The process of quantifying and measuring the aspects of a healthcare problem is often challenged with various problems. Some of them may be limited by patients’ lack of understanding and participation, while others will present clinicians with ethical concerns about anonymity and confidentiality. In the care of pressure ulcers, scholars find multiple ways to calculate their rate, including such concepts as incidence and prevalence as the primary approaches (Berlowitz, 2014).
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Nurses may encounter some of the mentioned above problems as well as some unique issues. For example, the definition of the condition called “pressure ulcer” may differ from one practice to another (Fletcher & Hall, 2018). Furthermore, the way of information gathering also impacts the authenticity of the final results. The multitude of descriptions and calculations poses another problem – the lack of reliable national data about the rates of pressure ulcers which can be used for comparison.
Identified Measures, Challenges, and Literature
The strategies to pressure ulcer measurement include their incidence and prevalence. According to Berlowitz (2014), these two approaches are the main ways in which hospitals and researchers may record the necessary data. Incidence, in this case, refers to the number of patients who have acquired a pressure ulcer during their stay in the medical facility where the data collection happens (Berlowitz, 2014).
This measure does not include patients who were admitted to the hospital with ulcers. Thus, this number allows the organization to see how bedsores form in this particular practice. The approach of calculating incidence may reveal the quality of care in the facility and determine how patients are treated by the staff (“How do we measure,” 2014). The second strategy is to measure prevalence – the overall number of patients with pressure ulcers in the practice (Berlowitz, 2014). As one can assume, this calculation yields a total number of all patients with pressure ulcers, regardless of the time of development.
Although these calculations seem straightforward, they present medical professionals with some issues. First of all, there exists an issue of defining pressure ulcers and their stages. This problem is international – Fletcher and Hall (2018) find that many clinics in the UK do not use a unified system of documenting bedsores which significantly affects the rates. Berlowitz (2014) also provides such terms as “moisture-associated dermatitis” and “sacral and gluteal lesions” which are still confused with pressure ulcers.
The scholar notes that the change in definitions introduced in 2007 by the National Pressure Ulcer Advisory Panel (NPUAP) leads to a substantial difference in numbers between the periods of measurement before and after that date. Second, there exist different ways of collecting data about pressure ulcers. Therefore, the reliability of these strategies also varies and poses unique challenges. For instance, physical examinations are reliable but time-consuming and difficult, requiring sufficient funds and each patient’s consent. On the other hand, available medical records are simple to use, but they are unreliable.
The abundance of different approaches creates gaps in available knowledge. The Agency for Healthcare Research and Quality (AHRQ) notes that reliable national benchmarks do not exist (“How do we measure,” 2014). State measurements use observed and expected numbers of bedsores instead of relaying the problem’s incidence rates (NYS Health Profiles, n.d.). Some articles show the incidence of pressure ulcers such as the research by Gardiner, Reed, Bonner, Haggerty, and Hale (2016). Although their sample is not very recent, it can be used as a foundation for other studies. Nevertheless, it also does not supply one with a reliable average for comparison, increasing the need to use many scholarly sources.
The research for improving the occurrence of pressure ulcers in a practice setting requires reliable and measurable data. One can use such calculations as incidence and prevalence of bedsores. For this particular research, the incidence is the most useful number as it demonstrates the quality of care in the facility. Such issues as the definition of a pressure ulcer and the way of obtaining information create challenges for nurses engaged in the study. Moreover, the lack of a national benchmark also limits the scope of available knowledge.
Berlowitz, D. (2014). Incidence and prevalence of pressure ulcers. In D. R. Thomas & G.A. Compton (Eds.), Pressure ulcers in the aging population: A guide for clinicians (pp. 19-26). Totowa, NJ: Humana Press.
Fletcher, J., & Hall, J. (2018). New guidance on how to define and measure pressure ulcers. Nursing Times, 114(10), 41-44.
Gardiner, J. C., Reed, P. L., Bonner, J. D., Haggerty, D. K., & Hale, D. G. (2016). Incidence of hospital-acquired pressure ulcers – A population-based cohort study. International Wound Journal, 13(5), 809-820.
NYS Health Profiles, (n.d.). Pressure ulcer. Web.