Assignment: Evidence-Based Pressure Ulcer Prevention Paper Assignment: Evidence-Based Pressure Ulcer Prevention Paper Abstract: This paper aims to discuss the literature pertaining to early pressure?shear induced tissue damage detection, with emphasis on sub?epidermal moisture measurement (SEM). The current method for pressure detection is visual skin assessment (VSA); however, this method is fraught with challenges. Advances in early detection of pressure ulcers are reported in the literature and mainly involve measuring inflammation markers on weight?bearing anatomical areas in order to capture the first signs of tissue damage. One novel technique currently in use is SEM measurement. This biophysical marker is the product of plasma that leaks as a response to local inflammation arising due to pressure?shear induced damage over bony prominences. The early detection of tissue damage is beneficial in two different ways. First, it enables early intervention when the damage is still microscopic and reversible and, therefore, has the potential to prevent further aggravation of healthy surrounding tissue. This arises by avoiding the causation of the problem and stopping the knock?on effect of inflammation, especially when the rapid pressure ulceration pathway of deformation is in place. Second, when the slow ischaemic?reperfusion related mechanism is undergoing, cell death can be avoided when the problem is identified before the cell reaches the ?death threshold,? completely averting a pressure ulcer. https://doi.org/10.1111/iwj.13437 Pressure Ulcer is commonly experienced by hospitalized adults. This skin condition is otherwise known as bed sores to which the patients skin as well as its underlying tissue breaks down due to pressure caused by prolonged non-movement of the affected skin areas. It provides discomfort to the patient especially to those who have medical conditions, which disable them from changing position. Pressure Ulcer can develop rapidly. However, there are several things that can help in prevention and help the patient in the healing process. The purpose of this paper is to develop a plan as to how the Pressure Ulcer can be prevented based on the evidence presented in the articles including the identified solution to the problem. The change plan will help the development of nursing practice when it comes to Pressure Ulcer and suggests that repositioning and turning the patient constantly will help in preventing the occurrence of this skin condition. Assignment: Evidence-Based Pressure Ulcer Prevention Paper ORDER Assignment: Evidence-Based Pressure Ulcer Prevention Paper Change Plan Using John Hopkins EBP Model Overview The John Hopkins Nursing EBP model or JHNEBP is a framework that is used to guide the translation of gathered evidence into practice (Buchko, 2012). It has encompasses three nursing foundations such as education, practice, and research. Nurses should use this model to as a guide to facilitate change because it includes both non-research and research evidence as they create basis for nurses decision making. Thus, this model also proves that both external and internal factors should be put in consideration before existing nursing practice may be changed. Practice Question Step 1?? Recruiting inter-professional team will be composed of nurses, attending physician, and nursing aid. Step 2?? The Evidence-Based Practice (EBP) question is ?Do frequent turning of patients lead to reduction of occurrence of pressure ulcers in hospitalized adults?? For PICO elements, it is identified that (P) is the hospitalized adults that suffer from Pressure Ulcer; (I) would be the intervention approach of the problem, which is the frequent turning of the patient to prevent or recover from Pressure Ulcer symptoms; (C) is the considered alternative in treating the Pressure Ulcer such as using special cushions and mattresses, which can help in relieving the pressure in affected skin areas; and (O) pertains to the gradual healing of skin tissues that suffered from Pressure Ulcer. Step 3 ? Pressure Ulcer prevents the patient from a complete recovery as it provides addition pain due to damaged skin tissues. Cases of Pressure Ulcer continue to increase. In fact, Sullivan (2013) says that it increased by 80% between 1995 and 2008. Not only in the hospital, but residents of nursing homes also suffer from Pressure Ulcer and was reported that there was an approximate of 11% case increase in 2004 (Sullivan, 2013). This problem affects the healthcare on a broader scale. It provides additional healthcare facility costs, which may not be covered as it is a hospital-acquired health condition. Thus, the overall nursing practice will be more challenging due to the occurrence of Pressure Ulcer among adult patients. Assignment: Evidence-Based Pressure Ulcer Prevention Paper Steps 4 and 5?? The team, which is composed of nurses, attending physician, and nursing aid will have their vital roles in achieving the targeted design for change. They are important as they hold different responsibilities. The nurses are responsible for ensuring that existing Pressure Ulcer will not become worse by constant checking the affected skin. The attending physician is responsible for knowing if there would be any other medical implication due to Pressure Ulcer occurrence. He is also responsible for providing additional medication, if needed, besides the existing medical condition. The nursing aid is responsible for providing assistance when it comes ensuring that the patients affected skin areas are well-ventilated through constant repositioning of the patients body. In combining