Prevent Pressure Ulcers in Surgical Patients

Essay about Executive Summary
Executive Summary
Mary Job
Grand Canyon University
NRS 451 V
Dinwiddie Sandra
April, 22, 2012
Pressure ulcer prevention (PUP) in surgical patients has become a major interest in acute care hospitals with the increased focus on patient safety and
quality of care. A pressure ulcer is any area of skin or underlying tissue that has been damaged by unrelieved pressure or pressure in combination with
friction and shear. Pressure ulcers are caused due to diminished blood supply which in turn leads to decreased oxygen and nutrient delivery to the
affected tissues (Tschannen, Bates, Talsma, &Guo, 2012). Pressure ulcers can cause extreme discomfort and often lead to serious, life threatening
infections, which substantially increase the ... Show more content on Helpwriting.net ...
The vulnerable bony areas prone to pressure ulcer are back, heels, hip, spine, elbows, shoulders and back of head. Studies have proved that total
operating time and overall number of surgical procedures are significant predictors of pressure ulcers. A research conducted by Lindgren et al found
that 14.3 % of surgical patients acquired a pressure ulcer during the time from surgery to twelve weeks after surgery. For every thirty minutes the
surgery went beyond four hours, the risk for a pressure ulcer increased by approximately thirty three percent.
As we are all aware that there is no reimbursement for a hospital acquired pressure ulcer and the cost for each pressure ulcer has to be absorbed by the
facility. A patient's development of a pressure ulcer while under the care ofhealth care provider or facility is viewed as grounds of a professional
liability law suit. The mere existence of pressure ulcer is often viewed as a physical evidence of medical negligence. The cost to treat pressure ulcers
are expensive, the United Sates (US) health care system spends more than one billion dollars annually to treat pressure ulcers. It has been estimated
that the cost of treating pressure ulcers is 2.5 times the cost of preventing them (Whitehead &Trueman, 2010). In order to reduce the strain on
hospital budgets caused by pressure ulcers, we need to implement a planned approach to PUP and
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Organizational Systems Task 1
Organizational Systems Task 1
Western Governors University
Task 1
A. Nursing–sensitive indicators
By understanding nursing sensitive indicators, the nurses in this case could improve the structure, process, and outcomes of their nursing care. The
structure of nursing care is indicated by the supply of nursing staff and the skill level of the nursing staff. By the nurses having increased knowledge
of the issues hip fracture patients are prone to having, such as decrease mobility, increase need for surgical intervention, and increase risk of falls,
could help improve the quality of patient care. A patient with decrease mobility is at higher risk for pressure sores. The nurses in this case may have
prevented the one by proper ... Show more content on Helpwriting.net ...
Now, the quality improvement department will need to determine what processes can be modified to improve outcomes. For example, if they see an
increase in pressure sores and prevalence of restraints. They could use computerized charting and order entry, along with the evidence–based guidelines,
to identify specific groups of patients who are vulnerable to developing pressure ulcers or closely monitoring use of restraints. With early identification,
automatic orders for preventive interventions can be implemented quickly. With the assistance of the automated consults and orders, the appropriate
equipment, the interdisciplinary task force, continuing education, and monitoring, the hospital system would be able to reduce unnecessary use of
restraints and hospital–acquired pressure ulcer prevalence rate (Cherry & Jacob, 2010).
Then, they would need to implement core measures and protocols. Continuously track performance and outcomes. Lastly, they can disseminate results
to throughout the hospital to increase quality improvement (Cherry & Jacob, 2010).
By educating staff on nursing sensitive indicators and the issues that need to be addressed, could advance the quality of patient care throughout the
hospital. In this case, educating hospital staff on ways to prevent restraint use and pressure sore prevention, the staff could have possible prevented the
use of restraints and the pressure sore. Also, by educating staff on how to use restraints would be

Pressure Ulcers In Nurses: Case Study
A2. Researcher's Conclusion
Based on the evidence of this trial the author could make a solid conclusion that the incidence of pressure ulcers in patients were comparable when
using an alternating low–pressure air mattress with a multi–stage inflation and deflation cycle when compared to the alternating low–pressure air
mattress with single–stage inflation and deflation. The author reviewed multiple articles as well as previous research to gain valuable information
regarding pressure ulcers, prevalence, and prevention. This trail was blinded so the nurses were not bias to one mattress or another. The nurses also
completed thorough skin assessments daily on the participating patients to ensure any sign of skin breakdown was discovered in ... Show more content
on Helpwriting.net ...
This study was granted approval from the independent ethical committee of each participating hospital. To gain this approval informed consent was
obtained from all patients or their legal representative. To ensure ethically valid consent, the participants decision to be included in the trail should have
been voluntary. The participants should have also been given information disclosures providing any necessary information for the patients to make an
informed decision to participate. And furthermore, the consent for participation should be obtained by an individual that is capable of understanding
the information provided. (Gupta, 2013)
To protect the patients included in this trial the end–point was set at the development of any pressure ulcer grade II or higher. This guideline helped to
ensure participant safety during the trial period by ensuring no undue harm was brought to any of these patients.
A4. Strengths and Limitations A major strength of this research is the large sample size that was including in the study. Six–hundred participants were
included. Randomization was also utilized. The included patients were randomly assigned to the study groups using simple randomization based on a
computer–generated list of random numbers. This allowed for an unbiased selection of the participants by the

Nursing Reflection on Pressure Sores Essay
Critical incident The aim of this reflection is to describe my personal experience in wound care and its management. Gibbs (1988) reflective cycle
has been adapted in order to provide structure to the reflection process. Description At the care home I had to nurse many client's who had
developed pressure sores. One particular wound stands out from the rest, it belonged to a lady in her late 70's who was immobile and suffers from
incontinence and slight dementia. Her wound was extremely large on her sacrum, black and very hard. At this point was extremely discoloured
(black) but the skin was intact and only had a light exudate. However there was evidence of full thickness skin loss which was masked by the necrotic
tissue, so... Show more content on Helpwriting.net ...
I have learnt the importance of good communication and how it is essential for building trust. (Spouse et al 2008). I did feel a little vulnerable
however but experience gave me the confidence to give the correct level of information. I have learnt that I need to show sensitivity and give the
correct amount of information that was required to facilitate their reassurance. Evaluation Although the situation was quite challenging, it provided me
with some useful experiences for the future practice. I understand that all institutions should have a policy for documenting the assessment of patients,
including pressure ulcers (Morison 2001). I have come to be familiar with the homes assessment policy using the Sterling Pressure Sore Severity Scale
and most importantly I have learned that by using a universal assessment tool it supports a systemic and consistent approach to pressure ulcer
evaluation. This therefore supporting continuity of care. I have significantly developed my skill in wound care assessment and dressing, in developing
this skill I now recognize the importance of documenting each dressing. Morison (2001) supports this in saying that by detailing pressure ulcer
assessment it provides a basis for deciding the effectiveness of the current treatment. Conclusion Skin tears and pressure ulcers are frequently seen in
the elderly and care home residents are prime candidates (Stephen–Haynes

