course materials

1. Prevention of Pressure Ulcers Discussion
Prevention of Pressure Ulcers DiscussionPrevention of Pressure Ulcers
DiscussionPrevention of Pressure Ulcers for End of Life Patients in Hospitals: Adoption of
an Evidence-Based Pressure Ulcers Risk Assessment Protocol for Standing Orders 1.0
Background The philosophical literature on good death ed the early framework of
achieving a natural death free from medical intervention at home surrounded by friends
and family (Campbell, 2020). This traditional way of conceptualising good death,
particularly outside the hospital setting, places palliative care in opposition to mainstream
healthcare services (Robinson et al.,2016). However, Palliative care, to help provide relief
from symptoms and offer to patients and their family members at the end of their lives, is
expected to be offered in all care settings (4th edition of the National Consensus Project’s
Clinical Practice Guidelines for Quality Palliative Care). Similarly, palliative care policy in
England emphasizes that high-quality care should be available wherever the person may be:
at a hospital, in home, in a care home, in a hospice, or elsewhere (Leadership Alliance for the
Care of Dying People, 2014 and NHS, 2008). This focuses on solving the problem associated
with the hospital as a place of palliative care and end-of-life. Also, in 2012, the NHS
identified pressure ulcer prevention as a quality improvement target, which was in
furtherance of the Department of Health set a target of an annual reduction of at least 5-
10% in the incidence of pressure ulcers in 1994 (Department of Health (DH), 2012.
However, as there was no requirement for trusts to provide data relating to this target,
there is no evidence to suggest this has been addressed. Likewise, there is no requirement
for data to be collected about the needs or outcomes of services used by patients of acute
hospitals, resulting in a significant lack of such literature in the United Kingdom (Kerrison
and Pollock, 2001). Therefore, despite the attention given to the area of pressure ulcer
prevention, what remains uncertain is what constrains hospitals from implementing
national guidelines on pressure ulcer prevention ((National Institute for Clinical Excellence
(NICE), 2001; 2003; DH, 2001; 2003)) and the evidence-based recommendations of the
International Pressure Ulcer Prevention and Treatment Guidelines (National Pressure Ulcer
Advisory Panel (NPUAP) et al, 2019) in terms of improving the outcomes for patients. This
study aims at addressing some of these gaps. Particularly, the researcher would be working
closely with the staff in one of the placement hospitals to identify the barriers to change and
then to work with the healthcare professionals and management to implement best
practices in pressure ulcer prevention. Prevention of Pressure Ulcers DiscussionORDER
NOW FOR CUSTOMIZED, PLAGIARISM-FREE PAPERSIn addition, considering the increasing

2. population of patients requiring palliative care in acute hospital (Cruz-Oliver, 2017; Etkind,
S.N., Bone, A.E., Gomes, B. et al. 2017; Healthtalk.org., 2014) amid established evidence that:
i) end-of-life patients are susceptible to pressure ulcer (Ferris, Price & Harding, 2019;
Carville, 2018), ii) Some 80 to 95% of pressure ulcers are preventable (Institute for
Healthcare Improvement, 2021; Ebi, Hirko & Mijena, 2019; NHS, 2015), and iii) hospital
settings are inadequate in providing palliative care (the Mid Staffordshire NHS Foundation
Trust, 2013; Gardiner et al., 2011), this area requires systematic application of evidence-
based practice research. The existing end-of-life and palliative care in hospitals in England
fit a proposed practice change given its inadequacy in terms of coverage, variation in
practices, and sustainability (Ó Coimín et al., 2019). For instance, dying in hospital in the UK
is characterised by a deficit of vital end-of-life care because of the lack of specialist
available out of hours and at weekends. Those who die overnight or at the weekend may be
denied the right care because only some (11%, 2016 End of Life Care Audit – Dying in
Hospital) of hospital trusts in England provide face-to-face specialist palliative services
round the clock 1 Monday to Sunday, as the majority of trusts offer a specialist telephone
helpline. Though most healthcare professionals giving end-of-life care do it to a very good
standard when things start to go wrong out-ofhours in the middle of the night and at
weekends, then the nurses that need access to specialists in palliative care are without it,
patients with complex problems like pressure ulcers may not get the care they need. Which
is a problem. Consequently, practice research toward improving the prevention of pressure
ulcers among end-of-life patients in an acute hospital is needed to ensure improved patient
outcomes, including symptom control and quality of life, and family outcomes, such as
decreased anxiety. Prevention of Pressure Ulcers DiscussionThe purpose of this study is,
therefore, to describe the process of a nurse-led practice improvement project to implement
an evidence-based standing order set for risk management of pressure ulcers in a hospital-
based palliative care setting using patients’ experience data as an evaluative component.
Considering the progressive end-stage deterioration of the skin usually experienced by
patients receiving palliative care, ongoing regular assessment of pressure ulcer risk is
required (NPUAP et al, 2019). The Marie Curie Centre Hunters Hill Risk Assessment Tool
(Chaplin, 2000), is identified in literature as a recommended tool that can be used in
conjunction with clinical judgment to conduct a broad pressure ulcer risk assessment in
patients under the end of life and palliative care (NPUAP et al, 2019). In this light, the
underlying elements of the PICO model: Patient / Problem, Intervention, Comparison and
Outcome being considered will be as follows: Table 1: PICO Process
Population/Patient/Problem Intervention Comparison Outcome In end-of-life patients and
Prevention of Comparison between Make a difference in among family members of pressure
ulcers in old and new standing meeting the care patients individuals receiving orders need
of patients and palliative care significantly reduce in-hospital using pressure ulcer evidence-
based risk incidence in hospital assessment management 2.0 Methods: The steps of the
Iowa Model for Evidence-Based Practice Change will be utilised for this practice
implementation project. Survey data will be conducted as a proxy for assessing the
intervention effectiveness. The Iowa Model of Evidence-Based Practice The Iowa Model of
Evidence-Based Practice for organizational scientific evidence as described by Spellman