their essential roles and responsibilities, prevention and treatment of Pressure Ulcer will be easier to achieve. Evidence Steps 6 and 7 ? The change plan is supported by evidence to which the guidelines of handling patients with Pressure Ulcer are presented. Whitney et al. (2006) say that Pressure Ulcer is one of the challenges of health care providers. The change plan plans to prevent the increasing occurrence of such skin condition to which the articles stated that there were almost 3 million patients affected in the United States alone (Whitney et al., 2006). The research encompasses insights from clinical experts as well as their opinion about the problem. Scientific evidence were also presented in the research such as proper patient positioning, nutrition, support surfaces, preparation of wound bed and dressing, and the underlying principles that were developed per category. The researchs quality improvement data was presented in a form of various guidelines and nursing principles. One of the strength of this research is its ability to provide detailed guidelines as to how the Pressure Ulcer can be handled accordingly without providing additional sufferings to the patient. It also highlights the principle behind every guideline in order to explain why such guideline must be followed during the treatment process. Steps 8 and 9 ? The evidence shows that frequent turning of patients will help in the reduction of the occurrence of Pressure Ulcer. There are various articles that presented the similar views and presumptions pertaining to the proper treatment of Pressure Ulcer. Kaitani, Tokunaga and Sanada (2010) suggest that there are risk factors that are related to the occurrence of Pressure Ulcer especially in critical care setting. One of the risk factors may start during the admission stage of the patient. The critical care setting involves medical conditions that will decrease the patients ability to move and change position from time to time. Therefore, it is important to know that at the beginning of admission stage, health care providers must be aware that the occurrence of Pressure Ulcer is high. In fact, almost 40 percent of the patients who suffer from Pressure Ulcer are the ones who are in the critical care setting or intensive care unit (Kaitani, Tokunaga & Sanada, 2010). Assignment: Evidence-Based Pressure Ulcer Prevention Paper The authors concluded that that there is no connection between the occurrence of Pressure Ulcers among patients and the involve medication. Therefore, the frequency of positioning and turning the patient especially in the ICU is a prognostic indicator as to whether Pressure Ulcer will occur. This is also to reduce the probability of extended admission of the patient in the hospital. The redistribution of the pressure is the main goal of repositioning the patient in order to prevent the occurrence of Pressure Ulcer. Sprigle and Sonenblum (2011) assert that such skin condition occurs when there is a constant pressure on the affected skin area. That is why; it is essential to conduct a pressure magnitude management through postural supports and support surfaces as well as proper body posture. This approach can be done through weight shifting and turning frequency including the use of dynamic surfaces (Kaitani, Tokunaga & Sanada, 2010). Besides frequent turning, positioning device can also help in distributing the weight of the patient and improving the blood flow on skin surface. Therefore periodic repositioning of the patient combined with the positioning device are two important preventive methods against Pressure Ulcer and ideal supporting treatment procedure for existing Pressure Ulcer. Generally, the standard turning by nurses in intensive care unit or ICU does not consistently unload all the areas of skin-bed interface pressures (Peterson et al., 2010). The standard of handling patients with Pressure Ulcer is to prevent most of the skin areas to be under pressure to avoid tissue damage. However, evidence shows that even with the presence of frequent turning and repositioning is not a guarantee that Pressure Ulcer will not occur as there are still skin areas that are at risk of tissue breakdown (Peterson et al., 2010).Assignment: Evidence-Based Pressure Ulcer Prevention Paper Conversely, using the support materials is also not an assurance to prevent the occurrence of this skin condition. Such materials for maintaining the patients turned position may also influence the tissue unloading, which may jeopardized the affected areas. Therefore, it is presumable that there is still a gap between the theory and practice when it comes to Pressure Ulcer management. Moore (2010) says that besides the increased length of stay in the hospital, Pressure Ulcer may also increase the health service costs. However, such condition is preventable through proper management in order to provide strategically-planned health service. One of the strategies that can be used is the 30 degrees tilting of the patients body to avoid too much pressure on the skin (Moore, 2010). Based on the evidence presented, repositioning the patient who is at risk of Pressure Ulcer every three hours using this tilt technique will reduce the possibility of Pressure Ulcer occurrence. Step 10 ? Based on the gathered evidence, the recommendation to prevent potential Pressure Ulcer is to conduct a constant turning of patient every 3 to 4 hours depending on the patients body weight. The heavier the patient is the shorter the time interval must be applied in repositioning the patients body. Thus, it is also recommended that patients, especially adults