This paper aims to review the issue of pressure ulcers in elderly patients in long-term care facilities. Research suggests considering modern-day evidence-based methods of preventing pressure ulcers, methods of management of PUs, and its causes, and the prevention methods and comparison of the effectiveness of existing management practices. The study will analyze the effectiveness of pressure redistribution surface mattress and the manual repositioning in the treatment of stage IV pressure ulcers involving elderly patients to find and change methods of preventing PUs. Appropriate keywords were used to find the most recent and relevant data.
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A literature review based on eight articles, which mostly included systematic reviews, revealed that the use of high and low technology pressure distribution surfaces prevailed (Kruger, Pires, Ngann, Sterling, & Rubayi, 2013). Although some studies found the effectiveness of interventions for pressure ulcers in specific populations and under certain conditions (Murray, Noonan, Quigley, & Curley, 2013), many researchers indicated an insufficient amount of studies in this area (Sullivan & Schoelles, 2013). Moreover, no research incorporated variables, such as specific settings, target population, and the stage of PUs together.
After careful investigation of conventional approaches to PU intervention, a practice involving close cooperation with management as well as constant meetings with colleagues was developed (Dogherty, Harrison, Graham, Vandyk, & Keeping-Burke, 2013). Staff should be provided with all necessary information about the importance of the issue and effective practices, while their feedback should also be taken into consideration.
Pressure ulcers, also called bedsores are areas of injured skin resulted from prolonged pressure (Thomas & Compton, 2013). Pressure ulcers represent a major problem for elderly patients in long- term facilities, as they worsen the quality of life and may aggravate the condition. Anyone can be affected by pressure ulcers. Prevention and treatment of PUs require a set of expensive procedures that might not completely solve the problem.
Currently, it is an attractive topic for researchers because of the shortage of information about effective management and treatment of pressure ulcers. Common areas of interest include causes of PUs, effective evidence-based treatment methods, management, and prevention methods. Present research indicates the importance of this issue on population and healthcare in general. At the same time, research does not focus on the variables of a target population, stage of PUs, and specific settings. In nursing practice, information about treatment and management methods of PUs is critical, since it can discover successful strategies for implementation to increase the effectiveness of the treatment.
The primary purpose of this paper is to examine and evaluate the effect of pressure redistribution surface mattress as compared with the manual re-positioning or the combination of both in the prevention and treatment of stage IV pressure ulcers in elderly patients in long-term care facilities. It also aims to review the current literature revealing the effects of available treatment methods and management and translate evidence into practice by incorporating gathered knowledge about pressure ulcer management and using successful examples of implementations.
A pressure ulcer is a widespread skin condition among elderly patients that imposes particular threats to their health. Often, complex and expensive treatments do not justify the expected results. Therefore, it is essential to search for highly efficient measures of treatment and prevention. Due to the lack of sufficient knowledge, researchers are particularly interested in this topic.
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This paper analyzes the effect of pressure redistribution surface mattresses in the prevention and treatment of stage IV pressure ulcers and compares with the manual re-positioning or the combination of both in old-aged patients in nursing homes. Studies that are focused on specific variables such as population, settings, stage of PUs are limited. Examined systematic reviews showed that both approaches are typical of PU management (Bååth, Idvall, Gunningberg, & Hommel, 2013). Some studies found that surface mattress was more effective in preventing surgery-related PUs rather than usual foam mattresses (Huang, Chen, & Xu, 2013).
Meanwhile, Lozano-Montoya et al. (2016) found only one study where manual re-positioning was effective, and others are suggested to be inefficient because guidelines and repositioning methods varied significantly. Implementation of practice requires close cooperation with management and staff. However, staff can perceive high technology surfaces as difficult (Hadorn, Comte, Foucault, Morin & Hugli, 2016). A high level of involvement with employees is necessary to share valuable information on the issue and to receive feedback from staff, but it was found to be problematic. Thus, communication is the determining factor in the implementation of the practice.
