Introduction
The term pressure ulcer (also known as the “bed sore”) is an acute condition when pressure contributes to the development of additional health issues in an immobile person. The source of the problem is the lack of blood flow that could prevent the soft tissues from destroying under pressure applied by the weight of the body itself. Moreover, pressure ulcers may be typical of patients who are confined to wheelchairs. It makes it essential for the care providers to receive adequate training in order to be able to respond to all kinds of potential complications and establish an environment where long-term care is viewed as one of the most viable options. Prevention and treatment pieces of training are essential because they help reduce the impact of ulcers on patients and reduce the amount of time required to treat certain conditions that only affect immobile individuals.
As the evidence on the subject suggests, pressure ulcers are a critical healthcare concern that has to be addressed on a statewide level to help providers prioritize accordingly and engage in learning activities (Smit et al., 2016). There is also an opinion in Smit et al.’s (2016) article that pressure ulcers contribute to the development of patient education and require care providers to review their decision-making methodology prior to assessing any risks related to pressure ulcer consultations. Accordingly, an additional way to resolve the issue of pressure ulcers in patients could be to provide the latter with wound care team consultation sessions intended to decrease the risk of getting exposed the above-mentioned condition. Appropriate learning initiatives could help care providers and patients develop a unified approach to the problem and create more opportunities for the deployment of consultation-based strategies intended to prevent pressure ulcers in all types of patients. The current paper is aimed at validating the idea that wound care team consultations may serve as a means of decreasing the risk for pressure ulcers in patients who received consultations instead of standard protocols over three consecutive months.
Nursing Practice Problem and PICOT Question
The PICOT question that the author is going to review within the framework of the current paper is as follows: (P) Nursing home patients (I) Effects of wound care team consultation (C) Compared with a standard protocol (repositioning) (O) Reduce risk for pressure ulcers (T) Over 3 months.
The nursing practice issue of wound care team consultation effectiveness versus repositioning is supported by several articles on the subject, as eHealth and patient education function simultaneously when it comes to developing the most efficient treatment process and appeal to patients of all ages, socioeconomic backgrounds, etc. (Moore & Cowman, 2015; Ousey et al., 2016). Wound management is a serious issue that also has to be addressed by practitioners because technical development offers more possibilities to improve clinical practice and engage eHealth appropriately (Black et al., 2015). Existing protocols suggest that care clinicians should invest more resources in technology-related research and consider the benefits of bed repositioning and patient education (Boyko et al., 2018). The thoughtful deployment of digital applications, together with detailed instructions for both providers and patients, would significantly improve the quality of life for patients and the quality of care for nurses. There are numerous potential opportunities related to how improvements could be achieved with the help of optimal treatment, and articles completed by Moore et al. (2015) and Ousey et al. (2016) carefully outline them.
Background, Method, and Results of Studies
Background
The problem of the study completed by Moore et al. (2015) was that a systematic evaluation of studies on how technologies could help practitioners treat pressure ulcers and provide patients with required education. The significance of the current study is highlighted by the idea that the researchers were able to collect evidence on the utilization of eHealth applications and define the future areas of research that could be investigated. The purpose of Moore et al.’s (2015) article was to address the aspects that were not completely assessed within the framework of previous research projects. The objective, on the other hand, was to test the integral elements of care provision and make sure that eHealth apps could benefit the process of pressure ulcers treatment. Moore et al. (2015) took on the research question of whether existing knowledge and skills could be useful in developing the best approaches to treating pressure ulcers with the help of available technologies.
The research problem outlined in Ousey et al.’s (2016) project was to investigate a gap in the literature related to how assisted living could relieve the burdens of pressure ulcers in adult populations. The overall significance of this study may be explained by an extensive insight into the importance of reporting and understanding the needs of patients. The purpose of the research was to communicate with care provision staff to find out if a national education program could be helpful in disseminating pressure ulcer-related information (Ousey et al., 2016). The objective, on the other hand, is related to the development of professional skills in care providers. The research question investigated by Ousey et al. (2016) touched upon the quality of life of patients with pressure ulcers and how the financial burden of educating patients could be reduced with the help of instruction and guidance.
