Clinical question
Patients who critically ill require nurses to have skills that ensure patients have the best outcomes. Quality care entails the provision of compassionate and holistic care requires the health care team to be equipped with critical thinking and scientific skills Allen-Duck et al., 2017). The skills assist the healthcare team in identifying patient's needs, planning for care, and providing interventions that restore and promote health. As nurses, we stay mostly with the patients during their hospitalization. This paper aims to present the causes of pressure ulcers among critical care patients and provide evidence–based solutions for nurses and other healthcare professionals in practice.
About 3 to 34% of patients admitted to critical care units are at risk of developing hospital-acquired pressure injuries (Nedergaard et al., 2018). Early assessment enables the caregiver to detect these ulcers and initiate treatment before developing or entering into advanced stages. However, decubitus management is difficult in most facilities because they are usually diagnosed when the patient skin integrity is worse.
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According to the study conducted by Nedergaard et al. (2018), critically ill patients possess the highest risk of developing pressure ulcers. Pressure injuries are more prevalent in critical care units due to prolonged positioning, severe illnesses and medications affecting tissue perfusion, altered intake of nutrients due to comma, and prolonged sedation. The study also shows that about 7 to 8% of patients with pressure ulcers develop paraplegia. Globally, more than 60000 patients in critical care units die annually due to pressure injuries. Patients with decubitus at 4 to 5 time’s greater risk of dying than people with similar conditions and risk factors but without pressure ulcers. However, using the evidence-based approach, the complications and mortalities can be reduced significantly.
During care delivery, various interventions are required to achieve specific desired outcome. We focus on ideas, activities, or processes that differ from the standard in practice during the intervention stage. Comparison, on the other hand, refers to seeking differences between the treatment and the comparison groups. Finally, Outcome refers to the effects that the interventions are designed to achieve. Therefore, we use PICOT to outline the process, identify the study population and problem, and deliver accurate and reliable evidence-based practice facts.
Levels of evidence
Evidence-based practice refers to the process of collecting and analyzing data to provide practical solutions that can achieve the best outcomes in a given profession. In nursing practice, we use evidence-based practice to analyze the existing clinical problem, using well-designed clinical studies and surveys to prove patient preferences and values (Khojastehfar et al., 2020). By analyzing the current clinical situation, we use a problem-solving approach that uses the evidence generated and expertise experience to make clinical decisions concerning patient care. The practice also makes the caregivers knowledgeable about what they need to focus on during patient care.
The high incidence of pressure ulcers among patients in intensive care units requires vigilance and evidence-based practices for the best patient outcomes.
Search strategy
Search terms included quality, high-risk patients and interventions.
Nurses attending to patients in intensive care units must conduct risk assessments for pressure ulcer development on every patient admitted in critical units. There are several risk assessment instruments that we should use to predict high-risk patients on admission. (Gaspar et al., 2019). However, some of the scales have been failing to meet the sensitivity and specificity criteria. Therefore, as the nursing team, we should be careful when selecting the test scale to choose the most appropriate and specific patient. For intensive care patients, we should use Jackson and Cubbin scale to predict the probability of developing pressure ulcers. Patients with higher scores require more vigilant observations to promote the best outcomes for them.
Skincare is the first evidence-based activity that prevents the development of ulcers in areas under constant pressure. The skin should be cleaned with soap and kept clean. We remove small particles and debris during skincare that cause minor cracks on the skin, further developing into deep wounds.
Position changing is another critical intervention that we should embrace to prevent decubitus (Khojastehfar et al., 2020). We should change the patient's position depending on the individual patient's needs and the risk assessment score. Evidence recommends that the patient's head be tilted to an angle of 30-40o to avoid long-lasting pressure on the sacrum, a common site for pressure development. However, we must turn the patient every 1-2hours or even shorter, depending on the patient's condition. We must massage the areas to restore circulation for an adequate supply of nutrients and oxygen to the affected areas.
Conclusion
The best approach for preventing pressure ulcer formation begins with a risk assessment to identify individuals most likely to develop pressure ulcers. The patient's assessment score guides the caregiver on the approach of preventing pressure injuries. The key activities used include positioning and turning, good skincare, adequate nutrition, hydration, and caregivers' training.
References
Allen-Duck A, Robinson JC, Stewart MW. Healthcare Quality: A Concept Analysis. Nurs Forum. 2017 Oct;52(4):377-386. doi: 10.1111/nuf.12207. Epub 2017 Apr 13.
Gaspar, S., Peralta, M., Marques, A., Budri, A., & Gaspar de Matos, M. (2019). Effectiveness on hospital‐acquired pressure ulcer prevention: a systematic review. International wound journal , 16 (5), 1087-1102.
Khojastehfar, S., Ghezeljeh, T. N., & Haghani, S. (2020). Factors related to knowledge, attitude, and practice of nurses in intensive care unit in pressure ulcer prevention: A multicenter study. Journal of tissue viability , 29 (2), 76-81.
Nedergaard, Helene K., Trine Haberlandt, Palle Toft, and Hanne Irene Jensen. "Pressure ulcers
in critically ill patients–Preventable by non-sedation? A substudy of the NONSEDA-trial." Intensive and Critical Care Nursing 44 (2018): 31-35