in ICU department must use positioning materials if possible. In this case, the bodys weight will be distributed evenly along with the frequent turning technique. It is also recommended to apply the 30 degrees tilt on the patient so that the weight will not produce too much pressure on the skins interface. Thus, the gravity pull will not be focused on the pressured area. Steps 11, 12, 13, and 14?? The plan for implementing the change will be based on the steps that need to be followed. Important procedures must emphasize on the implementation stage. This will be followed by the importance of conducting such procedures based on the evidence, which will also be presented. There will be a specified timeline to ensure the smooth transition for old to standard practice to developed change plan. For the first quarter of the year, an initial outcome will be evaluated using statistical reports of occurrence of Pressure Ulcer. A ratio between the number of patients and Pressure Ulcer occurrence will be the basis of quarterly reports, which are targeted to decrease after the fourth quarter. The reports will include the total number of patients within the first three months, patients at risk of the skin condition, and the number of repositioning done in every patient. Steps 15 and 16?? The desired outcome of the proposed change is to reduce the occurrence of Pressure Ulcer among adult patients especially in the critical care setting or ICU. It also aims to increase the awareness of techniques on how to apply the recommended strategies of the health care workers. The outcome will be measured based on the reports filed by the nursing staff, which is done separately from the existing medical condition of the patient. The results will be reported to the stakeholders in a quarterly basis, emphasizing how the strategies were conducted and what the specific results were. Step 17 ? The plan will be implemented on a larger scale to which other units will be included. The plan will primarily start on the intensive care unit for the first quarter and will also be implemented to regular hospital ward after the first three months. To ensure that the plan will be implemented permanently, it will be raised to the office of the director to be one of the standard procedures of the hospital. Therefore, whether or not the patient is in ICU, constant monitoring of potential Pressure Ulcer will be part of the nursing round.Assignment: Evidence-Based Pressure Ulcer Prevention Paper Step 18?? Findings will be disseminated internally through monthly meetings to provide developments after the implementation. On the other hand, it will be externally disseminated by providing its advantages to other hospitals and healthcare setting. If possible and available, strategies, techniques and findings will be published on the hospitals website to spread awareness throughout the concerned public. ORDER INSTRUCTION-COMPLIANT PAPERS HERE Conclusion Pressure Ulcer is an important problem that every health care provider must be aware of. The evidence presented is clear representation that such condition is preventable. Thus, should not be the reason for patients to extend their hospital confinement. The change model will ensure that every involved healthcare professional will be responsible in ensuring that the Pressure Ulcer will be prevented and treated accordingly to those who are already suffering from it. The three levels of change based on John Hopkins EBP process are essential aspects for the implementation of the change plan. Understanding the practice question would be the foundation of the process to which PICO elements will be analyzed for the success of change plan. On the other hand, the evidence will be the basis of the change plan as to how the and why the change plan is needed for the improvement of health service. Thus, the translation is the period to which the implementation will take place. It is essential to have these three levels of change so as to develop a strategic plan of the proposed change. In this case, once the plan has been implemented and permanently practiced, the occurrence of Pressure Ulcer will significantly decrease, which will help in the patient in the treatment process. Assignment: Evidence-Based Pressure Ulcer Prevention Paper References Buchko,B.L., & Robinson,L.E. (2012). An Evidence-based Approach to Decrease Early Post-operative Urinary Retention Following Urogynecologic Surgery.?Society of Urologic Nurses and Associates,?32(5), 260-264. Kaitani,T., Tokunaga,K., Matsui,N., & Sanada,H. (2009). Risk factors related to the development of pressure ulcers in the critical care setting.?Journal of Clinical Nursing,?19, 414-421. Moore,Z. (2010). Bridging the theory-practice gap in pressure ulcer prevention.?British Journal of Nursing,?19(5), s15-8. Peterson,M.J., Schwab,W., Van Oostrom,J.H., Gravenstein,N., & Caruso,L.J. (2010). Effects of turning on skin-bed interface pressures in healthy adults.?Journal of Advanced Nursing,?66(7), 1556-1564. Sprigle,S., & Sonenblum,S. (2011). Assessing evidence supporting redistribution of pressure for pressure ulcer prevention: A review.?Journal of Rehabilitation Research & Development,?48, 203-214. Sullivan,N. (2013). Preventing In-Facility Pressure Ulcers. In?Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. Rockville City, MD: Agency for Healthcare Research and Quality. Whitney,J., Philipps,L., Aslam,R., Barbul,A., Gittrup,F., Gloud,L., . . . Robson,M.C. (2006). Guidelines for the treatment of pressure Ulcers.?Wound Healing Society,?14, 663-679. Assignment: Evidence-Based Pressure Ulcer Prevention Paper Order Now