Pressure Ulcer Research Paper
Pressure ulcers additionally called bedsores or pressure sores, are wounds to skin and fundamental tissue coming about because of delayed weight on
the skin. A pressure ulcer is confined damage to the skin or basic tissue more often than not over a hard unmistakable quality, as a consequence of
weight, or weight in blend with shear and contact. Since muscle and subcutaneous tissue are more defenseless to weight incited harm than skin,
bedsores are regularly more awful than their introductory appearance. Pressure ulcers are then organized to direct clinical depiction of the
profundity of detectable tissue demolition. It is assessed that these ulcers commonness in intense consideration is 15%, while frequency in intense
consideration is 7%. It is evaluated that 2.5 million patients are treated for bedsores in US wellbeing acute care facilities every year. Pressure ulcers
cause significant damage to patients, obstructing useful recuperation, often bringing on torment and the improvement of genuine diseases. They
have additionally been connected with a broadened length of stay, sepsis, and mortality. Truth be told, about 60,000 US facility patients are
assessed to pass away every year from complexities because of these ulcers. The evaluated expense of dealing with a solitary full thickness ulcer is as
high as $70, 000, and the aggregate expense for treatment of pressure ulcers in the US is assessed at $11 billion every year. ... Show more content on
Helpwriting.net ...
Eschar or slough may be existing. This phase regularly incorporates undermining and burrowing. The profundity of this pressure ulcer differs by
anatomical area. The framework of the nose, ear, occiput and malleolus do not have fat tissue and these ulcers can be shallow. The fourth phase ulcers
can stretch out into muscle and supporting structures making osteomyelitis or osteitis prone to happen. Uncovered bone and muscle is

Observational Cohort Study Sample
This study provides important insights into the pressure ulcer prevention knowledge translation best practices at The Northern Hospital (TNH).
Recommended guidelines to understand whether it was effective in decreasing prevalence of pressure ulcer while patients staying in hospital has been
studied and examined for daily patient care at TNH.
This observational cohort study was conducted for 9 years in TNH, 370 beds in Melbourne, Australia. Sample data were divided into 3 parts in the
hospital pressure ulcers. First, the point of prevalence from 1045 patients gathered in 2003, 2004, 2006, 2007 and 2011. Point prevalence survey were
trained and bedsores were strictly confidential and hospital–acquired when the pre–existing admission. Second

Solving Pressure Ulcers
Pressure ulcers remain an all too common problem in the healthcare industry, yet they are entirely preventable. Changes were needed in the area of
prevention, however, and this is what led to the development of Oxy–Mat. Glenn Butler, Mike Kyevich and Bok Y. Lee, M.D. came together to create
products that help to prevent bedsores while making life easier for healthcare workers who are often overwhelmed with daily tasks. With the help of
these products, the level of care provided continues to rise and everyone benefits. Oxy–Mat remains committed to providing quality and innovative
products that, through the use of science, are design to provide superior outcomes.
The Founders
Bok Y. Lee, M.D., Mike Dyevcih and Glenn Butler all have experience... Show more content on Helpwriting.net ...
For example the National Pressure Ulcer Advisory Counsel recently sent out an advisory on frequently asked questions regarding the staging of
pressure wounds. Oxy–Mat follows these updates closely to determine if changes need to be to their products to better serve patients and healthcare
organizations.
Furthermore, recent research has suggested biomarkers could be of assistance in preventing pressure ulcers in those patients who have suffered a
traumatic spinal cord injury. As healthcare continues to advance, Oxy–Mat will work to improve their product using the new information obtained.
They understand science plays a large role in determining the best options for patient care, thus they make certain they follow the news in the area of
pressure ulcer prevention and treatment.
Request a free no–cost evaluation in your healthcare facility to see the benefits of the Oxy–Mat support surface system. In addition, be sure to ask
about the industry–unique leasing options available to clients. We want to ensure all patients receive the highest level of care and our system helps to
ensure this. Pressure ulcers are entirely preventable. Our system makes eliminating these all too common injuries an easy

Pressure Ulcer Prevalence In Hospitals
Pressure ulcer prevalence in the hospitals are remains a major problem in healthcare. Any patients can develop pressure ulcers. But there are increased
chances of occurrence in the bedsores patients who are seriously ill or unable to move. Intensive care units (ICUs) patients has excessive chances of
pressure sores. Several measures have been applied to reduce the incidence of pressure sores. One of the method tried is a Pressure ulcer prevention
bundle. And this study is to evaluate the bundle compliance rate, and the effectiveness of implementation strategies with in the ICU. Background of the
study Background of study including problem, significance to nursing, purpose, objective, and research questions is thorough with substantial relevant
... Show more content on Helpwriting.net ...
Patients who admitted in the general ICU mainly suffer from serious illnesses or injuries. The ICU has around 60 RN's and 24–bed capacity. Patients
care completely provided by RNs. They used snap shot sampling method and the study population was all the RNs from the ICU who met the
inclusion criteria. The inclusion criteria were RNs who were present at the first point in the data collection period, who worked one or more shifts
during the intervention implementation periods, who provided direct PU prevention care, and who agreed to participate. Data extraction form designed
by the research team and data collected on three levels. 1) prevention bundle check list– which is based on pressure ulcer prevention bundle with yes
(1) or no (0) questions. The instrument has 30 items and 6 elements of the prevention bundle. The total score for this is 30 and higher score represents
higher compliance to the PUPB and vice versa. Second level 2). Self–evaluation by RNs– The tool included 4 elements. RNs' demographic details, six
items addressing RNs perceptions of their compliance to the bundle. First 5 items related to acceptance and satisfaction in general this include
education and training. Satisfaction was rated on a four point Likert scale (one strongly disagree to four strongly agree). The percentage of RNs'
compliance to the bundle,

Nurse Prescribing
Within this assignment it is intended to present an example of a prescribing situation that arose in practice, to ensure prescribing issues are
illustrated. The rationale for the decisions reached will also be discussed. A brief overview of the nurse prescribing initiative and how it developed
will be addressed. The importance of ethical principles, accountability and legal issues that surround nurse prescribing will be demonstrated. As a
patient will be addressed in the example, a pseudonym will be used. According to Luker et al (1997), in 1985 the Royal College of Nursing (RCN)
made a case for the prescribing rights for nurse. The Cumberledge Report (1986) acknowledged that the government recognised that nurses should be
eligible to... Show more content on Helpwriting.net ...
To assess Katherine's risk the Waterlow Pressure Sore Prevention Policy (1995) was used. It was found her risk assessment score was 13 that, due to
her age, acute illness, nutritional status and reduction in mobility put her at risk of further deterioration if no intervention was established. It was
decided that in order to minimise the pressure in Katherine's sacral area and other bony prominences such as the heels and elbows, a pressure–relieving
mattress and cushion were needed. Further advice on the importance of moving around in bed was discussed with Katherine. The information leaflet
produced by NICE (2003) giving advice, to patients and carers on pressure relief was given to Katherine to enhance the verbal information. A full
assessment of the wound should be carried out prior to selection of dressings. Any allergies should also be noted. The wound should be traced,
photographed and measured providing data for comparison throughout the treatment. Consent should be gained prior to photographing the wound and
the patient should not be identifiable from the photograph (Benbow 2004). All information should be documented in patients' records, using the wound
assessment tool. The pressure sore was identified as grade two

Does the Assessment of Risk Factors Prevent the...
I will be writing this essay using a clinical question, which I formulated. My clinical question is based upon "Does the assessment of risk factors
prevent the development of pressure ulcers in hospitalised patients." I will be discussing and analysing my questions and findings from reliable,
current, valid and trustworthy sources found within five articles based on the subject of pressure ulcers. All articles are based on quantitative research
undertaken. "From the findings of a good, current, reliable, valid or trustworthy research is the basis for maintaining high standards of care and all
nurses must use practice based on the most up to date evidence (NMC 2008). It is now an important part of nursing to actively participate in research...
Show more content on Helpwriting.net ...
The final results were narrowed down by the titles and publications from any date after the year 2000. All the results were selected by reading through
the extracts which outline the aims, objective, design and methodology that were relevant to the search.
|Author and Year |Journal |Type of Study |Purpose |Sample |Design |Data |Key Findings |
| | | | | | |Collection | |
|Kaitani, Tokunaga, Matsui and Sanada |Journal of |Quantitative |To identify |606 bed |Prospective |Skin condition|There was no |
| |Clinical | |risk factors |tertiary care |cohort study |assessment |relationship |
| |Nursing | |for pressure |hospital | | |between pressure|
| | | |ulcer | | | |ulcer |
| | | |development in | | |