Method
The study completed by Moore et al. (2015) mostly focused on the crucial items that could be helpful in outlining the potential use of eHealth applications. The researchers conducted a literature review aimed at a comprehensive evaluation of the Model for Assessment of Telemedicine (MAST) framework and redefine the potential values characteristic of digital tools in care provision. Moore et al. (2015) identified the most valuable literature on the subject and developed a clear argument on the process of wound care. The benefit of this research project is that it allows the readers to realize the advantages of eHealth solutions and their place within modern care environments. The key limitation of this research is that Moore et al. (2015) failed to address the process of integrating eHealth into the process of care provision. A sole focus on the potential influence of eHealth tools on patients with pressure ulcers may not be deemed as overly effective.
Ousey et al. (2016), on the other hand, conducted their study utilizing a sample of care providers who were asked to provide their feedback on existing protocols and the use of technologies in care provision. The participants were asked to fill in a questionnaire where they would discuss their experiences related to the treatment of pressure ulcers and potential improvements that could facilitate the relationship with patients. The main benefit of Ousey et al.’s (2016) article is that it maximized the role of community nurses and outlined pressure ulcer care as one of the essential ideas in nursing that are interconnected with pain management, wound care, and other areas of health services. Regardless, the essential limitation of the current research article was that it did not allow for a high level of data clustering and did not reach the same level of representativeness as Moore et al.’s (2015) research project, for example.
Results
The results of the study completed by Moore et al. (2015) showed that the amount of evidence related to the application of eHealth tools is still limited and has to be expanded over time. The benefits and harms to patients characteristic of digital care instruments yet have to be researched in order to help providers evade wound care challenges and build positive relationships with patients. One of the potential solutions could be to pay more attention to the recurrent evaluation of technologies and support the innovation approach. The implication of these findings is that any given organization could benefit from such activities in the case where both the team and patients are ready to contribute to positive change.
The research conducted by Ousey et al. (2016) highlights the need for more community nursing initiatives and the importance of being able to share information with patients and receive timely updates from them as well. They suggested that changes made to the existing reporting mechanisms could become the one and only solution for patients with pressure ulcers. Every nursing professional should be concerned with evaluating existing protocols and making sure that vulnerable adults are not exposed to even more additional challenges. The key implication of these findings is that the lack of guidance could negatively affect patients with pressure ulcers and reduce the effectiveness of the repositioning protocol.
Ethical Considerations
The first ethical consideration was to preserve the anonymity of all participants that were involved in the process of data collection. Moore et al. (2015) addressed it by removing all personal data from their database that could be used to identify a study participant. The relevance of preserving anonymity may be explained by the large demographic variation and multiple cultural aspects that could affect study outcomes. In order to address the ethical consideration of preserving anonymity, Moore et al. (2015) only collect the data related to pressure ulcer treatment and outcomes, without focusing on personal information.
The second ethical consideration is the utilization of special equipment and techniques that may be best identified in Ousey et al.’s (2016) article. After ethical approval, the researchers conducted a survey via the Internet and then deleted all the raw data after the survey had been completed. Every interview recorded during the study was then transcribed with the help of the University of Huddersfield and sent to a secure server to protect study participants from sensitive data disclosure.
PICOT, Research, and Nursing Practice Problem Relationship
The relationship between research, PICOT question, and nursing practice problem is shaped by the necessity to attract more partnerships to the problem of wound care management and the increasing rates of pressure ulcer occurrence. Even though there may be regulatory issues affecting the wound care team when administering consultations, there should be no issues with the implementation of an interdisciplinary approach to pressure ulcer prevention. The team should constantly work on finding the best solutions for preventing the condition in question and managing those ulcers that had been acquired within the facility. An approach that features wound care team consultations may be deemed the best due to the existing evidence from the literature. It suggests that there is a chance to minimize the occurrence of rehospitalizations in the case where the wound care team is involved in the treatment process. The basics of pressure ulcer prevention do not include the activities completed by the wound care team. Because of this, many additional conditions have to be considered when the team expects to prevent ulcers with the help of patient consultations.