3. (2016) provides the framework for identification of a relevant topic for clinical inquiry,
team formation appraisal and synthesis of the relevant best evidence, application of
changes, evaluation and dissemination. It involves identifying practical issue of concern and
formulation of research questions; determining how much of a problem the priority issue is
for the organization; determine if the evidence is sufficient – otherwise, search; but if the
evidence is sufficient and the changes are appropriate, conduct 2 a pilot study to change the
practice; evaluate pilot results, disseminate results and implement change (Camargo et
al.,2017). Reference Campbell, S.M. (2020) Well-Being and the Good Death. Ethic Theory
Moral Prac 23, 607–623. https://doi.org/10.1007/s10677-020-10101-3 Robinson, J., Gott,
M., Gardiner, C. & Ingleton, C. (2016) The ‘problematisation’ of palliative care in hospital: an
exploratory review of international palliative care policy in five countries. BMC Palliative
Care 15:64. doi 10.1186/s12904-016-0137-0 Department of Health (2012) Using the
Commissioning for Quality and Innovation (CQUIN) Payment Framework: Guidance on New
National Goals for 2012–13 London: Prevention of Pressure Ulcers DiscussionDepartment
of Health, London. NHS (2008), High Quality Care for All. NHS Next Stage Review Final
Report No. CM 7432, Presented to Parliament by the Secretary of State for Health by
Command of Her Majesty. Leadership Alliance for the Care of Dying People (2014). One
chance to get it right, Reference 01509. Kerrison S, Pollock A (2001) Caring for older people
in the private sector in England. BMJ 323(7312): 566 National Institute for Clinical
Excellence (2001) Pressure ulcer risk assessment and prevention. NICE, London National
Institute for Clinical Excellence (2003) Pressure Ulcer Prevention. Clinical Guideline 7. NICE,
London Department of Health (2001) The Essence of Care – patient-focused benchmarking
for health care practitioners. DH, London Department of Health (2003) Essence of Care
Patient-focused benchmarks for clinical governance. NHS Modernisation Agency.
Department of Health, London National Pressure Ulcer Advisory Panel and European
Pressure Ulcer Advisory Panel (2019) Prevention and treatment of Pressure
Ulcers/injuries: Clinical Practice Guideline. The International Guideline, 3rd Edition (2019),
NPUAP, Washington DC Cruz-Oliver, D. M. (2017). Palliative Care: An Update. Missouri
medicine, 114(2), 110–115. Healthtalk.org. (2014) Living with Dying: Where people want to
die. University of Oxford; UK. [Accessed: 2/2/21]. Available from:
http://www.healthtalk.org/peoples-experiences/dying-bereavement/livingdying/where-
people-want-die. Etkind, S.N., Bone, A.E., Gomes, B. et al. (2017) How many people will need
palliative care in 2040? Past trends, future projections and implications for services. BMC
Med 15, 102. https://doi.org/10.1186/s12916-017-0860-2 Ferris A, Price A, Harding K.
(2019) Pressure ulcers in patients receiving palliative care: A systematic review. Palliative
Medicine 33(7):770-782. doi:10.1177/0269216319846023 3 Carville K. (2018) Pressure
Injury Prevention and Management in Palliative Care. In: MacLeod R., Van den Block L. (eds)
Textbook of Palliative Care. Springer, Cham. https://doi.org/10.1007/978-3-31931738-
0_116-1 Institute for Healthcare Improvement (2021). Pressure Ulcers. [Accessed: 2/2/21].
Available from: http://www.ihi.org/Topics/PressureUlcers/Pages/default.aspx NHS (2015)
Stop the Pressure. [Accessed: 2/2/21]. Available from: www.nhs.stopthepressure.co.uk Ebi,
W.E., Hirko, G.F. & Mijena, D.A. (2019) Nurses’ knowledge to pressure ulcer prevention in
public hospitals in Wollega: a cross-sectional study design. BMC Nurs 18, 20.