Finding Resources of Evidence-Based Practice: PICOT Questions on Pressure Ulcers in Elderly Patients in Long-Term Care Facilities
The first question is rather broad and less feasible. It requires analysis of a large amount of information, which can be time-consuming and costly. On the other hand, findings would provide rich background information and a good overview of evidence-based methods of preventing PUs. The second question is concerned with the methods of the management of PUs in the elderly population. A review of the literature on the topic shows that while the precise population and settings of the proposed research are not typically examined on their own, the reviews of relevant management approaches can be found in modern studies (Kruger et al., 2013; Sullivan & Schoelles, 2013).
Therefore, while it is possible to research the specific topic from these perspectives, they appear to be less immediately helpful as compared to the following questions. The third research question tends to explore the causes of PUs. This topic has a great potential for improving health care because the determination of the most frequent cause of this condition could guide the development of current approaches to the prevention of the issue. However, this question does not appear to be very feasible: it would require a careful sampling to ensure the validity of the results, meaning the necessity for more resources and time (Polit & Beck, 2017).
It also requires more consideration regarding ethical aspects to receiving consent to participate in the study, and time limits are not determined by this research. The fourth question can consider the prevention or treatment methods of a designated or identified facility to check if appropriate and may create potential change. It is an engaging and locally useful topic, and such studies are necessary for many facilities. However, it highly depends on the cooperation with facilities’ management; therefore its feasibility might be limited (Polit & Beck, 2017). The last question looks into the effect of pressure redistribution surface mattress as compared with manual re-positioning or the combination of both in the prevention and treatment of stage IV PUs. Because of its specificity, it is more feasible and has a chance of providing meaningful evidence for practice in the settings.
Bååth, C., Idvall, E., Gunningberg, L., &Hommel, A. (2013). Pressure-reducing interventions among persons with pressure ulcers: Results from the first three national pressure ulcer prevalence surveys in Sweden. Journal of Evaluation in Clinical Practice, 20(1), 58–65. Web.
Dogherty, E., Harrison, M., Graham, I., Vandyk, A., & Keeping-Burke, L. (2013). Turning knowledge into action at the point-of-care: The collective experience of nurses facilitating the implementation of evidence-based practice. Worldviews on Evidence-Based Nursing, 10(3), 129-139. Web.
Hadorn, F., Comte, P., Foucault, E., Morin, D., & Hugli, O. (2016). Task-shifting using a pain management protocol in an emergency care service: Nurses’ perception through the eye of the Rogers’s diffusion of innovation theory. Pain Management Nursing, 17(1), 80-87. Web.
Huang, H. Y., Chen, H. L., & Xu, X. J. (2013). Pressure-redistribution surfaces for prevention of surgery-related pressure ulcers: A meta-analysis. Ostomy Wound Manage, 59(4), 36-8. Web.
Kruger, E. A., Pires, M., Ngann, Y., Sterling, M., & Rubayi, S. (2013). Comprehensive management of pressure ulcers in spinal cord injury: Current concepts and future trends. The Journal of Spinal Cord Medicine, 36(6), 572-585. Web.
Lozano-Montoya, I., Vélez-Díaz-Pallarés, M., Abraha, I., Cherubini, A., Soiza, R., O’Mahony, D., & Cruz-Jentoft, A. J. (2016). Nonpharmacologic interventions to prevent pressure ulcers in older patients: An overview of systematic reviews. Journal of the American Medical Directors Association, 17(4), 370. Web.
Murray, J., Noonan, C., Quigley, S., & Curley, M. (2013). Medical device-related hospital-acquired pressure ulcers in children: An integrative review. Journal of Pediatric Nursing, 28(6), 585–595. Web.
Polit, D. F., & Beck, C. T. (2017).Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer. Web.
Sullivan, N., & Schoelles, K. M. (2013).Preventing in-facility pressure ulcers as a patient safety strategy: A systematic review. Annals of Internal Medicine, 158(5), 410–416. Web.
Thomas, D.R., & Compton, G.A. (2013). Pressure Ulcers in the Aging Population: A Guide for Clinicians, New York: Humana Press. Web.
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