In my professional practice in the field of clinical nursing, I have come across several challenges as far as care of critically ill patients is concerned. It has come to my realization that hospital-acquired pressure ulcer poses one of the most serious challenges to the wellbeing of patients. The complexity of modern healthcare has generated new demand in the nursing practice, with the rising need for nurses to extend the scope of their skills and knowledge to cope with the situation. A pressure ulcer, especially the hospital-acquired one, has emerged as one of the greatest challenges of this century as far as clinical care is concerned. Several efforts have been made in line with the regulatory level to minimize the occurrences of hospital-acquired pressure ulcers. However, the problem persists as patients in healthcare facilities continue to undergo immense pain. This paper presents a focused reflection on environmental, clinical, and professional barriers that pose challenges to the significant reduction of hospital-acquired pressure ulcers. It also discusses the use of tools and guidelines to effectively manage acquired pressure ulcers.
A complication of Pressure Ulcer
Agency for Health Care Research and Quality classification places pressure ulcers under “lesions caused by unrelieved pressure, resulting from the damage to underlying tissue” (Ellen & Gerrity, 2005, p.189). There are wide ranges of documentation on pressure ulcers and despite the increased knowledge and skills associated with its management; it has remained a common problem within many hospitals around the world as its complications continue to rise.
One of the most common complications associated with pressure ulcers is sepsis. It is considered the most serious complication, as it becomes the main source of infection especially when bacteremia is present in the body of the patient (Nolan & Schall, 2007). Other complications are localized infection, cellulitis, and osteomyelitis, which may highly affect the patient in the long run as their impacts could be cumulative. Mortality may also result from pressure ulcers as patients with non-healing complications are likely to have difficulty in developing concrete immunity to other opportunistic diseases. Studies suggest that about 60% of the elderly people discharged after pressure ulcers end up dying within one year (Nolan & Schall, 2007; Tippett, 2009).
Prevention of Pressure Ulcer
The first step for preventing pressure ulcers is increasing the frequency of repositioning (Nolan & Schall, 2007). A study conducted in one of the major hospitals suggested that repositioning bedridden patients after every four hours reduced the probability of pressure ulcer infections (Ellen & Gerrity, 2005). The other way of preventing pressure ulcer prevalence is through the improvement of nutrition, such as frequent use of mixed food supplements that contain all the elements needed for healthy leaving. Lastly, general skincare is paramount, hence preventing clogging of blood and moisture. In general, the most important approach to the prevention of pressure ulcers is the improvement of mobility.
Risk Factors of Pressure Ulcer
There are identified risk factors associated with care for patients who suffer from a facility-acquired pressure ulcer. The first one is the protocols that require patients to sit for several hours as part of the treatment regimen. Sometimes patients may spend extended periods lying or sitting, such as radiology or dialysis. The other problem is the lack of ability of some professional nurses, inadequate opportunity to learn the needed knowledge and skills, and the inconsistency in implementing the identified plans (Poolock, Legg, Langhorne & Sellars, 2000). Studies have also suggested that patients who have suffered from sensory loss due to spinal cord infection are highly at risk of developing pressure ulcers (Ellen & Gerrity, 2005). Others are involuntary weight loss, moisture that removes oil known to protect the skin from further damage; and general malnutrition. This immobility has been found to increase the chances of pressure ulcer attacks.
Classification of Pressure Ulcer
It is noted that the most common group affected by pressure cancer are the elderly and those patients whose mobility has been impaired in one way or the other. It, therefore, means that as the population ages, there is the possibility that the number of patients suffering from pressure ulcers will increase. The impact is that the quality of clinical care is compromised as well as the problem with an unprecedented increase in the cost of treatment. I have come across several cases of health facilities that have faced legal tussles and regulatory charges as far as management of pressure ulcers is concerned. In other words, many of these hospitals have faced numerous costs related to limited management of cases of pressure ulcers. This has led to the need to classify pressure ulcers. However, the classification is done based on the depth of tissue damage, with stages underlined from 1 to 4. These stages are categorized as under the ease or difficulty in the observable effects.
