Review of Literature
Pressure ulcers refer to those issues that are often faced by patients with limited mobility. They affect millions of people in the USA and often entail critical healthcare outcomes, which proves that they are to be thoroughly investigated and the most effective tools for their prevention are to be identified. Realizing the necessity to reach these goals and accomplish a research study, a range of related authoritative literature was approached. For this paper to be based on trustworthy information, six peer-reviewed articles were obtained from different sources. The BMJ database was addressed because it has existed for more than 150 years already and proved that it is a high-quality medical and surgical repository. The BioMed Central database was used, as it allows to find lots of freely accessible peer-reviewed journals related to medicine and health.
The NCBI database was used as an advanced resource that provides access to PubMed articles. The American College of Physicians database was used because it provides an opportunity to reach a clinical practice guideline that is utilized by professionals who operate in the sphere. Finally, Google Scholar allowed finding reliable articles from different peer-reviewed journals. In order to approach those sources that reveal the information appropriate for the topic and likely to answer the PICOT question developed beforehand, a range of keywords and phrases was used, including pressure ulcer, reduction, patient safety, risk assessment, scales, and preventive interventions, the Braden and Waterlow scale. To ensure the appropriateness of the received information, only current articles that were published within the last 5 years were considered. In fact, the oldest one was printed 4 years ago. Thus, this literature review is likely to be valid and reliable.
In her article Gill (2015) focused on the way pressure ulcers can be reduced in the hospital. The author notices that more people start facing this problem with the course of time, especially in the intensive care unit. As a result, they suffer from other complications, causing discomfort and economic issues. Thus, the professional conducted a research study that can be helpful when reducing hospital-acquired pressure ulcers and improving the quality of healthcare services. Gill organized weekly meetings with nurses, managers, physicians, and technicians who work in the intensive care units for them to implement a new four-step plan of action in two cycles. The outcomes were measured weekly using the computerized referral system. The result of the research study proved that acquired pressure ulcers have a negative influence not only on the patient’s health outcomes but also on the professionals working in the unit, as their workload increases. The problem can be reduced with appropriate training and education for nurses and practitioners. Regular monitoring and audit are also vital, as they allow to assess the success of new approaches.
Guy (2012) focuses her work on the main risk factors for pressure ulcers, advantages and disadvantages of tools that can be used to assess them, and obstacles faced when preventing them. Conducting a research study based on the analysis of related authoritative literature, the author developed five main points that are to be considered by practitioners, nurses, patients, and their families. The professional states that it is critical for the healthcare staff to recognize those individuals who are likely to have pressure ulcers before they face this issue because only in this way they can ensure successful prevention.
The very risks should be identified not just on the basis of one’s knowledge, skills, and perceptions but with the help of specifically developed and tested tools, such as the Braden and Waterlow scale. In this way, it is significant to refer to the combination of clinical judgment and risk assessment tools. What is more, the re-evaluation should be maintained in case of any skin damage even if initially it seems to have nothing in common with pressure ulcers. Finally, all parties involved in this issue need to realize that it is not possible to avoid pressure ulcers completely.
The connection between nurse staffing and patient health outcomes is discussed by He, Staggs, Bergquist-Beringer, and Dunton (2016). The researchers focused on the information obtained from the National Database of Nursing Quality Indicators® to consider how nursing hours affected inpatient fall risks and hospital-acquired pressure ulcers. As a result, almost 12,500 units from more than 1500 hospitals were assessed. A linear model was utilized to measure the data obtained during research and then analyzed according to the aggregation strategy with a grouping mechanism. As a result, professionals received an opportunity to conclude that trend and seasonal associations between nurse staffing and patient outcomes exist, and increased staffing levels can improve the situation for both practitioners and patients.
Lachenbruch, Ribble, Emmons, and VanGilder were willing to determine a patient’s risk of having hospital-acquired pressure ulcers, using the Braden scale (2016). In addition to that, the researchers paid attention to the cases of incontinence. They referred to the International Pressure Ulcer Prevalence surveys. Using a cross-sectional cohort database, they received an opportunity to consider how often pressure ulcers are faced by patients and how critical their condition is. The sample included more than 170,000 patients which allowed them to reach decent results. It was concluded that Braden scale results are higher in patients with incontinence. What is more critical, its connection with risk for all pressure ulcers was identified.
Qaseem, Mir, Starkey, and Denberg (2015) developed a clinical practice guideline that can be used by professionals who are working in healthcare facilities. They reviewed a wide range of literature sources published at the end of the 20th century and those that were current, which gave them an opportunity to reach their goal and develop recommendations on the basis of comparison of risk assessment scales and preventive interventions. They stated that clinicians should assess their patients’ condition to identify those who are likely to have pressure ulcers using advanced static and alternating-air mattresses and overlays.
