Two-hourly turning and positioning for pressure ulcer prevention in elderly nursing home residents

Pressure Ulcers in the Elderly

Gifty Appiah

Dr. Judi Kuric

DNP Project

Final Premise

DNP Project Question

Will Every Two Hourly Turning and Positioning Decrease Pressure Ulcers in the Elderly Bed Bound Population in Nursing Home.

Will Every Two Hourly Turning and Positioning Decrease the Pressure Ulcers in the Elderly Bed Bound Population in Nursing Homes.

Pressure ulcers are a common cause of immobility among the elderly, which results in immense pain, suffering, and substantial costs with charges because of increased length of stay in the nursing homes. Prior studies suggest that patients who receive care in accordance to evidence-based guidelines are not at risk of developing pressure ulcers. However, the empirical evidence on the effectiveness of the measures is inadequate. Nevertheless, frequent manual repositioning of patients is a firmly established standard of care for the elderly; although there has been no much evidence on the same, experts suggest that it is effective. There are several risk factors for pressure ulcers in the elderly:

Intrinsic

Extrinsic

Aging

Pressure

Chronic Disease

Friction

Impaired Mobility

Shearing

Limited Activity

Limited Activity

Fecal Incontinence

Moisture

Malnutrition

Sensory Impairment

Objectives

Pressure ulcers are common phenomenal in the elderly, and immobility is among the adverse effects associated with the condition. Although numerous nursing homes utilize mattresses, two hourly manual repositioning and overlays designed to prevent pressure ulcers; there is not enough evidence as to, which of them is effective. Therefore, this review aims to establish whether two hourly manual repositioning is effective in preventing pressure ulcers among the elderly. This being said, there is also research that shows simply turning the patient is not enough, by itself, to completely remove the threat of pressure ulcers, and must sometimes be combined with other methods in order to enhance efficacy.

Results

Gray and Krapfl (2008) systematically review suggests that two hourly manual repositioning, when combined with a proper pressure redistribution surface is effective in prevention of Pus among the elderly. A randomized trial by Grypdonck, et al., (2005) found out that two hourly repositioning reduced the incidence of PUs. However, a cohort study by Rich, et al., (2011) found out that two hourly repositioning did not reduce the incidence of PUs among the elderly. An observational study by Krishnagopalan, et al. (2002) found out that two hourly repositioning had the capacity to reduce ulcers. In addition, a cohort study by Rich et al. (2011) suggests that there is no relation between manual two hourly repositioning of elderly patients with the rate of ulcer reduction. Another randomized study (Vanderwee et al., 2007) found out that there was no difference in the incidence of pressure ulcer when compared to elderly patients fewer than two repositioning interval regimens. The reasoning behind this literature review is not only to discover whether the incidence of ulcers in the elderly residing in nursing homes can be lowered with automatic and periodic body turning, but also to determine just how important this type of review can be to the nursing field in general. One recent study determined that "pressure ulcer prevention is an important aspect in daily care for residents at risk in nursing homes" (Demarre, et al., 2012, p. 1426). If that statement is true, then this study will help to address the issue of pressure ulcers. Other studies indicate that regardless of the reason for incapacitation, turning is a basic step in improving the PU condition by removing stress and negative stimuli from the wound area (Pak, et al., 2009).

One important aspect of nursing home living is that most of the time the people living there are helpless to accomplish many tasks that are part of everyday living. The employees are trained (for the most part) and as one study found it is "important to assess whether nursing staff levels and skills are meeting nursing home resident care needs" (Zhang, Unruh, Wan, 2013, p. 290). For example, incontinence is a significant risk factor for skin breakdown. The moisture changes the chemical balance of the skin, and often without adequate ventilation and care, a route for bacterial infection. In either case, pressure on the wound area, increased bacteria and moisture, all contribute to the lesions becoming rather serious (Gefen, 2008).

Many of the employees are taught to turn the elderly in their beds to relieve pressure, presumably thereby lowering the incidence of pressure ulcers. According to Fossum et al., "pressure ulcers can be prevented if residents at risk are identified early and relevant preventive measures are implemented" (Fossum, et al.,, 2011, p. 2429).

Current research shows that, at least in nursing homes, employees have a cognitive nature concerning pressure ulcers (amongst other things) and the positive results from taking preventive measures. Much of the current literature espouses the fact that nurses are trained to do so, but there is not really a lot of specific information on