Treatment of Pressure Ulcer
To improve the management and treatment of pressure ulcer patients in a hospital environment, the first approach is to develop a structure that would ensure multidisciplinary teamwork with consistent vigor to achieve the goals needed. Studies show that although many hospitals have attempted to organize a multidisciplinary team to implement the programs, there has been a significant lack of inconsistency in the entire process. The infrequency with which the process is being applied has been a major barrier; even as it is evident that close adherence to the interdisciplinary team can be significantly successful in the long run (Nolan & Schall, 2007).
Recently published reports suggest that increased pressure ulcer prevalence needs an upgrade of the standards used in the management of wounds, especially on the national and international guidelines (Tippett, 2009). These reports also suggest that the laid down guidelines steered the reduction of pressure ulcers. However, the sporadic implementation lacks focus as far as accurate and consistent implementation is concerned. For instance, the guidelines provided by the European Pressure Ulcer Advisory Panel and American National Pressure Ulcer Advisory Panel, a consortium of experts from the US and Europe targets nurses working in diverse and advanced nursing roles. The document dubbed, “Clinical Practice Guideline” has provided a detailed guideline, with analysis of research findings, and adequate evaluation of various assumptions as far as research and analysis is concerned (Tippett, 2009). The main goal of the consortium was to develop an effective and evidence-based procedure to be applied by all advanced nurses around the world.
While this guideline may be sufficient, it is evident that deciding what is appropriate for all nurses and patients all over the world may be a tricky affair because understanding the roles of nurses differs and a uniform consensus is difficult to come by. It has been found out that this is one of the major barriers to the consistent application of the guidelines. It has therefore led to an increased number of guidelines adopted by different regional and national organizations. The best approach would be for the hospitals to identify specific guidelines, and apply them to the maximum to improve consistency, thus reliability.
General Strategies for Prevention
The other area where inconsistency existed most was in the external environment after the wound management program has been implemented. This was mainly common after the change in characteristics of many patients, either by age or reaction to the treatment and hospital environment by some patients. The processor protocol of admission, treatment, and assessment is critical, hence the need to follow properly designed guidelines as per the required standard of care. The standard of care as per the joint international guideline is based on the continuous monitoring of skin hygiene, which involves regular inspections (daily), and standardized monitoring of the process. According to Schober & Affara (2006), physical acts such as a gentle touch at the skin of the patient is critical as it enhances the process of care, although it is not easy to quantify the whole process of care as per the guidelines.
The approved tools for the care process are based on the fact that many patients affected by this process are those who are aged or frail and bedridden. The evidence-based guideline supports “the use of pressure support surfaces for beds and chairs as well as turning and repositioning immobile, inactive persons to prevent pressure ulcers” (Tippett, 2009, p.88). It is suggested that this approach is based on the belief that most of the processes involve reducing the disturbance of patients, as well as making them more active in the process of patient management. Lastly, it is provided that nurses continue to go through a rigorous training process so that they can adjust to the increased changes that occur in the nursing procedures. This will equip them with various changes that occur, especially as concerns cultural and age dynamics.
Reference List
Ellen, P., & Gerrity, R.N. (2005). Care Management and Wound Care: The Expanding Role of the Care Manager in the New Millennium and Opportunities for Collaboration and Innovation. Home Health Care Management Practice, Vol.17, No.3, 175-182.
Nolan, K., & Schall, M. (2007). Spreading Improvement Across Your Health Care Organization. London. Joint Commission Resource.
Poolock, A., Legg, L., Langhome, P., & Sellars, C. (2000). Barriers to Achieving Evidence-Based Stroke rehabilitation.Clin.14; 611-617.
Schober, M., & Affara, F. (2006). Advanced Nursing Practice. Hong Kong. Blackwell.
Tippett, A.W. (2009). Reducing the Incidence of pressure ulcers in nursing home residents: a prospective 6-year Evaluation. HMP Communication, Vol. 55, Issue 55 (11), 52-58.