Translation Evidence Into Nursing Health Care Practice.

¶ … Translation Evidence Into Nursing Health Care Practice. Chapter 6, "Translation Evidence Leadership" Article: Bakke, C.K. (2010). Clinical cost effectiveness guidelines prevent intravascular catheter-related infections patients' hemodialysis.

Briefly summarize your selected issue and propose new evidence-based practice strategies.

Pressure ulcers, commonly known as bedsores, are frequently observed in otherwise healthy bed-ridden patients in nursing homes. To promote wellness amongst this patient population, it has been suggested that regular turning and positioning of the patients by caregivers should be used to reduce their occurrence. Turning and positioning has long been used amongst healthcare practitioners for a variety of bed-ridden patients, usually at regimented intervals spanning 4-2 hours (Thomas 2001). Based upon the previous research conducted upon this population, the suggested shortened interval is 1-11/2 hours for repositioning of the patient (Thomas 2001).

Q2. Describe the theoretical basis for your strategies.

The theoretical basis for this initiative lies in the idea that passive movement can reduce the friction caused by pressure ulcers given that sustained pressure is the main cause of pressure ulcers (Krapil & Gray 2008). Turning and repositioning has been the most commonly-accepted practice but there is no universally-agreed upon interval with which to practice such interventions. There is, however, limited evidence that longer durations between turning and repositioning (every four hours) is effective as shorter durations (as prescribed in this current study) (Krapil & Gray 2008). The purpose of this EBP is to demonstrate that more frequent intervals have a demonstrable impact upon reducing the presence of pressure ulcers.

Q3. Discuss the potential economic impact of your suggested strategies.

Having more frequent turnings and repositioning may require more staff on hand, given that the time to engage in such duties will result in an opportunity cost of time that could be used to perform other duties by caregivers in a nursing home. On the other hand, treating pressure ulcers is costly, and a reduction in their presence could significantly lessen the need to treat the health consequences caused by infection and discomfort. Typical treatment for pressure ulcers includes "management of local and distant infections, removal of necrotic tissue, maintenance of a moist environment for wound healing, and possibly surgery. Debridement is indicated when necrotic tissue is present" (Bluestein & Javaheri 2008). Not only is the treatment itself costly; the wear upon the elderly patient's health can also be traumatic from the treatment. Avoidance is always the best possible. Remedies are considerably more expensive than turning and require additional equipment and trained staff. Turning and repositioning is relatively simple and if shown to be effective it could obviate the need for investing in higher-cost care management.