ADDITIONAL INFORMATION

Evidence-Based Pressure Ulcer Prevention

Introduction

Pressure ulcers are wounds that occur when a part of the body is under constant pressure. They can be an embarrassing and expensive problem to treat, but they’re preventable. This article will help you learn how to prevent pressure ulcers by identifying and treating risk factors.

Prevention is important and more cost effective than treating pressure ulcers.

Pressure ulcers are the most common type of burn and they can lead to long-term complications. They affect nearly 300,000 people each year in the United States, with over 2 million Americans suffering from them every year.

The costs associated with treating pressure ulcers are high. According to one study, the average cost per patient for treating a pressure ulcer is $5,912 per patient (2015). Additionally, additional health care costs due to complications related to pressure ulcers have been shown to be up to $12 million per year (Vital Health). These figures do not include lost productivity or decreased quality of life due to injuries that result from these wounds!

Prevention strategies like implementing evidence-based practices can save you money while improving your chances of preventing future injuries from occurring—and ultimately saving lives!

Risk Factors

Risk factors for pressure ulcers include:

• Age. Pressure ulcers are more likely to develop in older people, who have more skin damage and a higher risk of falls.

• Skin integrity. Pressure sores are typically caused by poor skin integrity (skin that has been damaged), which makes it more prone to tears and rips that can lead to infection.* Mobility impairment or immobility (for example, bed-rest) may also increase your risk of developing a pressure sore.* Obesity is another possible risk factor because it increases the amount of tissue around a wound that can be damaged by pressure.* Other factors that may increase your risk include: * Incontinence problems, such as bowel incontinence; this can make you more likely than other people with similar conditions not only because it causes an increased urine loss but also because it causes frequent coughing which increases the force exerted on your lower back muscles during standing up from sitting down at work or home.

– Immobility

Immobility is a risk factor for pressure ulcers. It can be caused by many things, such as surgery, stroke or paralysis. The longer you’re immobile, the higher your risk of developing a pressure ulcer.

– Aged skin (thin, fragile, easily injured)

• Skin is the body’s largest organ.

• It covers the entire surface of your body, except for your genitals and nose.

