Identifying practice issues and evidence-based solutions in healthcare

¶ … Practice Issue Evidence-Based Practice (EBP) Project in courses DNP program, asked

The practice issue I have chosen to explore is whether or not q2 hourly turning and positioning actually decreases the incidence of pressure ulcers in the elderly bed bound population in nursing homes. The conception that turning does help to relieve the pressure associated with these types of ulcers has been longstanding. Specifically, there is clinical evidence to indicate the fact that "Unrelieved pressure is a well-known clinical risk factor for ulcer development" (Salcido, 2004, p. 156). As such, the turning of patients at least every two hours has been carried on for quite some time in the nursing population, although there are some salient points of concern that need to be addressed with this issue.

One of the major things that individuals need to be aware of who take on such a practice is the fact that the actual turning and repositioning of patients is performed by two types of workers. Licensed nurses are expected to perform this duty, but they typically do so with the help of "unlicensed assistive personnel" (Leeds, 2004). The fact that there is a tandem effort involved in carrying out this procedure helps to underscore some of the difficulties and even hazards associated with it -- on the part of medical personnel. There are a number of patients who are overweight and who are heavy. Turning them -- especially at regular intervals -- can significantly harm individuals who are chosen for doing this task. A 2012 survey of 173 wound care nurses revealed that "74% of nurses said themselves or a co-worker has been injured due to repositioning of a patient" (WOCN, 2012).

In addition to helping to care for the individuals who have been charged with carrying out repositioning and turning nurses, it is important to realize that there are a number of specific tools that they can use to assist them in this process. Such tools include quantitative measurements such as the Braden Scale assessment which is a form of predicting pressure sore risk for patients. There is also valuable equipment that can assist to relive the sort of pressure that can cause ulcers. Such equipment includes mattresses, padding and specialized beds that are designed to provide comfort for individuals with wounds. This equipment can provide a valuable form of intervention that assist patients, and which works in conjunction with the traditional practice of turning patients every two hours.

There are also some aspects of q2 hourly turning that indicates that this practice may need some form of updating or revisions to successfully help patients with pressure ulcers. It is extremely noteworthy that the aforementioned 2012 survey reveals that despite utilizing pillows and other equipment to assist with turning and with the positioning of patients, "72% of nurses said their patients move out of position "very often" after a turn" (WOCN, 2012). There is also other research that indicates that turning individuals every two hours may not be sufficient. As an article by Leeds (2004) implies, "It is time to look more closely at this practice. Is turning patients every 2 hours really enough? Or should we be turning them more often" (Salcido, 2004, p. 156).