Organizational Systems Task 1

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
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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

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 surface area 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

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
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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

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

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

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 ... Show more content on Helpwriting.net ...
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.,

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

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
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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 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,

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

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

Essay on Validity of Waterlow Scale

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

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
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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
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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,

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 of blood 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, a skin 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

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
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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 of health 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

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.

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
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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 | | |

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.
21017869
On this

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

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,

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

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

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.

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

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

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

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

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

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, mobüisation 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,

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 more content on Helpwriting.net ...
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.

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

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

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

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

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

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 of skin 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

Organizational Systems Task 1

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Organizational Systems Task 1