Biology assignment analysis on: A pressure ulcer 

Introduction:    

A pressure ulcer is “an inflammatory, often suppurating lesion on the skin or an internal mucosal surface of the body, as in the duodenum, resulting in necrosis of the tissue.” Ulcer – “a local defect or excavation on the surface of an organ or tissue which is produced by sloughing of inflammatory necrotic tissue.”Pressure ulcers (PU) have plagued critically ill and debilitated patients since the dawn of recorded medicine. Pressure ulcers are associated with adverse patient outcomes, and contribute to patient pain, depression, loss of function and independence, increased incidence of infection and sepsis, additional surgical interventions, significant economic costs and prolonged hospital stays. Therefore, the most effective treatment for pressure ulcers is to prevent their development (McColl & Thomas, 2009).

Relatively little has been written about Pressure ulcer in the intensive care unit (ICU) setting, making this topic relatively ‘forgotten’ not only from clinical but also from research standpoint. For the intensives, the concern for the total welfare of the sickest and most dependent persons implies an excellent understanding of the epidemiology, causes, and effective methods for the prevention and treatment of Pressure ulcer in the context of a multidisciplinary team.. This review focuses to assess intensive care nurses’ knowledge of pressure ulcers and the impact of an educational program on knowledge levels Pressure ulcer prevention, diagnosis and treatment in the intensive care setting. (Kaltenthaler et al., 2008)

Pressure ulcers are localized areas of tissue necrosis that develop when soft tissue is compressed between a bony prominence and an external surface for a prolonged period of time. Numerous consensus conferences clearly established the preferred use of the term pressure ulcer rather than synonyms such as “deceits ulcer” or “bed sore”. There is also consensus that four ulcer stages are useful for reporting the prevalence and guiding the therapy of Pressure ulcers (Midwifery, 2007).

ressure ulcers are a major health problem causing in United Kingdom, a substantial amount of suffering which leads to a reduction in the quality of life for patients and their cares.Pressure ulcers are a problem for immobile individuals, and having pressure ulcers impact and restrict the daily and are often associated with pain. Pressure ulcers occur frequently and cause high costs for the health care system. The prevention of pressure ulcers by focusing on different mattresses and overlays aimed to reduce the interface pressure or the pressure exposure of the tissue (Vanderwee K, 2006). The problem is the poor evaluation of this type of equipment. There are important factors regarding pressure ulcer envelopment, pressure, shear, temperature and humidity. People are affected by external pressure in different ways and therefore my research is done in Kingston hospital UK preferable to measure the effect of pressures and role of nurses in the treatment. Kingston hospital is very good hospital in UK that provides diagnostic and treatment services to 3 lakh 20 thousand people. The intensive care is given to the patients who are suffering from pressure ulcers in Kingston hospital UK.

In this study, the attitude of staff nurses will be demonstrated towards pressure ulcer prevention.  Since attitudes are considered important because they give an indication of what to expect from others. A positive attitude towards an issue is an important influencing factor that determines an individual’s likelihood of carrying out the behavior in question (Moore & Cowman, 2008). In this study, lack of time and staff were commonly cited as barriers towards carrying out pressure ulcer prevention, whilst lack of training and education was rarely mentioned. Pressure ulcer prevention is a multi disciplinary problem. Therein lays a primary problem; if all members of the team do not contribute fully, the efforts of the other members may be fruitless. A second problem is the whole area of staff shortages, which results in the overstretching of staff at a clinical level. Certain aspects of pressure ulcer prevention, such as repositioning, are difficult to carry out unaided. If staff shortages continue, and given the pressure on staff to prioritize tasks, it will be of no surprise if pressure ulcer prevention becomes less of a priority. (McColl & Thomas, 2009).

Objectives of the study:

The aims and objectives determine the framework of the project in Royal Sussex Hospital,Uk.  After considering the depth and knowledge required for the study, the following aim has been chosen for conducting this study.