Pressure Ulcer Risk Assessment Paper
Braden Ulcer Risk Assessment Tool For Predicting Pressure Ulcer Risk
Angela Twiss 3021221
Grant MacEwan University
December 8, 2014
HLST 350 WM50
Instructor: Jane Ratay
BRADEN RISK ASSESSMENT TOOL FOR PREDICTING PRESSURE ULCERS
Pressure ulcers are; damage to the skin or underlying structures from either inadequate perfusion or tissue compression. (Taber's Cyclopedic Medical
Dictionary, 2009, p. 1889). Those at an increased risk for pressure ulcer formation: older adults, persons with spinal cord injury, surgical patients,
obese patients, underweight patients, children and patients at end of life. (Ruth & Nix, 2012, p. 125). The Braden Scale, is a tool used to help
identify a patient's risk of developing a pressure ulcer. ... Show more content on Helpwriting.net ...
White and should be implemented. A Low Air Loss mattress allows for air to be evenly distributed thus pressure on the skin should be more evenly
dispersed to help decrease moisture and may help her pressure ulcer heal. (Ruth & Nix, 2012, p. 162). The Low Air Mattress should also help wick
moisture away as Mrs. White experiences hot flashes throughout the day and is also fecal incontinent resulting in both conditions increasing the
moisture on Mrs. White's skin. (Bryant & Nix, 2012, p. 162).
Mrs. White's heals are reddened with skin intact at the moment but the possibility of an ulcer developing on either heel or both heels needs to be
addressed. Mrs. White has spastic movement in her extremities and is transferred in and out of bed putting her heels at risk for a shear injury.
Implementing an offloading product such as heel protectors that will help distribute the weight of the legs without putting pressure on the Achilles
tendon. The Use of a Low Air Loss Mattress may help her heel pressure as well. (Bryant & Nix, 2012, p.

Pressure Ulcers Essays
Pressure Ulcers Donna Long Grand Canyon University NRS 433V Introduction to Nursing Research February 11, 2012 Shahin E. S. M., Dassen T., &
Halfens R. J. G. (2009). Incidence, prevention and treatment of pressure ulcers in intensive care patients: A longitudinal study. International Journal of
Nursing Studies 46: 413–421 Introduction Pressure ulcers refer to damage that occurs to the skin of a patient. Pressure, shear and friction are among
the known causes (Shahin, Dassen & Halfens, 2009). Pressure ulcers mostly affect the lower part of the body, the elderly and patients with spinal
injuries (Shahin et al, 2009). They are expensive to treat, require long periods of time and numerous treatments to heal. As a... Show more content on
Helpwriting.net ...
A total of 224 patients were approached for the study but only 121 patients consented (Shahin et al, 2009). Some patients refused to participate in
the study, while others agreed to participate but failed to sign the consent form. All the patients admitted to the intensive care unit during the
month of April to October 2006 were eligible to participate in the study and a questionnaire was used as the tool to collect data. The privacy of the
patient was maintained at all times while the nurses collected the data. Patients provided information of their own will. Patients were tested on
admission and on discharge. The researchers conducting the study held a high level of confidence in each of the hospitals involved. The
incomplete information was discarded and was not used in the analysis. Finally, the collected data was analyzed using the Statistical Package of
social Science (SPSS) to give the following data. Results of study The number of patients who complied with the study was 121. 56.2% are males
and 43.8% are female (Shahin et al, 2009). Out of the 121 patients, 23 were admitted in a coma. The average length of stay for the 121 patients was
one week. Sixteen patients were found to have pressure ulcers on admission. The final results showed a decrease in the number of pressure ulcers. Six
people obtained pressure ulcers during their stay in the intensive

Quantitative Reserch Study
Running head: QUANTITATIVE RESEARCH STUDY
Quantitative Research Study
Knowledge Pressure Ulcer Prevention among Nursing Professionals
Jeamol Joseph
Grand Canyon University
NRS–433=
Introduction to Nursing Research
24 July, 2011
Quantitative Research Study Nursing research is a process which helps to improve the patient outcomes through a thorough analysis of data collected
and making new contributions to the healthcare field. Evidence based nursing is the process by which nurses make clinical decisions using the best
available. In quantitative studies researchers identify the problem and collect relevant data from subjects. The researchers plan in advance the steps to
be taken and collect data in numerical form. In ... Show more content on Helpwriting.net ...
All participants signed the free and informed consent form. The study was conducted and data were collected from January to March. The data were
collected by a validated questionnaire. The test was conducted individually during work hours. The data analysis considered the two professional
groups such as nurse and auxiliaries. Student's t–test for two independent samples was applied. Results Research participants were 386 nursing
members with nursing technicians and auxiliaries. Both professional groups displayed knowledge deficits in pressure ulcer prevention
recommendations. The nurses scored in the test 79.4% and auxiliaries and technicians scored 73.6%.Participants were expected to get 90% above for
the test. These data of study verified that members of nursing team lack knowledge deficits with pressure ulcer prevention guidelines. Patients get
pressure ulcers due to many reasons. Age, poor mobility, poor diet and altered elimination are important factors. Uneven pressure crated by wrinkled
bed sheets and creases can increase the chances for developing new pressure sore for elderly patients. The article describes different study conducted
on same theme results were scored by nursing team was below 80%. Implication for practice and Research Educational programs can have positive
effects on pressure.

Essay on Pressure Ulcers
Feature
Strategies to improve the prevention of pressure ulcers
Judy Elliott describes a project that sought to improve tissue viability during the patient journey from admission to discharge
Summary
This article outlines the actions taken by one acute trust to implement evidence–based, best practice recommendations for pressure ulcer prevention.
Initially, an exploratory study identified specific areas for practice development, particularly improving early risk assessment, intervention and focus on
heel ulcers. Further actions included recruiting tissue viability support workers to promote a pressure ulcer campaign. Prevalence audit results
demonstrated improved prevention and reduced prevalence of hospital–acquired pressure ulcers ... Show more content on Helpwriting.net ...
include observable discolouration and palpable tissue changes such as localised bogginess, heat or cold (NICE 2005). International guidelines (EPUAP
/NPUAP 2009) advise a structured approach to risk assessment using a combination of all three techniques. Ecirly intervention Once risk is identified
immediate action is imperative to minimise risk of pressure ulcer development. As evidence is weak for specific interventions a number of areas should
be addressed, involving ecirly initiation of preventive action, improving tissue tolerance and protecting from the adverse effects of pressure, friction
and shear (Calianno 2007). Nutrition and tissue loading are two areas of nursing influence. Strategies to ensure optimal nutrition should be used and the
provision of oral nutritioneil supplements has been associated with reduced tissue breakdown (Bourdel–Marchasson et al 2000). Tissue loading may be
addressed by manual and mechcinical repositioning, mobГјisation and exercise. Strategies to minimise shear forces include addressing posture, moving
and handling techniques and use of electric profiling beds (Keogh and Dealey 2001). Positioning and repositioning Research has not established an
optimeil frequency of patient repositioning (Defloor et al 2005). Repositioning should be undertaken on an individual basis in Une with ongoing skin
evaluation,

