Wednesday, January 29, 2020
Pressure Ulcers in the Hospital Essay Example for Free
Pressure Ulcers in the Hospital Essay Introduction            Pressure ulcers remain a common health problem throughout the health care system. It has been conservatively estimated that annually 1 million adults develop pressure ulcers due to faulty nursing or care management. The incidence rates vary greatly depending on the health care sector. However, pressure ulcer incidence rates for hospitals range from 0.4% to 38%, for skilled nursing facilities from 2.2% to 23.9%, and for home health agencies 0% to 17%. The development of pressure ulcers occurs when there is sufficient progressive or reoccurring pressure over time to case capillary destruction, which in the end results to tissue necrosis. The development of a pressure ulcer or failure to prevent such condition from progressing to a more severe stage can result in negative consequences for the health care system (Fitzpatrick and Wallace, p.482). Nursing research has remained at the force-front in building knowledge-based related to pressure ulcer prevention. Pressure ulcers have become a quality issue for all areas of health care. The incidence and severity of the condition are used as markers of quality of care by agencies and acute care hospitals. This emphasis on pressure ulcers across the spectrum of health-care settings highlights the importance of the condition for clinicians (Sussman and Jensen, 2007 p.337). Pressure ulcer management can be based on clinical practice guidelines, which can be a source of enhancement for care plan development. The existing guidelines are broad based and general and, as such, for a good basis for wound care when the goal is comfort as well as healing (Coyle and Ferrel, 2005 p. 320). Purpose of Research            The purpose of the study is to illustrate the physiological relationship between wound healing and the occurrence of pressure ulcers in hospital work-settings in order to provide means to come-up with another research procedure. In this case, we have utilized various quality researches and validated supporting studies in order to illustrate probable connections. Critical analysis, comprehensive data integration, and interpretation of research outcomes are the founding methodologies applied in the course research. The value significance of this study provides awareness to the public especially in terms of what can these contributing factors impregnate to the condition occurrence. The relationship of wound healing and the occurrence of pressure ulcers are necessary knowledge contribution in the field of health care; since, this is one of the major quality indicators in the clinical setting. Problem and Rationale            Pressure ulcers or decubitus ulcerations are the result of mechanical injury to the skin and underlying tissues. The primary forces involved are pressure and shear, which is the perpendicular force or load exerted on a specific area causing ischemia and hypotoxia of the tissues. High-pressure areas in the supine position are the occiput, sacrum, and heels. In the sitting position, the ischial tubersosities exert the highest pressure, and the trochanters are afflicted in the side-lying position (Beck 2005, p.205).            As the amount of soft tissue available compression decreases, the pressure gradient, consequently, increases, and vise versa. The occurrence of these pressure ulcers are greatly manifested on bony prominences where there is less tissue for compression and the pressure gradient within the vascular network is altered easily upon compression. The changes in the vascular network allow an increase in the interstitial fluid pressure, which exceeds the venous flow. This results in an additional increase in the pressure and impedes arteriolar circulation. The capillary vessels collapse and thrombosis occurs. Increased capillary arteriole pressure leads to fluid loss through the capillaries; hence, tissue edema, and subsequent autolysis results. Lymphatic flow is decreased as well, allowing further tissue edema that contributes to the occurrence of tissue necrosis (Sussman and Jensen, 2007 p.337).            Unfortunately, there is substantial evidence to show that many patients develop their sores in hospital. Versluyen (1995) demonstrated that 66% of patients admitted with fractures involving hip developed pressure ulcers in hospital. This particular medical condition occurs almost exclusively among the elderly and involves immobilization for at least 24 hours. Areas such as accident and emergency, X-ray department, and theatres are all implicated in the causation of pressure sores as trolleys in these areas have been shown to generate pressures (Walsh and Ford, 1999 p.71).            Pressure ulcers are serious and frequent occurrence among the elderly, especially those who are immobile and debilitated. There are estimated 1.5-3 million Americans affected. A pressure ulcer will develop in approximately 5% of patients admitted to acute care hospitals. Studies have shown that 60% of pressure ulcers develop in the hospital, 18% in the nursing home, and 18% at home. Pressure ulcers prolong the hospital stay, and the pre-operative mortality rate is increased to 27%. The prevalence of pressure ulcers in the long-term care setting is reported to be 15-25% at the time of admission (Moylan, 2003 p.55). Obstacles and Solutions The problem of pressure development is a natural consequence of faulty health care management, poor health care quality, and negligence. Such condition is now associated, especially those with prolonged pressures, with contractures and/or shearing forces that frequently occur during transfers. Without diligent behavior modification related to skin inspection, and unless intervention strategies are employed to abort the process of skin breakdown, there will always be an open invitation to local, systemic, and generalized infection caused by pressure ulcerations (Whiteneck, 1993 p.231).Various proposed treatments in enhancing wound healing of pressure ulcerations are expensive and to be considered rare; hence, the treatment means may still be unrealistic. In this case, another research to enhance pressure ulceration healing is through the use of therapeutic air mattresses. According to the research of Sinclair and the group (2004), the utilization of air mattresses can further enhance the conditions of wound healing among pressure ulceration incidents. The proposed argument of the research involves the effectiveness of traditional turning and positioning protocols, which is evidently predominant in the nursing setting, and the therapeutic air mattresses. The study has covered elderly patients not less that 75 more than 75 years of age and in a condition of long-care term facility. Upon the progression of the overall research process, the results obtained do suggest that therapeutic mattresses are effective in preventing and healing ulcers. However, considering surface characteristics between beds utilized are still on the process of determining. Therefore, the clinically accepted practice of bed turning and repositioning still needs to be adhered until further research proves such intervention absolutely effective or otherwise (Sinclair, 2004).            