• It protects you from bacteria, viruses and other foreign objects that could harm you.

Skin also has many functions in addition to protecting us against germs: it acts as a protective barrier between our bodies and the outside world; it collects nutrients from food we eat; it regulates body temperature through sweating or shivering (which helps keep us cool in summer); while at rest or inactivity, it converts energy into heat via respiration (breathing).

– Incontinence

Incontinence is a risk factor for pressure ulcers. It can be caused by physical disability or psychological factors, but both types of incontinence are common among people with diabetes and other chronic conditions.

Incontinence can be managed with medications and/or lifestyle changes such as increasing activity levels, avoiding constipation, wearing supportive underwear (such as cotton), using bathroom accessories such as a toilet seat cover or weighted garment to help prevent straining when sitting down to urinate or defecate).

– Decreased nutrition

• Poor nutrition can cause anemia. Anemia is a disease that occurs when there isn’t enough red blood cells in your body, which can lead to fatigue and fainting.

• Poor nutrition can cause skin to be thin, fragile and easily injured. Skin is made up of three layers: epidermis (the top), dermis (the middle) and subcutaneous fat (the bottom). If you have poor nutrition or lose too much weight, you may experience wrinkles on your face as well as dryness or flaking skin on other parts of your body such as feet or hands due to lack of moisture from adequate hydration levels within the body tissue itself.”

– Blood flow problems (low blood pressure, anemia, vasoconstriction, diabetes)

Blood flow problems (low blood pressure, anemia, vasoconstriction) can cause pressure ulcers. This is a common condition that occurs when your blood circulation doesn’t work properly and causes swelling from the inside out. Blood flow problems are caused by a number of conditions such as diabetes, heart disease and kidney disease. Treating these conditions will help to improve your overall health and prevent future problems with high blood pressure or low oxygen levels which in turn can lead to more serious health issues like heart failure or stroke if left untreated for too long.*

Signs and Symptoms of a Pressure Ulcer

The signs and symptoms of a pressure ulcer include:

• Redness. This may be visible, or it may be more subtle, such as an increased color of the skin or a feeling of warmth in the area where you are feeling pressure on your skin.

• Warmth. Pressure ulcers can sometimes cause areas of your body to feel hotter than normal at times when they should not be hot, such as when lying down or applying heat to them after being in bed for a while without moving around much..

• Swelling/Tenderness/Pain/Itching (red and warm). These are all common symptoms related to pressure ulcers that need treatment right away! They should definitely not be ignored because if left untreated for too long then permanent damage could result from infection developing into gangrene which would require surgery again!

– Vary depending on the stage of the wound (see illustrations below)

• Stage 1: The skin is intact and does not have any visible signs of damage.

• Stage 2: The surface of the wound has become dry, scaly and hard to the touch. This stage can be further divided into three sub-stages:

• Stage 2A ( dry): The wound is moist but flaky, with no blood or pus present.

• Stage 2B ( wet): There may be some bleeding from this stage but it’s minimal compared with other forms of infection that can occur during this point in time.

• Stage 3: The entire area surrounding an ulcer has become inflamed with redness, swelling and pain that makes sitting uncomfortable – especially after prolonged periods of standing or lying down at night when you wake up feeling sore everywhere except your lower back where there isn’t much tenderness due to its location being higher off ground level than where most people sleep on their backs due to gravity pulling everything down towards Earth’s center rather than up away from it like would happen if one were laying flat on top instead!

Conclusion

Pressure ulcers are a common problem that can be prevented. While they are extremely painful and disabling, they occur most frequently in people who are very old or who have been lying immobile for long periods of time. These individuals often do not recognize the signs of an early pressure ulcer, since it is rarely visible to those who do not experience them firsthand. The best way to prevent this type of wound is by following a few simple guidelines: keep yourself hydrated; avoid smoking; stay active and move around every day; eat healthier foods; use compression stockings if needed; get medical attention for any wounds or sores on your feet as soon as possible (ideally within 24 hours).

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