4. https://doi.org/10.1186/s12912019-0346-y Gardiner, C., Cobb, M., Gott, M. & Ingleton, C.
(2011) Barriers to providing palliative care for older people in acute hospitals, Age and
Ageing, Volume 40, Issue 2, March, pp.233–238, https://doi.org/10.1093/ageing/afq172
The Mid Staffordshire NHS Foundation Trust (2013). Public inquiry. [Accessed: 2/2/21].
Available from
http://webarchive.nationalarchives.gov.uk/20150407084231/http://www.midstaffspublic
inquiry.com/r eport. Ó Coimín, D., Prizeman, G., Korn, B. et al. (2019). Prevention of
Pressure Ulcers DiscussionDying in acute hospitals: voices of bereaved relatives. BMC
Palliative Care 18, 91. https://doi.org/10.1186/s12904-019-0464-z Spellman, C.F. (2016) A
Practice Improvement Project to Improve Knowledge and Perceptions of Palliative Care
among Patients with Heart Failure and Cancer in the Acute Setting Using Video Enhanced
Education. DNP Projects submitted to College of Nursing, University of Kentucky Camargo,
F.C., Iwamoto, H.H., Galvão, C.M., et al (2017). Models for the Implementation of
EvidenceBased Practice in Hospital Based Nursing: A Narrative Review. Texto Contexto
Enferm 26(4):e2070017. doi.org/10.1590/0104-07072017002070017 Chaplin J. (2000)
Pressure sore risk assessment in palliative care. Journal of Tissue Viability, 10(1):27-31 4
Part 1: Literature review Introduction and background • Put the innovation in context of
local and National policy • Give a rationale for the focus of your project and say why it is
important • State the aims and outcomes of the proposed innovation Literature review •
State the purpose of the literature review and identify the different types of literature
included in the review • Describe how you searched, selected and appraised the literature •
Discuss and summarise your findings. Give a picture of the overall body of knowledge in this
field – point out its strengths and weaknesses and highlight any gaps • Make a critical
analysis of the evidence informing the need for your innovation. Critically analyse the
evidence that informs your innovation. • You should demonstrate your ability to
systematically search for research, select and appraise research, analyse several studies and
form conclusions linked to your innovation plan. Part 2: The implementation plan
Introduction and background Introduce your choice of change model and briefly explain
why you have made that choice. Change management plan Move on to look at ing theories
for preparing for change – such as SWOT analysis, stakeholder analysis (these are
suggestions not requirements) You need to describe the step by step process of your plan.
There should also be a discussion with evaluative commentary. You should highlight any
strengths and acknowledge any limitations of your plan. Evaluating the success of the
innovation You need to return to the aims and outcomes of the innovation plan and discuss
how you will know if they have been achieved. Your discussion should be informed by
theory related to evaluation methods as well as give practical examples of measure or data
collection tools that could be used. Chapter 2. Literature Review 2.1. Introduction
Prevention of Pressure Ulcers DiscussionThis paper planning to explores a proposed
Innovation and expliontes on a strategy. wpich may optimally contribute to resolving the
problem of falls in the inpatient settings: The use of a yellow wristband to identify the
inpatients at high risk of folls. The purpose of this literature review is to critically analyse
and synthesise the relevant literature on this topic and the consequent review will underpin
the construct of project proposal The Problem.Intervention-Comparison-Outcome (PICO)

5. framework, as recommended by Gerrish and Lacey (2010) forms the basis of the current
literature review Gerrish and Lacoy (2010) explain that the PICO framework) works well
for questions about healthcare Interventions”. PICO is particularly useful in formulating
questions about the offectiveness of a particular intervention (Moule & Goodman, 2013). It
is also useful for collating quantitative questions, answered with numerical data (Houset.
2012). This project has utilized both these tools in the review, The problem (P) explored in
this review is falls in the inpatient settings. The intervention (1) and comparison (C) refer to
the foll’s prevention strategios generally, and colour coded wristbands for high-risk patients
specifically – versus no fail’s prevention THARAMA in in the center les into the LIELM D
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MOBBODI med en gang handige le Sublime effectiveness of a particular intervention (Moule
& Goodman, 2013). It is also useful for collating quantitative questions, answered with
numerical data (Houset, 2012). This project has utilized both these tools in the review. The
problem (P) explored in this review is falls in the inpatient settings. The intervention (1)
and comparison (C) refer to the tall’s prevention strategies – generally, and colour- coded
wristbands for high-risk patients specifically – versus no fall’s prevention strategies. The
outcome (o) is the number/rate of falls, and also indicates the consequences of falls (for
example, injury to the patient or extended hospitalization). Some of the studies selected also
consider nurses’ awareness of fallsrisk as an outcome. 22. Aims and Objectives for the
literature review • Prevention of Pressure Ulcers Discussion