Tayyib and Coyer (2016), in their turn, focused on ulcer prevention strategies. They were willing to synthesize the best evidence of their effectiveness in pressure ulcer reduction and prevention. The authors referred to articles published since 2000 and reviewed 25 studies. They found out that a silicon foam dressing can be rather effective in critically ill patients. What is more, changes in nutrition, repositioning, and support services also proved to be rather beneficial.
Thus, it can be stated that professionals investigate the issue of pressure ulcers rather thoroughly. However, they tend to focus on different perspectives, which makes it difficult to gather the best approaches in general. With the help of the proposed project, some gaps in knowledge that currently exist can be filled. While the Braden and Waterlow scales are often utilized by healthcare staff, researchers do not consider their effectiveness compared to clinical judgment and just discuss them separately. In this way, proposed research can also be useful in practice.
Theoretical Framework
The proposed project can be supported by Watson’s theory, according to which caring is critical in nursing. The thing is that it is not always enough for healthcare professionals to simply perform their duties to avoid such critical issue as pressure ulcers. According to this theory, nurses should interact with patients more, focusing not on their illnesses but on them as individuals. This can be rather advantageous, as people with limited motion may hide the fact that they want to change their position just because they do not want to disturb anyone or feel pathetic. In this way, caring is the thing that is expected to make healthcare professionals utilize all available resources that can help them to determine what kind of care is needed by a patient and how likely is one to face problems connected with the development of pressure ulcers. Watson’s theory presupposes the usage of scientific problem-solving approaches when making decisions, which can also support the implementation of the Braden and Waterlow scale in order to prevent pressure ulcers in patients with limited mobility (Clark, 2016). The usage of such tools is additional to clinical judgment so professionals should be encouraged to refer to it.
In this theoretical framework, four major concepts should be discussed. The first one is a human being. Hospital staff members who take care of patients need to value them and respect as a fully functional integrated self even though they are not able to maintain basic actions. Considering pressure ulcers risks only with the help of clinical judgment, they tend to see a patient as a sum of parts, a part of which can operate normally and a part of which is dysfunctional. When resorting to additional risk assessment tools, nurses show that their clients deserve more than simple assessment. The second concept emphasized in this theory is health. Professionals are to place all their efforts to ensure positive health outcomes for their clients.
Thus, they need to use all possible tools and approaches to minimalize pressure ulcers risks, including the utilization of both the Braden and Waterlow scale and clinical judgment. The third concept is the environment that should be transmitted from one generation to another and be present in every society. In this way, the best practices of pressure ulcers prevention should be spread throughout the healthcare system. Finally, the concept of nursing requires holistic healthcare (Ozan, Okumuş, & Lash, 2015). According to it, it is impossible to limit interventions only to clinical judgment alone. It is critical for healthcare professionals to use as many approaches to pressure ulcers prevention as possible because only in this way they can be able to ensure that they have done their best and reached the most positive outcomes.
Thus, the necessity of the implementation of the proposed project is supported by Watson’s theory. Its main concepts prove that medical staff members should not limit their decisions regarding the pressure ulcers risks and prevention only on the basis of clinical judgment alone. They need to do their best, and add the utilization of the available risk assessment scales, such as the Braden and Waterlow scale, to ensure positive health outcomes for their patients.
References
Clark, C. (2016). Watson’s human caring theory: Pertinent transpersonal and humanities concepts for educators. Humanities, 5(21), 1-12.
Gill, E. (2015). Reducing hospital acquired pressure ulcers in intensive care. BMJ Quality Improvement Reports, 4(1), u205599-w3015.
Guy, H. (2012). Pressure ulcer risk assessment. Nursing Times, 108(4), 16-20.
He, J., Staggs, V., Bergquist-Beringer, S., & Dunton, N. (2016). Nurse staffing and patient outcomes: A longitudinal study on trend and seasonality. BMC Nursing, 14(15), 60.
Lachenbruch, C., Ribble, D., Emmons, K., & VanGilder, C. (2016). Pressure ulcer risk in the incontinent patient: Analysis of incontinence and hospital-acquired pressure ulcers from the international pressure ulcer prevalence™ survey. Journal of Wound Ostomy & Continence Nursing, 43(3), 235-41.
Ozan, Y., Okumuş, H., & Lash, A. (2015). Implementation of Watson’s theory of human caring: A case study. International Journal of Caring Sciences, 8(1), 25-35.
Qaseem, A., Mir, T., Starkey, M., & Denberg, T. (2015). Risk assessment and prevention of pressure ulcers: A clinical practice guideline from the American college of physicians. Annals of Internal Medicine, 162, 359-369.
Tayyib, N., & Coyer, F. (2016). Effectiveness of pressure ulcer prevention strategies for adult patients in intensive care units: A systematic review. Worldviews on Evidence-Based Nursing, 1, 1-13.