The connection between existing research and nursing practice problems highlights the need for an interdisciplinary approach that would be utilized to establish proper expectations of care and help facilities admit patients with preventive measures being already in place. Without an adequately prepared team of experts who could consult patients in regard to pressure ulcer prevention, the facility is going to experience an upsurge in the occurrence of the given condition and not have the opportunity to recognize the importance of addressing pressure ulcers as soon as possible. The most important responsibility of wound care team members would be to point out the atypical characteristics of treatment guidelines and ensure that pressure ulcer prevention measures are applied immediately. Regardless, accurate communication among the staff members is also essential because it would protect them from picking the wrong treatment path.
Therefore, there is a rather high risk of experiencing an educational deficit during the process of wound assessment, which is going to result in further deterioration of a patient’s health. To prevent rehospitalizations and higher care costs, wound care team members should educate patients on how to prevent pressure ulcers and propose possible interventions depending on the patient’s condition. The possibility of facing legal and regulatory repercussions should also move the staff toward an interdisciplinary approach aimed at the development of a positive care environment where pressure ulcers are prevented in a timely manner.
Proposed Evidence-Based Practice Change
The existing evidence on the subject suggests that the most appropriate way for the team to change its practice and implement wound care team consultations would consist of three essential steps. Initially, care providers would have to review their skin assessment methodology and pay more attention to the potential complications existing in patients. Furthermore, the team would have to reach out to other agencies and the government to standardize a new method of pressure ulcer risk assessment. Thirdly, the team would have to address the potential areas of risk by planning and implementing the new care methodology, which would also touch upon wound care consultations. As an interdisciplinary practice change initiative, the current proposal would include three important teams:
- An implementation team that is going to draft and implement the change project related to managing and preventing pressure ulcers via wound care team consultations;
- A wound care team that would be responsible for establishing the resources that are necessary to implement the program and provide daily skincare intended to protect patients from severe pressure ulcers;
- A unit-based team that will be responsible for everyday patient care, skincare management, and consistent risk assessment procedures.
As the core element of the proposed care change initiative, the wound care team would represent a set of experts expected to analyze the quality and relevance of the content on pressure ulcer prevention provided to patients. The expertise of wound care practitioners would become rather beneficial, as they would establish the resources required to prevent pressure ulcers or at least minimize their impact on patients. Effective communication is going to be the cornerstone of the proposed change initiative, which also means that all members of the interdisciplinary team described above should collaborate meritoriously and create a positive image of the unit. Every key stakeholder should be involved in the process of pressure ulcer prevention, with the members of the team sharing their knowledge with other teams and patients. In order to be able to implement the strategy, the staff should track the statistics on pressure ulcers and develop an expert understanding of how patients could be supervised in the case where wound care team consultations are going to be implemented. Patients and their families should be engaged in the process of knowledge dissemination as well.
The set of actions required to strengthen the team’s understanding of why wound care management is crucial should start with improved equipment use and an extended share of clinical processes cultivating patient safety. Environmental surveillance is another essential element intended to provide the staff members with enough evidence to communicate with patients and help them overcome the issue of pressure ulcers. Every stakeholder involved in the program should be trained in accordance with the proposed standardized strategies introduced in order to decrease the occurrence of pressure ulcers in patients. Across the whole organization, the team should validate the need for additional orientation training that would help more care providers realize the benefits of pressure ulcer prevention and get them acquainted with the essential equipment utilization directives. On the other hand, consequent competency assessments would help the team establish the best consultation options and outline a training program that would include the strongest points related to preventing pressure ulcers. This is why the team would have to establish unit champions and have them communicate and report all the data associated with pressure ulcer management in all patients.
The proposed change management strategy stands for an interdisciplinary approach where the staff shares the most important concepts regarding pressure ulcers with patients that are susceptible to the latter. Short meetings intended to help care providers dwell on the preventive procedures would also include thorough discussions of how safety issues and patient risks could be evaded on a long-term scale. Nevertheless, the team should make sure to engage every team member and gain their support to achieve the best possible outcomes. Moreover, every stakeholder should have access to a reasonable amount of time and change-related resources that would aid them in adopting the new practice. An ongoing monitoring process would be required for the team to realize the key benefits of the wound care team consultations and how the process of managing pressure ulcers could be improved. Overall, the strategy that involves patient consultations may be expected to improve health outcomes and also close numerous knowledge gaps that averted patients from managing their exposure to pressure ulcers in the first place.