Pressure Ulcer Research Paper
A pressure ulcer is localized in some part of the skin that break down when it stays in a same position because is pressing the skin or rubbing with
something for a long time. Pressure ulcers have symptoms but it depends on the category, first category looks redness at the skin and the skin is not
yet broken, second starts to look pink, like a blister and break the skin, the third may have some parts badly damaged that look yellowish, and fourth
in the ulcers can have dead skin can be dark color that can expand to the bone and requires surgery to move the damaged parts. A patient that suffer
pressure ulcer describe the color of the ulcer, how feel around the area and if they have a little bit of pain. Some patients say that ulcer look horrible,

Essay on Unit 229 Workbook Pressure Sores
Unit 4222–229 Undertake agreed pressure area care
Unit 4222–229 Undertake agreed pressure area care
Outcome 1 Understand the anatomy and physiology of the skin in relation to pressure area care
The learner can:
1. describe the anatomy and physiology of the skin in relation to skin breakdown and the development of pressure sores
Skin is the largest organ of the body, covering and protecting the entire surface of the body. The total surfacearea of skin is around 3000 sq inches or
roughly around 19,355 sq cm depending on age, height, and body size. The skin, along with its derivatives, nails, hair, sweat glands, and sebaceous
glands forms the integumentary system. Besides providing protection to the body the skin has a host of ... Show more content on Helpwriting.net ...
Which is automatically regulated to reduce pressure as and when required.
Special dressings and bandages can be used to protect and to speed up the healing of pressure sores.
Topical preparations such as cream and ointments can speed up healing process and prevent further tissue damage.There is also a vast range of
equipment that is designed specifically to assist with moving and handling.– Chairs – Wheelchairs – Beds – Shower/Commode Chairs – Sliding Boards
– Sliding Sheets – Low Friction Rollers – One Way Slides – Turntables – Hoists and Slings|
6. describe changes to an individual's skin condition that should be reported. |
Outcome 2 Understand good practice in relation to own role when undertaking pressure area care 1. identify legislation and national guidelines
affecting pressure area care
|
2. describe agreed ways of working relating to pressure area care |
3. describe why team working is important in relation to providing pressure area care. |

Outcome 3 Be able to follow the agreed care plan
The learner can:
1. describe why it is important to follow the agreed care plan
|
2. ensure the agreed care plan has been checked prior to undertaking the pressure area care
|
4. describe actions to take where any concerns with the agreed care plan are noted
|
5. identify the pressure area risk assessment tools which are used in own work area
|
6. explain why it is important to use risk

Applying Clinical Decision Making in Adult Nursing Essay
Applying Clinical Decision Making In Adult Nursing Ahh2036–N This assignment will critically analyse and justify the decisions based around a
fictitious patient using a clinical decision making framework highlighting its importance to nursing practice. The chosen model will demonstrate
clinical decision making skills in the care planning process. The patient's condition will be discussed in–depth explaining the pathophysiology, social,
cultural and ethical issues where appropriate in the care planning and decision making process. Any vulnerability that the patient may experience will
be discussed and dealt with in the care planning and decision making process. The supporting evidence based literature will be analysed and... Show
more content on Helpwriting.net ...
Huber (2006, p154) states that clinical decision making in nursing relates to the quality of care the patient receives and how competent the nurse is.
Over the past 30 years nursing has evolved from a task–oriented to a logical and systematic approach to care, using theories and models to guide
practice. According to Jasper (2007, p117) theories of decision making in medicine tend to favour logical, precise analytical models which are held to
be testable, unambiguous and repeatable, therefore satisfying scientific principles. These represent important ideas of certainty and rationality that are
intended to provide a sense of security and reliability. When used correctly a nursing model should give direction to nurses working in a particular
area, as it should help them understand more fully the logic behind their actions. It should also act as a guide in decision–making and so reduce
conflict within the team of nurses as a whole. This in turn should lead to continuity and consistency of the nursing care received by patients according
to Pearson et al (1999,p ). Banning (2008, p ) states knowledge for decision making is obtained from many sources and has been described as both
informative

Pressure Ulcers As A Hospital
Upon admission to a hospital, a patient may be at risk for numerous hospital–acquired conditions. Pressure ulcers, also known as pressure sores or "bed
sores", are a type of hospital–acquired condition that may develop during a hospital admission if proper risk assessment is not performed by a
registered nurse (RN). Pressure ulcers form over bony prominences, such as the back, heel, ischium, sacrum, and elbow, when circulation of these
prominences is impaired (Jarvis, 2012). Pressure ulcers may develop when a person is confined to a bed or immobilized, which impedes proper
delivery of oxygen and nutrients to the skin resulting in cell death (Jarvis, 2012). Pressure ulcers are divided into four stages. In stage I, a
nonblanchable redness of intact skin appears that does not disappear for 24 hours after pressure is relieved. In stage II, there is partial–thickness
erosion of the epidermis or the dermis layer of the skin. Full–thickness pressure ulcers are a stage III ulcer, which extend into subcutaneous tissue.
Lastly, stage IV pressure ulcers involve all skin layers and may expose muscle, tendon or bone. Pressure ulcers can be prevented if risk assessment is
performed and at–risk individuals are identified (DeLaune & Ladner, 2011). Risk assessment scales, such as the Braden Scale and Norton Scale, are
used to determine the likelihood of skin breakdown in a patient. The Braden Scale is divided into six categories that help predict pressure sore risk
and each category is

The Importance Of Pressure Ulcer
Previously known as Pressure Ulcer is now being called Pressure Injury (PI), according to the National Pressure Ulcer Advisory Panel (2016). The
name was changed due to the different formation and presentation of PI. What many appear as intact clear skin may actually be deeply damaged within
the tissues making it invisible to the naked eye. PI is acquired through ischemia the skin on bony prominences of the body usually from pressure.
Pressure to the area within 1–2 hours can cause PI, thus the importance of repositioning our patients every 2 hours is emphasized nationwide. However,
other contributing factors also play a major role in the formation of PI, the problems of pressure, shear, friction, immobility worsens the condition and it

Essay on Validity of Waterlow Scale
пЂ
Sydney nursing school
INTRODUCTION:
Pressure ulcers are areas of localised damage to the skin and underlying tissue caused by pressure. (Stechmiller et al., 2008) Pressure ulcers still one of
the most significant health problem in our hospitals today, It affects on patients quality of life patient self–image and how long they will stay in
hospital then the cost of patient treatment . Moore (2005) estimate that it costs a quarter of a million euro's per annum to manage pressure ulcers in
hospital and community settings across Ireland .which allows one to take immediate actions and prevent the ulcer if possible. To support pressure ulcer
risk assessment several standardized pressure ulcer risk assessment scales have been introduced ... Show more content on Helpwriting.net ...
Polit and Hungler (2001) . In (Shukla et al.,2008) study the Waterlow scale was used on 15 patients in two wards. Each patient was assessed daily
by two different nurses over a period of seven days. A total of 28 clinical nurses were involved and a total of 210 assessments obtained. Statistical
analysis demonstrated weak or a moderate degree of inter–rater reliability. Other authors suggested the water low scale too long and time consuming.
Pang and Wong (1998).
Edwards (1995) examined the reliability of the Waterlow Scale he did a cross–sectional observation survey of 40 elderly patients with or without ulcers
in a community setting. The results failed to display high levels of reliability and in line with other studies over predicted ulcer development.
Literature suggests that there limitation to using this scale with elderly people because the continence, neurological deficit and medication affect on
scale result. (Cook et al., 1999) said the Categories where disagreement occurred the most were (skin type), (build/weight for height) and (mobility)
again indicating that the score is affected by a lack of adequate definitions in these categories. Furthermore, this study highlights that the elderly
population proves difficult to obtain scores at the low end of the range. This indicates a limitation of the scale that perhaps the risk thresholds are too
high for elderly people
Other Literatures examined the scale parts and examined if the variation

