Pressure Ulcers-Introduction
Pressure ulcers are of great health concern since they depict the quality of care in a hospital, and greatly affect the prognosis of a patient. Some of the pressure ulcers witnessed in hospitals are as a result of hospital care hence, the reason why they are used to evaluate the quality of hospital care. Determining the likelihood of patients developing pressure ulcers is very important so that preventive measures can be put in place to avoid fatal consequences. The elderly are the most vulnerable as far as the development of pressure ulcers is concerned. One of the tools used to assess the risk of developing pressure ulcers is the Braden. This paper will therefore discuss the issues associated with pressure ulcers among the elderly, and the use of the Braden as a geriatric tool for assessing the risk of pressure ulcers.
Background Information
Pressure ulcers (PUs) are particular areas of the body characterized by tissue damage. They are a result of unrelieved pressure over bony prominences like heels, sacrum, ischial tuberosities, lateral malleoli, and greater trochanters (Javaheri &Bluestein, 2010). The terms ‘pressure ulcers’ or ‘pressure sores’ are better preferred to ‘decubitus’ ulcers or ‘bed sores’ because the former factors in the element of ‘unrelieved pressure’ as a primary attributor in the pathogenesis of the localized damage to tissues. Pressure Ulcers are a common attributing factor of morbidity or death in institutionalized and hospitalized individuals. Some of the co-morbidities that arise as a result of Pus are osteomyelitis, sepsis, and cellulitis.
Pressure ulcers are due to various risk factors such as friction, poor nutritional status, immobility, incontinence, shear, and cognitive impairment (Salcido, 2012). The elderly are usually at the highest risk of developing pressure ulcers due to various reasons. Around 70% of PUs occur in individuals aged 65 and above. All, or almost all of the factors mentioned above lead to the development of pressure ulcers among the elderly.
To begin with, older adults have a problem with their nutritional status due to among others, dentition problems and taste acuity. In addition, they may be having degenerative diseases which affect their quality of life, rendering them weak and immobile. This is because the functioning of old people dwindle by 25% to 60% upon admission into a hospital environment (Javaheri, & Bluestein, 2010). As a result, friction occurs between the body and surface, and this eventually leads to pressure ulcers.
In addition, most old people are senile and therefore have impaired cognitive ability, which affects their functioning to the extent that they cannot properly reason when their need to empty their urinary bladder. As result, most of the elderly patients (≥65 years) have problems with continence. This is a very attributing factor of pressure ulcers for these patients due to other related attributing factors around them. Assessment of pressure ulcers in hospitals is a very important activity because pressure ulcers are used as one of the indicators of hospital care (Salcido, 2012).
According to Ayello (2012), the prevalence rates for pressure ulcers are “11.9% in acute care, 29.3% in long term care, 11.8% in long term care, and 19.0% in rehabilitation”. Approximately 9 to 22% of pressure ulcers occur in nursing homes, while 5-23% of pressure ulcers occur due to hospitalization (Javaheri, & Bluestein, 2010). The use of pressure ulcers risk assessment tools is very important to avert the severe health consequences that follow as a result of pressure ulcers development.
Early detection of patients’ risk factors to pressure ulcers is therefore very fundamental to enable timely implementation of preventive interventions. Pressure ulcers are a very challenging health problem for the United States. Annually, the US spends $11 billion as a result of these ulcers. Extra time is required to take care of these patients, who would otherwise not have developed the PUs had risk assessment and proper intervention strategies been carried out. 60,000 patients die each year due to co-morbidities associated with pressure ulcers. In addition, the ulcers hurt patients’ physical, social, psychological, and financial statuses.
Assessment Tool-Braden Scale
There are several tools used to assess the risk of developing pressure ulcers. However, due to the purpose of this paper, concentration will be on the Braden scale. The Braden Scale is a risk assessment tool that is used in clinical settings to determine the risk of pressure ulcers. It is a clinically validated tool that enables nurses and other health providers to reliably establish the likelihood of patients developing pressure ulcers through scores. It also determines the extent of pressure damage if it has already occurred, and evaluates the course of certain treatments. It is extensively employed in “acute, home, and institutional long term care settings” (Ayello, 2012).In most cases, the Braden scale is used among the elderly, who are medically and cognitively impaired.