However, further researches may be suggested especially in air mattresses’ effectiveness in providing healing enhancements as well as pressure ulcer prevention. Such procedure is more practical and publicly realistic than the other proposed treatment measures. Research in antimicrobial application for the benefit of pressure ulcers should be well researched again considering the number of subjects involved in the research. The implication of such methodologies in accordance to wound healing involves the utilization of bed mattresses as the most economic and nursing-care enhancing procedure for clinical setting. If such procedure is proven effective, nursing efforts of bed turning and repositioning shall be reduced significantly. If such procedure is proven effective, treatment measures on such condition can be enhanced in terms of cost-effectiveness and practicality. In general view, pressure ulcer occurrence in a particular clinical setting connotes decreased quality of care management; since, pressure ulcers are prevented acceptably through bed turning and repositioning; hence, such methods are essential. Prevention of pressure sores in the hospital is a complicated process involving the assessment of complicated factors and accordingly the recommendation of interventional strategies. The traditional idea that the nurse alone should be responsible for the prevention of pressure ulcers is therefore ineffective (Coyle and Ferrel, 2005 p. 320; Webster, 1991p.53). A team of nursing and medical staff responsible for this task can produce more effective outcomes in terms of preventing such pressure sore occurrences. Nevertheless, the nurse remains the most essential part of such a team and acts as the main source of information about patient condition (Webster, 1991p.53). Executive Summary and Conclusions The problem of the study is basically the occurrence of pressure ulcers among hospital setting, which on the irony, should not even occur due to the presence of clinical managers. The condition of pressure ulcer is basically caused by prolonged stationary immobility conditions of the patient, such as those with paralyzed conditions, unconscious, in coma, and basically immobile. With prolonged immobility, the parts of the body exposed to pressure, such as bony prominences (e.g. trochanters, hip area, scapular region, etc.) are the usual site for its occurrence. The etiological character of the pressure acts in two ways in order to induce the condition: (1) Obstruction of vascularization, which further impedes oxygenation of the area causing tissue necrosis, and (2) prevents healing process of the area. Pressure ulcerations have been a major health care problem as well as the indicators of adequate and proper delivery management of care. In such case, it is therefore necessary to maintain strict, adequate and the best possible appropriate intervention against the occurrence of pressure ulcerations. In the light or research developments progressing in the medical field, various wound enhancing treatments have been proposed in order to enhance the means of curing pressure ulcers. Hospital setting accounts as the highest place of occurrence of pressure ulcerations with percentage rates of 60% as of 2002 survey. The primary age group involved is the elderly individuals who are usually prone to immobilizing conditions, such as (CVA) Cerebrovascular Accident, cardiac problems, etc. With the impaired capacity of the patient to move, pressure accumulates in those sites afflicted; hence, inducing the condition of ulcerations or sore-formation. There are two basic rationales that cause the condition of pressure ulcers for the elderly: (1) aging conditions that impairs the skin integrity of the aged patients, which further predispose them from the conditions of pressure ulcers, and (2) degenerative conditions that cause their immobility. The obstacles of such condition occurrence involve the faulty care delivered by the health care managers (nurses and medical physicians). Hospital management is the prime essential intervener of the condition. In fact, clinical settings view that such condition depicts the status of health care system in the hospital. The justifications of such perspectives are based on the logic that nursing and medical interventions involved in this condition are the most basic procedure of health care field. The inadequacy of proving such care protocol is mainly the responsibility of the health care team. As with the standard protocol of bed turning and positioning, the patient obtains reduction of risks in terms of pressure ulcerations. However, nurses are not the only one involved in the care management of such condition but also the medical care team, although nurses are the primary managers of care delivery for this condition. With the advent of nursing research and enhanced interventions, air mattresses has been deemed to reduce the risks of bed sore formations. As the conducted study proposes, air mattresses reduces the pressure thus aiding in the partly oxygenation of the area exposed to pressure. Such action helps prevent and even slows down the progression of pressure ulcerations. However, due to the small population size of the research, further study has been advised. If the study is proven effective, this may provide decrease work load from the health care practitioners and also helps prevent or reduce the risk of progression of the condition. References Beck, J. C., Ferrell, B. (2005). Geriatrics Review Syllabus. Blackwell Publishing. Coyle, N., Ferrell, B. (2005). Textbook of Palliative Nursing. Oxford University Press Publishings. Fitzpatrick, J. J., Wallace, M. (2006). Encyclopedia of Nursing Research. Springer Publishing Publisher. Moylan, K. (2003). The Washington Manual Geriatrics Subspecialty Consult. Lippincott Williams Wilkins. Rai, G. S., Mulley, G. P. (2002). Elderly Medicine: A Training Guide. Informa Health Care. Sinclair etal, H. J. (2004, February). Do Therapeutic Mattresses Enhance the Healing of Pressure Ulcers in the Frail Elderly Population?. American Journal of Nursing, 62, 243-2451. Sussman, C., Jensen, B. (2007). Wound Care: A Collaborative Practice Manual. Lippincott Williams Wilkins. Walsh, M., Ford, P. (1999). Nursing Rituals, Research and Rational Actions. Elsevier Health Sciences. Webster, J. G. (1991). Prevention of Pressure Sores. CRC Press. Whiteneck, G. G. (1993). Aging With Spinal Cord Injury. Demos Medical Publishing.
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