Why Is Pressure Ulcer Important
One of the greatest indicators for the quality of care is health care facilities is the amount of pressure ulcers acquired in patients. Approximately 1
million people develop hospital–acquired pressure ulcers each year affecting hospitalized patients in both acute and long term care settings. The
incidence of pressure ulcers ranges from 0.4%–12% in acute care settings, along with the prevalence range from 12%–18%. Pressure ulcers cause
increase pain, suffering, and decreased quality of life along with extended hospital stay. According to the national pressure ulcer advisory panel a
pressure ulcer is defined as "localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in
combination ... Show more content on Helpwriting.net ...
HAPU greatly depend on skin breakdown and skin incontinence. Monitoring for incontinence prevents the development of pressure ulcers by reducing
the inflammation of incontinence associated dermatitis. The intervention can be evaluated by looking at the correlation between pressure ulcer
development and the incontinence associated dermatitis. Researchers Beeckman, Van Lancker, Van Hecke, and Verhaeghe define incontinence
associated dermatitis as, "Erythema and edema of the surface of the skin, sometimes accompanied by bullae with serous exudate, erosion or
secondary infection" (2014). The moisture from incontinence results in the skin and superficial tissue to have decreased blood flow reduction and
leads to increased pressure and shear. Skin incontinence can be monitored by offering the proper use of frequent urinary/stool collection systems,
assessing/changing diapers frequently, keeping skin dry regularly, use of barrier creams over the perineal area, and offering toileting regularly
(Mallah et al . , 2015). Patients who were offered proper incontinence care between risk assessment scales have shown moisture to be the key factor in
pressure ulcer incidence prevention (Beeckman . , et al

Rtt1 Task 1 Essays
Organizational Systems and Quality Leadership
Task 1
It is critical to have an understanding of nursing–sensitive indicators in order to provide safe, quality, compassionate and satisfactory patient care. In
this scenario, applying restraints to Mr. J, a demented patient with hip fracture seems appropriate. However, it is standard practice that restraints
are to be removed as soon as possible, and the patient in restraints may need assistance to change position every two hours. In Mr. J's scenario, there
should have been a bedside commode, and a urinal for him to use at the bedside so he does not have to walk very far to the restroom. As for the CNA,
if she was well trained, she would have been able to recognize the marks on his spine ... Show more content on Helpwriting.net ...
J's scenario is pressure ulcer. From analyzing Mr. J's case one can see the correlation between the use of restraints and pressure ulcers. Obtaining data
listed on the Braden Scale such as moisture, mobility, activity, and nutrition are important when assessing for pressure ulcer risks. Once the collected
data indicates the patient is high risk then the established pressure ulcer protocol needs to be followed. Nurses will need to minimize friction, support
bony surfaces, manage moisture, and maintain adequate nutrition to advance quality patient care. The other nursing–sensitive indicator in this case is
restraints. As I have mentioned earlier the use of restraints in Mr. J's case seems appropriate as he pose great fall risk which may further complicate his
current health condition. However, it is important to perform a complete assessment on the parameters for restraint such as cognitive functioning,
history of dementia, physical impairment, and drug interactions to determine the need for restraints. When restraint is clinically indicated, and the
benefits outweigh the risks then protocol for restraints has to be followed. Once the patient is restrained, it is standard practice that restraints are to be
removed as soon as possible, and the patient in restraints will need assistance to change position every two hours. B) To improve quality patient care
throughout the hospital, the quality improvement department should scrutinize, and keep track of the

Preventing Spinal Cord Injury Essay examples
Pressure ulcers (PrUs) are a high–risk, high–volume, high–cost problem for persons with spinal cord injury (SCI). Approximately 273,000 persons are
living with SCI in the United States today and approximately 12,000 new injuries occur per year [1]. Persons with SCI are at extreme risk for
developing PrUs due to lack of sensation, immobility, moisture, and multiple other risk factors.2 Prevalence for PrUs in persons with SCI ranges from
14–32%, and recurrence rates have been reported to range from 31–79%.3 PrUs account for approximately one third of all VA SCI admissions and
over half of all hospital days for veterans with SCI.3 The cost to manage one full–thickness ulcer can be as much as $70,0008 [JRRD paper] and over
$17 billion is spent... Show more content on Helpwriting.net ...
See Figure 1 for an example of an individual suspended in a universal sling. Although universal slings are the most common, many others have been
designed to ambulate patients, to reposition them in bed, or to lift appendages. Furthermore, current nursing practice is to use universal slings and lifts
for all transfers and transports involving dependent patients, as taught by practice algorithms in collaboration with the American Nursing Association.14
The impetus behind this research was the observation that patients are frequently left sitting on their slings while in their wheelchairs, for long periods
of time, which may interfere with the pressure–reducing properties of the wheelchair cushion, placing the patient at risk for PrU development. This
research aims to examine whether patient handling slings might contribute to pressure ulcer development in vulnerable populations, specifically
persons with SCI. No evidence to date has been published that links the use of slings and lifts to pressure ulceration, and no literature exists which
describes the interface pressures developed during suspension from patient handling slings. The main goals of this study were to describe and quantify
risks associated with

Nursing Care
Introduction P.R. is a 34 year–old male from Guatemala who went to a lake for cliff diving. He dove off of a cliff 20 feet from the water, hitting a
rock, and fractured his neck at C6. This left P.R. as an incomplete quadriplegic, with partial gross movement of his upper arms. P.R. is able to move
his shoulders to slightly lift his arms, but has no movements in his legs or the trunk. P.R. requires total assistance for all activities of daily living, and
is incontinent of both bowel and bladder function. He speaks primarily Spanish and cannot communicate in English. He is verbally abusive and
becomes combative with care givers. He does not have family support in America and is having difficulty adapting to American foods. P.R. has
... Show
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is not receiving enough nutrients such as protein and vitamins that are crucial to wound healing, which impedes healing of the pressure ulcers (Myers,
2012). Last but not least, he has sexual dysfunction that can be detrimental to his psychosocial well–being. He is physically unable to achieve erection
and orgasm. Appendix A is provided at the end of the paper to show an example of nursing care plan for physiological issues.
Psychosocial Issues Spinal cord injury is a sudden and devastating event for patients. The injury can be extremely debilitating and it may require a
significant alteration in lifestyle post injury. P.R. has sustained a relatively high level (C6)spinal cord injury, which makes him very limited functional
capacity. He will go through grieving process followed by anger for the loss of function and independence. This may be especially difficult for P.R.
because he is a young man in his thirties who sustained a debilitating injury in a foreign country without any support from family and friends. Spinal
cord injury has left P.R. unable to move his entire lower extremities and trunk muscles. He is unable to do the most basic activities, such as feeding
and bowel movement without the help of a caregiver. For a young man who was active and completely independent, it is very difficult to accept this
reality. It should also be noted that most of the nursing staff are females, which further damages his male ego for having total dependence.