• To develop an understanding about the role of nurses that will be helpful in the prevention of pressure ulcer,
• To analyse the factors affecting the nurses’ role in preventing pressure ulcer.
  • To improve the attitudes of the nurses for the prevention of the pressure ulcer,
  • The activities related to pressure ulcer prevention for the nurses,
  • The hindrances for the nurses for the prevention of the pressure ulcer,
  • To explain and analyse the nature of risks based on the observed impact on the patients. (Paisely,2010)

Literature review:

Pressure ulcers are associated with adverse patient outcomes, and contribute to patient pain, depression, loss of function and independence, increased incidence of infection and sepsis, additional surgical interventions, and prolonged hospital stays. Therefore, the best treatment for pressure ulcers is to prevent their development. Relatively little has been written about pressure ulcers in the intensive care unit (ICU) setting, making this topic relatively ‘forgotten’ not only from clinical standpoint but also from research standpoint. For the intensives, the concern for total welfare of the sickest and most dependent persons requires an excellent understanding of the epidemiology, causes, and effective methods for the prevention and treatment of Pressure ulcers in the context of a multidisciplinary team (Paisely, 2010). This review focuses on Pressure ulcer prevention, diagnosis and treatment in the intensive care setting. Pressure ulcers are not a plague of modern man; they have been known to exist since ancient Egyptian times. However, despite the increasing expenditure on pressure ulcer prevention, pressure ulcers remain a major health care problem. Although nurses do not have the sole responsibility for pressure ulcer prevention, nurses have a unique opportunity to have a significant impact on this problem. (Thomas et al, 2005).

Bedsores, more properly known as pressure ulcers  are lesions caused by many factors such as unrelieved pressure, friction, humidity, shearing forces, temperature, age, continence, and medication to any part of the body, especially portions over bony or cartilaginous areas such as sacrum, elbows, knees, and ankles. Although often prevented and treatable if found early, they can be very difficult to prevent in frail elderly patients, wheelchair users (especially where spinal injury is involved) and terminally ill patients (Jordan & O’Brien, 2006). Bedsores are often fatal even under the auspices of medical care and are one of the leading iatrogenic causes of death reported in developed countries, second only to adverse drug reactions. The primary cure and treatment is to remove the pressure by turning the patient regularly (every two hours is often quoted, though the evidence for this figure is not strong and four hourly turns may be as effective in some patients). However the relief of pressure to avoid further sores is well documented since at least the 19th century; regular turning was advised to prevent sores by Galloway (though some of her other recommendations are not current practice, for example massage of the pressure area is probably contra-indicated) and virtually all authors since (Bain & Ferguson-Pell, 2007).

Research questions:

Following are the list of questions that are the concerned study:

• What are staff nurses’ attitudes towards pressure ulcer prevention?

• Do staff nurses’ carry out, document and read pressure ulcer prevention strategies?

• What are staff nurses’ perceived barriers towards pressure ulcer prevention?

• Do staff nurses routinely use pressure ulcer risk assessment and pressure ulcer grading tools in clinical practice?

• What is the status of education in pressure ulcer prevention among staff nurses?

• What is the nature of education on pressure ulcer prevention among staff nurses?

Limitations:

The rapid turnover of staff at each of the study sites compounded the problem of identifying key staff. However, Potential barriers in carrying out pressure ulcer risk assessment and pressure ulcer prevention are ‘The patient’ was the most frequently cited barrier like the patients may be too ill to assess or may be uncooperative, making assessment difficult. Lack of time and lack of staff were also perceived as important barriers. Lack of training, resources and guidelines and problems with the risk assessment tool in use were rarely considered to be important. (Thomas et al, 2005)

Methodology:

I have used qualitative and quantitative research methodology for this study. The secondary data is collect through website, internet, books and journals, etc and primary data is collected through the hospital records available in libraries and other research books which show the number of patients suffered from pressure ulcers in Kingston hospital UK. The perception about hospital treatment and diagnostic services are given in this research report.

I have selected few patients’ records as a sample for collecting the data about patients. The patients are suffering from pressure ulcers. It is very difficult to get the information from the whole population that is why a sample is selected from the population that describes the character of the population.

Standardized measuring techniques are necessary to provide quantitative information on wound healing and to validate research.

The most common method of monitoring the healing of pressure ulcers utilizes photography and diagrams. (Thomas et al.,2005), The Vista MED wound measurement system, manufactured by Verg, Inc (Manitoba, Winnipeg, Canada), uses color-balanced and light-balanced computerized photographic images to help clinicians obtain precise objective information about the size, shape, outline, area, and color of the wound. It also provides objective information regarding the changes of surrounding tissue.

In addition, (Niezgoda & Mendez-Eastman, 2006) digital subpixel techniques are available to measure clinician-defined image areas, such as wound edges, eschar, necrotic tissue, or granulation formation. Concise documented measurement contributes to efficient wound treatment, management, and progress review.

