Pressure Ulcers and Their Treatment Thesis

Excerpt from Thesis :



Evidence-based studies that delineate how to manage and treat pressure ulcers have determined that the most effective approaches include keeping the wound moist, appropriate repositioning, using support surfaces, and proper nutrition. Non-traditional approaches, including electrical stimulation, hyperbaric oxygen, growth factors and skin equivalents, and negative pressure wound therapy, are also showing promising results (Resources for Managing Hospital-Acquired Conditions, 2008).

Organizational level activities for dealing with hospital-acquired pressure ulcers include:

developing and adhering to a written plan and procedure for preventing and treating pressure ulcers educating and training staff in the care processes associated with skin assessment, staging of pressure ulcers, prevention strategies, and treatment modalities carefully selecting and provisioning the necessary equipment and supplies to prevent and treat pressure ulcers the measuring and monitoring of pressure ulcer rates that depend on honest, transparent reporting of all pressure ulcers (Resources for Managing Hospital-Acquired Conditions, 2008).

The significance of this study in regards to nursing is made explicit when the author states that nursing staff play a major role in the prevention, treatment, management and care of pressure ulcers. Some of the preventive steps to reduce the prevalence of pressure ulcers either by the staff or attendants of the patients included: change of side or position (95%); removal of wrinkles from the bed sheet (60%) and use of cushions or air rings (55%). More than 50% nurses reported 'care of back' as a preventive step. In addition, cleanliness (35%); and massaging (25%) also help in the prevention of pressure ulcers. Although care of pressure points is a fundamental care activity many nurses are unable to adopt preventive measures dues to lack of time and low priority given to prevention of pressure ulcers in the clinical practice. Thus there is a great need to educate not only the nurses but relatives of the patients to adopt certain preventive strategies to reduce the prevalence of pressure ulcers (Vati, Chopra, and Walia, 2004).

A skin care plan to prevent tissue injury in patients at risk for developing pressure sores is necessary to promote wound healing in patients. The staff must be involved in planning, implementing, and evaluating the skin care plan in order for it to be effective. Developing a shared vision with a sense of team spirit within the unit can promote common interests and goals. This can ultimately lead to inspiration, motivation, and accountability. The nursing staff must rely on the management skills of the unit manager in order to provide guidance that includes clear expectations and maintains a challenging and effective approach. The role of the nurse leader is significant in shaping the environment of care. Nurse executives play a vital role in providing quality patient care and safety. The chief nursing officer, the unit manager, and the bedside nurse must all collaborate to address this nurse-sensitive issue and improve performance by exceeding benchmarks of the National Data base of Nursing Quality Indicators (Role Nurse Leaders Can Play in Reducing the Incidence of Pressure Sores: Addressing a Complex Issue, 2007).

Hospitals in the United States are growing more concerned with the rising number of hospital-acquired pressure ulcers. And in order to try and reduce this, hospitals have begun implementing Pressure Ulcer Strategic Plans. With the introduction of these plans there was a better appreciation for and enhanced utilization of Certified Wound Ostomy Continence Nurses that was encouraged and new support surfaces were purchased. Implementing these changes has resulted in a decrease in the quarterly hospital-acquired pressure ulcer occurrences in participating units, including the Medical Intensive Care Unit where rates dropped from a high of 29% to near 0%. Clinicians now see pressure ulcers as preventable rather than inevitable and view Certified Wound Ostomy Continence Nurses as resources and clinical experts for prevention and treatment. Overall quality of care and financial resource utilization also have substantially improved (Hiser, Rochette, Philbin, Lowerhouse, Terburgh, and Pietsch, 2006).

References

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http://www.ncbi.nlm.nih.gov/pubmed/16464994

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http://www.merck.com/mmpe/sec10/ch126/ch126a.html

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