Based Practice : Braden Scale For Predicting Pressure Sore...
Evidenced Based Practice: Braden Scale Alexa M. Diaz Lienahard School of Nursing Pace University Word Count: 972 Introduction The Braden Scale
for Predicting Pressure Sore Risk is a tool that assesses the risk for ulcers in six zones of the body: sensory perception, skin moisture, activity, mobility,
nutrition, and friction/shear. Nurses and clinicians in settings such as acute, home, and long–term care places use this tool. There is no set time length
to complete one of these assessments. The Braden Scale uses a score system where each item on the chart ranges from one to three or four; one
signifying "highly impaired" and three/four signifying "no impairment". The total amount of the score ranges from 6–23. The lower the score a patient
displays, the higher at risk the patient is for developing a pressure ulcer. The cut–off point would be a score of 18 or less. Anything at or below this
point means that the patient is at high risk for developing a pressure ulcer. A score of 19 or higher means that the patient is at low risk for
developing a pressure ulcer. (Ayello. A. E., 2012) Clinical Problem Pressure ulcers often occur in hospitals and nursing homes (Ayello. A. E., 2012).
As a result, the patient's stay is extended and their medical bill inflates, in addition to their quality of life feeling diminished by the pain and infection
(Ayello. A. E., 2012). Prevalence rates for pressure ulcers exist by 11.9% in acute care, 29.3% in long–term acute care,

Nvq3 Unit 4222 Essays
[pic] Unit4222–229: Undertake agreed pressure area care Outcome 1: Understand the anatomy and physiology of the skin in relation to pressure
area care 1. Pressure ulcers, also known as bed sores or pressure sores are injuries of the skin and underlying tissue. They appear when the affected
area of skin is under too much pressure. Due to the pressure the blood flow is disrupted, the area does not irrigate, therefore nutrients and oxygen do
not reach the skin cells. The skin then breaks and pressure ulcers form 2. The parts of the body most at risk of developing pressure ulcers are in
direct contact with a supporting surface, such as a bed or a wheelchair. These might be: shoulders or shoulder blades elbows... Show more content on
Helpwriting.net ...
The changes in an individual's skin conditions that should be reported are: red patches of skin that don't go away, blisters, or damage to the skin,
patches of hot skin, swelling, patches of hard skin, patches of cool skin. Outcome 2: Understand good practice in relation to own role when
undertaking pressure area care 1. Some of the legislation and national guidelines affecting pressure area care are: Care Standards Act2000 Human
Rights Act NICE Guidelines European pressure ulcer advisory panel National pressure ulcer advisory panel CQC Essential Standards of quality
and safety Manual handling Health and Safety Act 2. Working according to the agreed ways means following the organisation's policy and
procedures in relation to pressure areas. It also means following the individual care plans and respecting the instructions in place. For example
making sure a resident is turned every two hours, applying Cavilon cream on areas; fill in turning charts, prompt fluid intake. Under the duty of care
a care assistant must always be aware of and raise concerns regarding possible pressure areas. Always record information in care plans accurately and
in confidentiality. 3. Team working is important in relation to pressure area care because pressure ulcers are a complex health problem which arises from

The Stages Of Clinical Reasoning
Clinical reasoning can be defined as, 'the process by which nurses (and other clinicians) collect cues, process the information, come to an understanding
of a patient's problem or situation, plan and implement interventions, evaluate outcomes and reflect on and learn from the process' (Levett–Jones &
Hoffman 2013, p.4). It requires health professionals to be able to think critically and ensures better engagement and results for the patient (Tanner 2006,
p.209). The Quality in Australian Healthcare Study (Wilson 1995, p.460) discovered that 'cognitive failure' resulted in approximately 57% of
unfavourable clinical events involving the failure to produce and act correctly on clinical information. It also recognises that often nurse's
preconceptions and assumptions can greatly affect patient care and by going through such a process, one can take into account the holistic nature of
the patient and provide the best, most appropriate care. Process Information The third stage in the clinical reasoning cycle is process information. This
involves the gathering of signs and indications and the recognition of patterns (Levett–Jones & Hoffman 2013 p.5). It is also when one can begin to
form hypotheses and predict potential outcomes. In regards to Mrs Checkett's case, there are many cues that need to be taken into consideration in
order to best care for her. According to Chester and Rudolph (2012, p.2), vital signs in the elderly change due to the reduction of function of homeostatic

Pressure Ulcer Prevention Essay
Pressure Ulcer Prevention in the Acute Care Setting Pressure ulcers are localized wounds to the skin that are also known as decubitus ulcers, or are
known by the colloquial term "bed sores." They are common occurrences in healthcare that result from injuries to the skin and the tissues beneath it
when the patient remains in one position for long periods of time. Pressure ulcers are typically located over an area with a bony prominence that then
causes pressure on the skin. Pressure ulcers are especially common in individuals in extended care facilities, but can occur even in an acute setting.
Pressure ulcers, in fact, can develop in just 24 hours, although they may not be apparent to healthcare providers until up to 7 days later (Truong,
Grigson, Patel, & Liu, 2016). For immobile or relatively immobile patients, pressure ulcers are one of the most serious problems that can occur,
because they can result in infections or other complications, and decrease the quality of life. As an example, a prospective cohort study conducted in
Brazil found that pressure ulcers could harbor multi–drug resistant bacteria that conferred a mortality rate of 100 percent (Braga, Brito, Filho, Filho, &
Ribas, 2016) and that were able to spread to other patients in the form of infected pressure ulcers or other hospital–acquired infections. The subject...
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Pressure ulcers occur in hospital and nursing care settings around the world, and Chaboyer et al. (2016) find that hospital–acquired pressure ulcer
prevalence in the UK, Sweden, Belgium, and Australia is approximately 15%. In 2007, recognizing that hospital–acquired pressure ulcers are an
indicator of the quality of nursing care, the Medicare and Medicaid Services of the United States stopped all reimbursement of facilities for these
claims (Cene et al.,

Reflection Paper On Nursing Practice
Gibbs Reflective Model (1988) Reflection Relating to Care on Pressure Sore In Nursing Practice The purpose of this assignment is to reflect on
the aspect of my Adult Nursing Practice placement, and study that was gained by me in my studies and the need of pressure sore care and
management in nursing practice. To reflect on my learning action, I am going to apply Gibbs (1988) Reflective Cycle to highlight the need for
nurses to provide holistic care. It will outline the basic aspects of clinical nursing skills that have taken place in my placement. This will also
highlight how it helped me to enhance my knowledge and ethical values and learning the process in order to bring excellence and safety of care.
To reflect on my learning process, I am going to apply Gibbs ' reflective model' which is a renowned model in reflective practice. This model
requires passing through six stages to complete one reflective cycle. Gibbs (1988) reflective cycle can be seen as cyclical in nature which
incorporates six stages to enable me to continuously improve my learning from the event for better practice in the future(Heitkemper, 2010).
Description My practice placement area was a Spinal Ward for 8 weeks. The ward, almost all service users are all age people who are prone to get
pressure sores. During my practice placement, I met Jack, who is 35 years old and has been admitted to the ward where my patient journey started. His
name has been changed to protect his identity and