Numerous other devices have been used to measure the volume (volumetrics) and the dimensions of the pressure ulcer wound. One simple method is to use a measured amount of saline to infer the volume of the wound. More sophisticated radiographic techniques, such as sinus radiographs, CT scans, and MRIs, are available but too expensive for routine use. (Pressure ulcers in America,2010).

Findings and Analysis

1. Analysis from primary resources:

Primary Resources shows that nursing department of Kingston Hospital UK is very efficient and patients are too much satisfied with this. 90% of patients are satisfied with the nursing services in the hospital there are 10% of patients that are not satisfied but overall we can say that the nursing staff is too much concerned about the duty and satisfy patients and take care of their needs. 75% of patients think that nursing staff of Kingston hospital is very humble and well behaved (Vander wee et al, 2007).  They treat patients with good manner and very kind hurt and treats patients empathically. Their work is not just a work, they are performing their duty with full dedication and kind hurt manner

2. Analysis from secondary Data:

Secondary resources show that 75% of patients think that nursing staff uses proper hygiene and care while treating patients. The nursing staff is very clean and well dressed. They used sterile and un-used appliances while treatment. But 25% of patients do not find nursing staff clean and hygienic. But overall we can assume that nursing staff is hygienic.95% of patients think that nursing staff of Kingston hospital is very humble and well behaved.  They treat patients with good manner and very kind hurt and treats patients empathically (Tubaishat et al., 2010). Their work is not just a work, they are performing their duty with full dedication and kind hurt manner. 

Discussion:

Pressure ulcers are areas of localized damage to the skin and underlying tissues caused by prolonged and/or repeated ischemic injury without adequate time for tissue recovery. More than 100 risk factors for pressure ulcers have been identified. Pressure ulcers have been reported in all health care settings and in many countries and contribute to morbidity and mortality. Critically ill patients in the intensive care unit (ICU) are at particularly high risk for pressure ulcers. Although prediction and prevention of pressure ulcers involve health care personnel in many disciplines, nurses are patients’ primary caregivers and thus have the most responsibility for preventing and managing this complication (Guy, 2009).

Studiesof nurses’ knowledge of pressure ulcer prediction, prevention, and management have had conflicting results; knowledge was good in some studies and poor in others. These studies were limited by a lack of clarity of content, differences in scoring, and differences in standard setting of the assessment tests. Educational programs can have positive effects. In one study, nurses who reported attendance at a pressure ulcer educational program within the preceding year scored significantly higher on a knowledge questionnaire than did nurses who did not. Educational programs can improve decision making, and informed decision making can reduce the incidence and prevalence of pressure ulcers (Bain & Ferguson-Pell, 2007). In a study of the effect of an educational program for registered nurses on knowledge of pressure ulcer risk and prevention, data were collected immediately before and after the program. Scores on knowledge assessment improved significantly after the program for reporting numbers of risk factors, use of the risk assessment tool subscales, and use of more preventive strategies.

Recommendations:

Risk Assessment and Prevention of Pressure Ulcers

This best practice guideline assists nurses who work in diverse practice settings to identify adults who are at risk of pressure ulcers. This guideline further provides direction to nurses in defining early interventions for pressure ulcer prevention, and to manage Stage I pressure ulcers.

This guideline focuses its recommendations on: Practice Recommendations including assessment, planning, intervention and discharge/transfer of care; Educational Recommendations for supporting the skills required for nurses working with adults at risk for pressure ulcers; and Organization & Policy Recommendations addressing the importance of a supportive practice environment as an enabling factor for providing high quality nursing care, which includes ongoing evaluation of guideline implementation.

Conclusion:

According to the responses of patients it can be inferred that nursing staff of Kingston hospital is very good enough. They use proper hygiene while treatment of a patient. The nursing staff treats the pressure ulcers patients very empathically and very compassionate about their pain. The patients are too much satisfied with the services given by nursing staff. The responsibility of skin care is a total team responsibility of client, family, caretakers, and the health care professionals. The key to preventing skin lesions is knowledgeable and consistent assessment and provision of primary skin care for older clients. Among this cohort of ICU registered nurses, knowledge levels of pressure ulcer prevention and management were good at baseline. Knowledge levels improved with an educational program but soon returned to baseline. Validation of test content and standard setting was achieved by using a variety of techniques.

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