conduct regular skin assessments, ensure that patients comply with nutritional recommendations, and are repositioned as frequently as possible. In the process of patient care, nurses are expected to assess the needs of each patient individually to ensure that the aspects of the proposed intervention cater to the specific risks and peculiarities. Developing trusting relationships between patients and their nurses is at the core of nursing practice that would help practitioners to be more proactive in catering to the needs of their patients.
A nursing intervention targeted at preventing pressure ulcers is expected to benefit the nursing practice in general because it encourages paying more attention to the needs of patients. Nurses act not only as carers but also as advocates and companions because they are the ones to interact with patients the most. Nurses are also educators within the intervention because they will inform their patients and families on appropriate methods of ulcer prevention upon discharge.
Thus, the solution is multi-dimensional and encourages nurses to be more attentive to the needs of their patients. The success of the intervention will be measured by comparing the pre-intervention and post-intervention rates of ulcer occurrence in a given facility. In addition, patient attitudes will be measured in order to assess the effectiveness of nursing care based on their perceptions. Appropriate updates in the intervention will be made upon the assessment of its impact on the target population.
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.
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Demarre, L., Verhaeghe, S., Van Hecke, A., Clays, E., Grypdonck, M., & Beeckman, D. (2015). Factors predicting the development of pressure ulcers in an at‐risk population who receive standardized preventive care: Secondary analyses of a multicentre randomised controlled trial. Journal of Advanced Nursing, 71(2), 391-403.
Yap, T. L., Kennerly, S. M., Bergstrom, N., Hudak, S. L., & Horn, S. D. (2016). An Evidence-Based Cue-Selection Guide and Logic Model to Improve Pressure Ulcer Prevention in Long-term Care. Journal of Nursing Care Quality, 31(1), 75-83.