Nursing Research Critique
Research Summary and Ethical Considerations
Introduction
"A pressure ulcer is a localized injury to the skin and/ or underlying tissue usually over a bony prominence, as a result of pressure or pressure in
combination with shear and/ or friction." (National Pressure Ulcer Advisory Panel, 2007). It is essential to give education to the patients, family, care
givers and health care providers to decrease the pressure ulcer rate. Multiple study about pressure ulcer revealed that pressure ulcer causes significant
harm to the patients by increasing the length of stay in the hospital due to frequent pain, discomfort, infection and poor healing. The infection and
sepsis occur from pressure ulcer can even lead to death. However, pressure ulcers ... Show more content on Helpwriting.net ...
The study highlighted that operation theatre, critical care unit and emergency care unit are the most high risk places for the development of pressure
ulcer.
Factors connected to the health care personnel are views and values, responsibility and commitment, knowledge and competence and co–operation and
communication. "The personnel's view of their work was seen as one reason for the development of pressure ulcer." (Athlin et al. 2010). In a hospital
situation the main care focuses to treat the disease whereas in the communities care focused on prevention and basic pressure ulcer care.
Responsibility and commitment of the nurses can prevention of pressure sore to certain extend. It is the responsibility of the Registered nurse is to
assess for risk factors, prevention of pressure ulcers. Nurse should show an interest in their work especially to take the patient's total care in order to
prevent pressure sore. Nurses should constantly update their knowledge and implement evidence based practice in their care. They need to educate the
patients, families and other health care providers about the measures to prevent bedsore. Proper communication between the nurses regarding the
preventive measures implemented is very important to maintain continuity of care and prevent bedsore. Factors related to

Basic Nursing Care in Pressure Sore Prevention Essay
Introduction For many hundreds of years, pressure sores have been recognized clinically. Throughout this time different pedagogies have been
explicated to prevent patients from developing pressure sores (R. J. G. Halfens & M. Eggink 1995). What is more, less is known about the
effectiveness of these methods. On account of this observation the author opted to recapitulate the fundamental care of preventing pressure sores
among high risk individuals in a nursing home setting. Search Strategies The search strategies to be utilized in completing this essay will be first and
foremost choosing a certain topic from the list of action plan presented. The writer will select the topic, Basic Nursing Care in Pressure Sore
Prevention as a... Show more content on Helpwriting.net ...
Patients get a pressure ulcer for a legion of rationalities. According to Alene Burke of Nursing Assistant Education, some of the elements why people
get them which she cited from Nettina, S. (2009), are old age, deficient mobility, lack of moisture, and insufficient diet. Moreover, factors like
neurological and other physical problems, friction and shearing, bed and chairs with wrinkled linens or hard objects and pressure ulcers in the past
may similarly predispose pressure ulcer. This observations implies that in nursing care pressure ulcers are prospected as negligence, however it is
arrogated that pressure ulcers are avoidable on the condition that prime level of care is continuously rendered to patients and residents. (Burke 2010).
Working in a healthcare domain means providing the most effective and beneficial care for the incompetent patients. Particularly, to those who needs
intimate nursing assistance such as dressing, bathing, eating, toileting and skin care activities ( Wurster 2007).This is especially true if the person is
mentally, emotionally, and physically dependent like the clients in nursing homes. Nurses, health care assistants or support workers and other health
care providers ought to educate themselves for improving quality of care and exceeding specific benchmarks in regards to pressure sores ( Wurster
2007). All the same the basic

Pressure Sore In Home Care
Home Health Care and Pressure Sores The best way to deal with pressure sores is to prevent them from ever happening in the first place. Once they
occur, pressure sores are quite difficult to treat and can cause a number of very serious complications. Home health care aides can help your senior
loved one take the steps and precautions necessary to avoid getting pressure sores. Pressure sores are also known as bedsores, pressure ulcers, and
decubitus ulcers. Regardless of what you call them, they are horrible, painful skin injuries that occur when blood is restricted from an area of the skin
due to constant pressure. When the skin cannot get blood, it also cannot get oxygen and other nutrients so the cells die. Soon, the cells in the surrounding

Bed Sores Case Study
Patients should also be engaged in exercises in order to reduce weight. Overweight and obese patients pose a huge problem in management of bed
sores. They are rigid, immobile and very inactive. The suggested exercises are advised to be considered for reduction of weight, increasing flexibility
of joints, promote blood flow as well as strengthening of muscles and bones. These exercises should be supplemented with proper feeding,
repositioning as well as other methods used to reduce pressure sores.
Distribution devices These are pressure redistribution equipment and are used to distribute patients' weight. Research shows that the use foam
mattresses that are comfortable and thick have a relative reduction in risk of developing pressure ... Show more content on Helpwriting.net ...
This was compared to the normal ICU beds, which are noted to propagate formation of bed sores.
Other types of weight pressure distribution tools include beds that are air fluidized, turning beds, beds with lower air loss, water–filled beds,
fiber–filled beds, silicone–filled beds as well as bead–filled beds.
Repositioning
Repositioning of patients prone to pressure sores refers to turning these patients in order to promote aeration and prevent excessive pressure being
exerted on one body part for a long time. Research has demonstrated that turning of these patients every 4 hours with foam mattresses developed from
visco–elastic polyurethane has superiority in outcome compared with lack of turning of these patients. The same research indicated that turning these
patients every 4 hours has better outcome in reducing risk of grade 1 and grade 2 bed sores than turning them once daily on the same foam mattresses.
This 4–hour turning schedule also has been shown to have little significant results compared a 2–hour turning schedule on the foam mattresses made of
visco–elastic polyurethane (Vanderwee, Grypdonck, De, & Defloor, 2007). Nursing interventions in repositioning of these bedridden patients include
occasional turning of these patients from one side to the next. The basis for this is to facilitate air circulation and relieving body

Best Evidence Based Practice Of Prevention And Management...
Best Evidence Based Practice of Prevention and Management of Pressure Ulcers "Evidence based practice is a process involving the examination
and application of research findings or other reliable evidence that has been integrated with scientific theories" and taking into consideration the
patient's preferences and values (Schmidt & Brown, 2015, p.4). It is constructed from the three components of patient preferences, clinical judgment
or expertise, and the best available evidence (Schmidt & Brown, 2015). Evidence based practice is an important tool to provide the highest quality
of patient care, improve patient outcomes, and reduce patient care costs (Schmidt & Brown, 2015). Pressure ulcers, also known as pressure sores,
bedsores, and decubitus ulcers, result from pressure or shear friction and pressure that cause skin and underlying tissue to breakdown (Pamaiahgari,
2014, p.1). This is commonly seen over bony prominences such as the sacrum or the heel. Pressure ulcers prove to be an issue for the patient and
require the determination of best practice to prevent the pressure ulcer and the complications that can accompany it. Pressure ulcers can be infected,
increase in size, odor, and drainage, have necrotic tissue, be indurated, warm, and painful (Lewis et. al, 2014, p.184). Furthermore, untreated pressure
ulcers can lead to more serious conditions such as cellulitis, chronic infection, sepsis, and possibly death (Lewis et. al, 2014, p.184). Recurrence of
pressure ulcers