It was developed by American researchers during the late twentieth century. The development of this tool was based on the identification of ‘pressure’ and ‘tissue tolerance’ as imperative factors in the development of pressure ulcers through a “conceptual schema of etiological factors” (Barbara, 2012). The score while using the Braden scale ranges between 6 and 23, where low scores indicate higher risk. The cut-off points that indicate that a patient is at risk of developing pressure ulcers vary between 16 and 18 because of the clinical environment in which the tool is being used acts as an influencing factor on the tool’s functioning (Kim, Lee, Lee, & Eom, 2009).
The Braden scale as indicated in appendix 1 assesses six areas: dietary intake, sensory perception, activity, mobility, skin moisture, and friction, which act as the subscales against which nursing interventions are correlated. The subscales are used to determine the functional ability of the patients that enable them to withstand higher intensity and duration of pressure (Denby & Rowlands, 2010). Each domain is rated between 1 and 3 or 4. Based on the overall range of risk from 6 to 23, scores of 15 to 18 are indicative that the patient is at risk, 13 to 14 are indicative of moderate risk, 10 to 12 are indicative of high risk, while ≤9 are indicative of very high risk.
A score equal to or higher than 19 is indicative of low risk and less need for treatment. The predictive validity of the Braden scale concerning pressure ulcers has been extensively studied, and inter-rater reliability ranging between 83% and 99% was established. It is equally reliable when used across races. This tool is widely used in acute care institutions for the identification of at-risk patients within 48hours after admission or when there is an alteration in either one of the critical areas for risk assessment of pressure ulcers as mentioned earlier.
Implications
The use of the Braden scale to assess the risk of developing pressures in the elderly is very fundamental in nursing practice. This is because it leads to timely intervention. As a result, the prevalence of pressure ulcers will reduce since counteractive measures will be put in place early enough. Secondly, there will be reduced medical complications that are usually associated with pressure ulcers such as sepsis. Nurses will be able to take care of more deserving patients since the time that would have otherwise been spent trying to treat the ulcers will be reduced. In addition, healthcare costs will largely reduce since there will be no additional costs. Patients will have a reduced stay at the hospitals, and their quality of life will be enhanced.
Conclusion
A risk assessment tool is very important is as far as pressure ulcers are concerned. This is due to the detrimental consequences that arise as a result of these ulcers. The Braden scale is one such tool that enables nurses and other healthcare givers to detect the risk of developing pressure ulcers in patients. Effective prevention protocols applied to those at risk of developing pressure ulcers have yielded positive results. There should be laid down protocols on when the risk assessment ought to be done since at times it takes place when the ulcers have already occurred. This is important in the provision of healthcare because it takes a few hours for pressure ulcers to develop and several months for them to heal, of which healing is not guaranteed depending on the stage of the pressure ulcers.
References
Ayello, E. (2012). Predicting Pressure Ulcer Risk. Web.
Barbara, B. (2012). The Braden Scale for Predicting Pressure Sore Risk: Reflections after 25 Years. Advances in Skin & Wound Care, 25 (2), 61.
Denby, A., & Rowlands, A. (2010). Stop them at the door: should a pressure ulcer prevention protocol be implemented in the Emergency Department. JWOCN, 37 (1), 35-38.
Javaheri, A., & Bluestein, D. (2010). Elder Care: A Resource for Interprofessional Providers. Web.
Kim, E., Lee, S., Lee, E., & Eom, M. (2009). Comparison of the predictive validity among pressure ulcer risk assessment scales for surgical ICU patients. Australian Journal of Advanced Nursing, 26 (4), 87-94.
Salcido, R. (2012). Pressure Ulcers and Wound Care. Medscape. Web.