Statement of the Problem
One of the prevailing issues in the long-term care facility for the elderly is the prevailing incidences of ulcers in elderly patients. Pressure ulcers result in unbearable pain, which significantly reduces comfort for patients; hence, solutions to the issue should be established. The purpose of this paper is to examine the highlighted problem and suggest a strategic plan for change.
What is the Problem?
The primary protocol in use in the current health care system in the prevention of pressure ulcers in patients on long-term care is manual repositioning on the bed. However, this approach has proved to be inadequate in preventing pressure ulcers because incidences of the same are quite common in health care facilities. It is imperative to select the most feasible model to base the required changes because an evidence-based approach should prevail (Mitchell, 2013).
Reasons for Change
An evidence-based approach has been emphasized by current policies governing the conduct of nurses and doctors. Whenever a given approach for enhancing the quality of health services and the associated outcomes is proved to be insufficient, new paradigms of operation are devised for improvements. In this case, it is apparent that manual repositioning of patients is not adequate for preventing pressure ulcers; hence, a new protocol should be unveiled. Communicating with the patients might be a good start to ensure they are engaged in planning the change (Radtke, 2013). The transition process from the traditional protocol to the proposed protocol should be planned accordingly to ensure that it is applied in agreement to the requirements of the evidence collected on the issue (Mclean, 2011).
Review of Literature
Franca, Melo, & Araujo (2013) conducted a study to establish whether all elderly patients on long-term care in health care facilities face similar risks in developing pressure ulcers. The study was conducted in organizations that apply Protocol 1286 in handling elderly patients. Findings from the quantitative study revealed that 18.6% of the participants did not show any risk of developing ulcers, while 13.9% of the patients faced a high risk of suffering from lesions. The researchers concluded that since different patients placed under similar care conditions face varying risks of developing pressure ulcers, an individual-based approach should be applied in determining whether manual repositioning is sufficient for mitigating the risk.
A quantitative study focusing on the prevention of pressure ulcers among critically ill patients revealed that one of the most effective approaches is applying countermeasures before the patients are transferred to the intensive care unit (ICU) (Santamaria et al., 2015). The study used a sample space of 440 patients, and it is apparent that the use of multi-layered soft silicone to cushion the patient’s pressure against the mattress is a viable method of eliminating pressure ulcers. The researchers’ conclusion emphasized applying the preventive material before the patient is transferred from the emergency department. This is meant to ensure that the patient does not develop lesions at any given time during their stay in the ICU.
Sullivan & Schoelles (2013) reviewed various components of interventions applied in health care facilities in response to pressure ulcers. The qualitative study highlighted the risks associated with developing ulcers when receiving care on a long-term basis, and some of the solutions that have worked in reducing the risks in various health care facilities. 26 of the studies indicated that the application of several preventive components in the prevention of pressure ulcers is an ideal approach to significantly reduce such cases. The standardization of interventions for the problem, accurate documentation of cases, and the involvement of various inter-professional teams were one of the popular approaches toward reducing the risk of developing pressure ulcers among patients.
Qaseem, Mir, Starkey, & Denberg (2015) conducted a comparative quantitative study that focused on providing guidelines to prevent pressure ulcers in care facilities. The study focused on analyzing the effectiveness of the current guidelines and providing recommendations for the most effective approaches toward reducing the risk of pressure ulcers faced by patients in care facilities. The investigators concluded the study with three recommendations. Firstly, the researchers called for caregivers to assess the risk of developing ulcers for respective patients. Secondly, they suggested the use of static mattresses to reduce the risk of ulcers developing because of the pressure exerted against the mattress by the patient’s body. Lastly, the scholars called for facilities to stop using alternating-air beds because the evidence did not support their viability in preventing pressure ulcers.
Moore and Webster (2013) conducted a quantitative study aimed at establishing the viability of dressing the main pressure areas in the prevention of pressure ulcers among patients on long-term care in facilities. The researchers established that most ulcers are formed on the pressure areas, which include areas where the skin and the bone are close. Applying to dress in these areas reduced the cases of pressure ulcers significantly. The findings indicate that reducing the pressure on the skin is a viable approach for the elimination of pressure ulcers.
Synthesis of the Evidence
Based on the reviewed literature, it is apparent that the current protocol in the development of preventive approaches for pressure ulcers is not sufficient for elderly patients in long-term care. The various studies revealed that one of the most effective ways is ensuring that the pressure areas of the patients are cushioned appropriately. Using material such as soft silicone is a viable approach, but it is relatively expensive for the facilities. This approach is viable in the private sector because the facilities have the freedom to offer premium rates for services. However, in the public sector, a cheaper option should be devised to ensure that the cost of health care does not increase.
The most plausible suggestion derived from the reviewed literature is the integration of various preventive components. Firstly, it is important to understand the risk factors associated with the respective patients. This calls for an evaluation of the types of skin for individual patients and recording the risk level associated with their condition. This would ultimately demand an individual-based provision of care for the patients. Secondly, the inter-professional team should collaborate in monitoring the condition of the patients. Lastly, the most effective and affordable approach for preventing pressure ulcers is ensuring that the patients are repositioned more frequently and the use of pressure redistribution surface mattresses is embraced. Instead of using methods that might hinder easy movement for the patient, such as multilayered soft silicone, ensuring that the pressure exerted by the body on the mattress is constantly redistributed would solve the underlying problem.
Course of Action
There is a need for health care facilities to develop a paradigm shift in the prevention of pressure ulcers. The change should be based on a SWOT analytical platform. The strength of the proposed approach is that it will require no additional material and human assets for health care facilities to enhance the prevention of pressure ulcers. Nurses and doctors will only be provided with training on the redistribution of pressure on mattresses as they reposition patients on the beds. One of the weaknesses of the approach is the lack of evidence to support it. However, it is an opportunity to enhance the quality of life for the patients while eliminating the threat of patients having a reduced quality of wellness while undergoing care services.
This course of action is based on Florence Nightingale’s theory of holistic nursing. The theory provides guidelines aimed at compelling caregivers to enhance the quality of wellness for the patients through the application of evidence-based approaches to improve the quality of the environment (Alligood, 2014). Nightingale’s model compels nurses to always look for ways to eliminate physical and emotional pain for the patients (Rich, 2013). Holistic care is a function of ensuring that all the health needs of the patient are provided, while also focusing on preventing the development of other conditions that jeopardize patients’ health outcomes. The change management theory should also be implemented in the case to ensure that the outcomes are positive (Marquis & Huston, 2015). Training and development programs should be provided as health care facilities update the protocols used in handling patients (Salmela, Eriksson, & Fagerstrom, 2013).
There is a clear indication that the current protocol for preventing pressure ulcers among patients on long-term care in facilities is not effective. Repositioning the patients regularly needs to be reinforced by the redistribution of pressure surface on the Mattress. This is quite a simple intervention that will not incur any financial liabilities on the patients. The need for changes in the preventive protocol for the underlying issue is based on the theory of holistic nursing, which compels caregivers to enhance the wellness status of the patients. Change management approaches also need to be embraced through training of the associated inter-professional teams to assume enhanced protocols.
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