Pressure Ulcers And A Critical Care Situation
Pressure Ulcer Prevention
Preventing pressure ulcers in an acute care or a critical care situation can be challenging for nursing staff. Pressure ulcers cause an increase in
morbidity and mortality, along with very high cost for the hospitals. Treatment cost average $11 billion per year in the United States. (Skolnik M.D. &
Carcia, D.O., 2015) They cause patient pain and are preventable by all nursing staff. "The skin is the body's largest organ and the first line of defense
against the internal and external environment, and it plays an important part in maintaining health." (Brunner et al., 2012) For adult patients does the
use of a skin care products reduce the risk of pressure ulcers compared to those patients using no skin care ... Show more content on Helpwriting.net ...
Incorporating the use of a cost–effective skin care product, daily skin assessments, and staff education, may be an effective way of managing the
healing of skin breakdown in the hospitalized patient. (Brunner et al., 2012)
Reliability
Reliability describes the consistency of a measurement method within a study. (Burns & Grove, 2011) In critiquing the reliability of the Brunner et
al. (2012) article, the study was completed at a large urban hospital using three critical care units and two acute care units. The two skin care
products were randomly assigned to the participants. The sample size goal in each group was to be 100 participants. Results of the study included
that only 64 participants were enrolled. The article written by Brunner et al. (2012) was not reliable for measurement methods. The study is not
described in great detail, does not have evidence of accuracy, and has a lack of participants.
Validity
Validity deals with determining "how well the instrument reflects the abstract concept being examined." (Burns & Grove, 2011) In critiquing the
validity of the Brunner et al. (2012) article, they used a quasi–experimental, two–group study without a control group to conduct their study. Their
study examined two skin care products used to prevent skin breakdown in acute and critical care patients with various lengths of stay. According to
Brunner et al. (2012), nurses approach skin care in various

Why Is Pressure Ulcer Important
The National Pressure Ulcer Advisory Panel defines pressure ulcer as "localized injury to skin and/or underlying tissue usually over a bony
prominence, as a result of pressure, or pressure in combination with shear." Pressure ulcers are caused by unrelieved pressure usually located over
bony prominences and are localized area of tissue injury. Agency of Healthcare Research & Quality has an effective vision regarding pressure ulcers:
If you can't measure it, you can't improve it. To determine the severity of a pressure ulcer, an assessment of the lack ofskin integrity is categorized
according to severity by stages to reflect level of tissue injury or damage . Variations in the breakdown of skin are staged to correspond to the level of
wound severity and the extent of tissue involvement which can range from mild reddening of skin to severe tissue damage to muscle and bones.
Pressure ulcers can also result in severe infection. As ... Show more content on Helpwriting.net ...
Stage III pressure ulcers involve lack of skin integrity that extends into the tissue beneath the skin and result in possibly exposure of fat; however, no
muscle, tendon or bone is exposed during this stage. Skin slough may be present but should not obscure the depth of tissue loss. Stage III may also
include tunneling. Stage III pressure ulcers are classified as an event that should never occur within acute or long term care settings. Stage IV pressure
ulcers are the most severe type of ulcer in which there is full–thickness tissue loss. Stage IV pressure ulcers are deep and effect muscle and bone
causing extensive damage. Stage IV pressure ulcers cause severe damage causing the surrounding tissue to begin necrosis. Stage IV pressure ulcers
lead to an increase risk of severe and possibly life threatening infections. Stage IV pressure ulcers are classified as an event that should never occur
within acute or long term care

Pressure Mapping
In Behrendt et al (2014) in summary of the article reviewing continuous bedside pressure mapping (CBPM) devices were studied on the effects of
pressure ulcer prevention. It focused on reducing the number of hospital–associated pressure ulcers. Prevention of pressure ulcer is a very important in
nursing, we can provide a better quality life for patients in the hospital. Patient with the CBPM devices had an occurrence of developing a pressure
ulcer in 2 of 213 patients and in patients with no CBPM the occurrence of developing a pressure ulcer were 10 of 209 patient (Behrendt et al., 2014).
We can see a good change in occurrence between in the two groups, the percentage of a pressure ulcer occurring on a patient with a CBPM device
was at 0.9%.... Show more content on Helpwriting.net ...
They evaluate if the skin was at risk for developing pressure ulcers after the patient was repositioned routinely every 2 hours. Measurement of the
pressure points were taken every 30 seconds continuously (Peterson et al., 2013). The study is relevant to my study as well because they use the
same method as far as pressure mapping as Behrendt et al (2014) but they measured pressure points. Their study showed that patients are still at
risk to develop pressure ulcers when repositioned every 2 hours, some area of the body did not relieve from pressure after repositioning. This
means that even after the patient was repositioned to prevent or reduce the risk of pressure ulcer formation, there are substantial areas of skin that
do not get relieved and remain at risk for pressure ulcers regardless of routine repositioning by experienced nurses (Peterson et al., 2013). The study
was done to reduce pressure ulcers prevention by revealing that other areas of the skin were still at risk after repositioning the patient. Further studies
would reveal inconsistencies in this study whether or not these "triple jeopardy" areas will into pressure ulcers, progress a pressure ulcer or occur at
specific tissue location only, these can be tested by expending the testing time to 24 hours rather than 4 to 6 hours. Expansion of

Symptoms And Treatment Of Ulcers
In today's world, elderlies suffering with ulcers are very common. Ulcers are sores that occurs on the external surface or internal surface of the body,
which is caused by a break in the skin that does not fully recover or fail to heal. Ulcers come in different forms, targeting different areas, due to
different reasons with some slight similarities to them.. People with ulcers has many treatment options, depending on their case, stage, and kind of
ulcer, for example stasis and pressure ulcer. Stasis and pressure ulcer are two ulcers that has lack ofblood flow as a factor why it occurs, even though it
gives a different outcome for both ulcers. Pressure ulcers is also known as pressure sores or bed sores, these sores occur when an individual is not
being repositioned for some time, causing constant pressure to an area. Some of the etiology of pressure ulcers stated by Jones, D (2013) are, "poor
nutritional status, posture problems, medications, reduced blood flow, and reduced mobility". Elderly nursing home patients has a very high rate of
gaining this kind of ulcer due to limited or reduced mobility and bed rest causing the blood flow to be cut off due to the constant pressure. On the
other hand, there is stasis ulcer, also known as venous stasis ulcer, askin condition which occurs in people with poor circulation. The stasis ulcer
usually occurs in the lower legs. The etiology of stasis ulcer stated by Beckerle, Carla Moore, "Pathogenesis of venous system can result in

A Critical Understanding Of An Older Adult
In this reflective essay, I shall be representing a critical understanding of the Risks in view of, an older adult, as an alternative area of practice, to
that of my own nursing Adult field. The scenario takes place, within a clinical acute setting, with following the use of Driscolls Reflective Model
(1994), Driscoll uses a framework to reflect on the scenario, What? Happened, So, What? How you were feeling at the time, and Now, What? Actions
to be taken. However, to maintain confidentiality, which is set by the (NMC) Nursing and midwifery council (2008) all names of places and patients
names have been changed and I shall be using the pseudonym Mrs M, for an 85–year older patient.
How do we define what an older person is, without being, ... Show more content on Helpwriting.net ...
When the pressure, is not frequently relived, the damage is caused and a pressure ulcer occurs. Judy waterlow (1985) introduced the Waterlow Score,
whilst working as a clinical nurse, she designed this as a tool for her students to use as a guidance, for a risk assessment tool, to help in maintaining
skin integrity. Waterlow (1985) suggests, that as a nurse professional, we can only use this as a guide, we must also use our own judgment, in defining
the risks of the patient in our care. The cost implications to treatment of pressure ulcer care is expensive, costing the national healthcare service
provider millions, with additional longer stay in hospital, the cost of each pressure ulcer and even reconstructive surgery, also with the additional
suffering, of the patient at hand, the importance of minimizing the risks to pressure ulcer prevention, is imperative. Not only to bring, the costs down,
but to serve our public, to the best of, our ability, in bringing excellence, in the care provided (Dziedzic, 2014).
First stage: What happened, whilst out on my nursing placement, in clinical practice, I was allocated to a bay of patients to care for, these consisted of
7 female patients, with a variety of care complex mobility needs. During my shift, I assisted the patients with personal care, helping them to wash and
dress for the day, with nutrition and assisting the patients out of the bay to use the toilet and aiding them in their mobility.
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