Conclusion
The essentials of preventing pressure ulcers have been reviewed in many articles on the subject that addressed the necessity to alter the existing guidelines to cater to patients and also help care providers to achieve better outcomes without additional expenditures. As the research completed within the framework of the current paper indicates, strict adherence to a set of standardized rules could be helpful in terms of reducing the amount of time required to establish a friendly care environment and leave patients contented. The occurrence of facility-acquired pressure ulcers hints at the fact that wound care team consultations could become an essential element of the imminent prevention programs aiming at all types of patients. Not only would it be important to increase exercising habits in patients, but also ensure that secondary conditions are considered as well (for instance, blood pressure, blood sugar maintenance, or stress management). The existing evidence suggests that risk assessment protocols have to be followed to the dot in order to remain efficient, as otherwise, the team is going to fail to redistribute pressure, improve patients’ mobility, and manage moisture.
Accordingly, the key takeaway is that many facilities experience the absence of consistency when it comes to finding solutions to long-standing wound care issues and pressure ulcer prevention. This problem stems from the fact that the majority of customized fixes are relatively costly and do not reflect the values and aspirations of care team members. Even though repositioning is not considered to be the best option for pressure ulcer treatment, there is enough evidence in the literature supporting the idea that it may be just as effective as wound care team consultations are in general. The advent of new technologies and advanced processes, though, hints at the fact that the health care landscape should move toward more inclusive treatment methods that would engage patients in the process as well. The presence of pressure ulcer prevention protocols makes it possible for care providers to manage the outcomes of prolonged nursing home stays and regulate the patients’ attitudes in accordance with the expected products of care and preventive measures.
The general conclusions that can be made on the basis of the information presented above revolve around the importance of creating the right treatment environment that would advance pressure ulcer management and create additional opportunities for wound management. First, the wound care team consultations should go in line with the numerous virtual medicine options that are currently available to care professionals (for example, electronic medical records). Second, the treatment process should preserve standardization and address patients’ needs to nurture diversity and customization of care. The majority of risks related to pressure ulcers and patient injuries shall be mitigated with the help of risk prevention methodologies. The latter, in turn, should engage care consumers in the treatment process and assist them in picking the right treatment options without exposing themselves to negative health outcomes. In order to succeed, the team should take on an interdisciplinary approach and increase both staff and patient participation to make consultations even more effective.
References
Black, J., Alves, P., Brindle, C. T., Dealey, C., Santamaria, N., Call, E., & Clark, M. (2015). Use of wound dressings to enhance prevention of pressure ulcers caused by medical devices. International Wound Journal, 12(3), 322-327.
Boyko, T. V., Longaker, M. T., & Yang, G. P. (2018). Review of the current management of pressure ulcers. Advances in Wound Care, 7(2), 57-67.
Moore, Z., Angel, D., Bjerregaard, J., O’Connor, T., McGuiness, W., Kröger, K.,… & Yderstrœde, K. B. (2015). eHealth in wound care: From conception to implementation. Journal of Wound Care, 24(Sup5), S1-S44.
Moore, Z., & Cowman, S. (2015). Repositioning for treating pressure ulcers. Cochrane Database of Systematic Reviews, (1), 1-17.
Ousey, K., Kaye, V., McCormick, K., & Stephenson, J. (2016). Investigating staff knowledge of safeguarding and pressure ulcers in care homes. Journal of Wound Care, 25(1), 5-11.
Rafter, L. (2016). Employing e-health in the palliative care setting to manage pressure ulcers. Wounds UK, 12(1), 114-123.
Smit, I., Harrison, L., Letzkus, L., & Quatrara, B. (2016). What factors are associated with the development of pressure ulcers in a medical intensive care unit? Dimensions of Critical Care Nursing, 35(1), 37-41.