Nursing practice is evolutionary in that it undergoes changes. Nurses adopt changes in keeping with shifting patient needs and the emergence of new information. When new evidence emerges, it is common practice for nurses to integrate it into practice. This allows them to provide their patients with care that is has the support of solid evidence resulting from years of rigorous research (Stevens, 2013). The treatment of pressure ulcers is one of the areas of nursing practice that has benefited from research. Guidelines have been provided regarding how hyperbaric oxygenation therapy in the treatment of the pressure ulcers. Current evidence supports the use of this intervention for treating patients with pressure ulcers.
Pressure ulcers affect a large proportion of the population. People who lead sedentary lifestyles are most at risk of developing the ulcers (NHS UK, 2017). Left untreated, the ulcers can develop into open wounds that could expose an individual to the risk of other infections. Elderly and obese individuals who usually lead lives with little activity are among those who are most at risk (NHS UK, 2017). Other risk factors for pressure ulcers are diabetes, Parkinson’s disease and heart failure. Hyperbaric oxygenation therapy is among the interventions that are currently in use for the treatment of pressure ulcers. Recent research supports the continued use of this intervention owing to its effectiveness and safety.
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Rui Liu joined forces with other scholars to investigate the effectiveness of hyperbaric oxygenation therapy (HBOT) in the treatment of patients with chronic diabetic foot ulcers. One of the key findings that they made is that this intervention does not harm the wellbeing of patients. They observe that “adverse effects associated with HBO treatment were rare and reversible and not more frequent than those occurring without HBO treatment” (Liu et al., 2013). This finding means that nurses can continue to rely on HBOT without being worried that they will harm their patients. Perhaps the key finding that Liu and his team makes concerns the effectiveness of HBO treatment. They state that “treatment with HBO improved the rate of healing and reduced the risk of major amputations in patients with diabetic foot ulcers” (Liu et al., 2013). This finding is essentially an endorsement of HBOT. Not only is this intervention safe, it is also effective. Therefore, nurses can confidently use it and expect to witness significant improvements in the health of their patients. The intervention also spares patients of the need to have their feet amputated.
Rui and his colleagues are not isolated in their finding that HBOT is effective and safe. Kaplan and a team of other researchers who probed how effective and safe this therapy is are in agreement that it does indeed enhance the wellbeing of patients. They conducted a study in which they sought to establish if HBOT is effective in treating diabetic foot ulcers and to identify the factors that predict amputation. To establish the effectiveness of HBOT, they provided the participants who had developed diabetic foot ulcers with 100% oxygen for 120 minutes (Kaplan et al., 2017). The results of their investigation reveal that HBOT therapy’s effectiveness is not in question. They make it clear that “the inclusion of HBOT with standard treatment and a multidisciplinary approach may be useful in the treatment of DFUs” (Kaplan et al., 2017). It is important to note that Kaplan and his team appear reluctant in their endorsement of HBOT. They point out that this intervention is only effective when it is combined with standard treatment. This is an issue that nurses must have in mind when treating patients with pressure ulcers. They cannot rely on HBOT alone. Another important issue to note is that Kaplan and his colleagues encourage practitioners to adopt a multidisciplinary approach. This is vital and is essentially a call to nurses to join forces with other practitioners when using HBOT to treat patients with pressure ulcers.
Kranke and his colleagues are yet other researchers who have concluded that HBOT is an effective intervention for treating pressure ulcers. They conducted a review of literature which focuses on the use of this intervention. A majority of the articles that they examined established that HBOT is indeed an effective intervention. They note that Diabetic patients which chronic wounds are among the main beneficiaries of HBOT. However, Kranke and his team note that the evidence for the effectiveness of HBOT is not sufficiently weighty. They state that “in people with foot ulcers due to diabetes, HBOT significantly improved the ulcers healing in the short term but not the long term” (Kranke et al., 2012). The tone in this statement is evidently cautious. It is as though Kranke and his colleagues do not want to be too quick to endorse HBOT without overwhelming evidence that is effective. What nurses should take from the statement is that HBOT may become ineffective if it is used beyond one year. Kranke and the other researchers also observe that HBOT is a costly intervention whose application is very difficult to justify (Kranke et al., 2012). There are few patients who need the intervention. They also caution that they are not confident in the results of their study. The implication of this for practice is that nurses need to apply HBOT with extreme caution and keep a close eye on their patients to ensure that the intervention is actually working.
Most of the evidence points to the effectiveness of HBOT. To ensure that nurses have all the information regarding this intervention, it is important to include the evidence which raise questions regarding the impact of HBOT on patient wellbeing. Katrien and other researchers set out to determine how effective HBOT is. Although they focused their study on patients with lower extremity ulcers and Diabetes, the insights that they share applies to pressure ulcers. They claim that “additional HBOT did not significantly improve complete wound healing and limb salvage” (Katrien et al., 2017). Katrien and her team appear to be isolated. There is little evidence that supports their claim that HBOT is not an effective treatment. This means that nurses can continue to apply the treatment to pressure ulcers. However, it still appears that the evidence supporting the effectiveness of the intervention is limited and not too convincing. For example, despite finding that HBOT can be effective, Kranke and his team still make it clear that they have little confidence in this finding. It is evident that more research is needed to conclusively establish the effectiveness of HBOT in the treatment of pressure ulcers.
In conclusion, evidence based practice is at the heart of modern nursing. Nurses continue to integrate the latest evidence into their mandate. The scholarly community has not disappointed as it has conducted research that has allowed them to provide nurses will well-informed insights. For the most part, the research on the effectiveness of HBOT suggests that this intervention is effective. However, there is some evidence that this treatment does not yield much success. To address this confusion and to provide nurses with clear directions, further research is urgently needed. Before this research is conducted, nurses can continue to use HBOT. However, since this intervention is yet to be solidly verified as effective and safe, the nurses must remain cautious and monitor their patients closely.
References
Kaplan, S. T., Hemsili, D., Kaplan, S. & Arslan, A. (2017). Amputation Predictors in Diabetic Foot Ulcers Treated with Hyperbaric Oxygen. Journal of Wound Care, 26 (7). DOI: https://doi.org/10.12968/jowc.2017.26.7.361
Katrien, T. B. S., Stoekenbroek, R. M., Koelemay, M. J. W., Reekers, J. A., Van Dortmont, M. C., Oomen, A., Smeets, L., Wever, J. J., Legemate, D. A. & Ubbink, D. T. (2017). Hyperbaric Oxygen Therapy in Treatment of Ischemic Lower Extremity Ulcers in Patients with Diabetes: Results of the DAMO 2 CLES Multicenter Randomized Clinical Trial. Diabetes Care. DOI: https://doi.org/10.2337/dc17-0654
Kranke, P., Bennett, H. M., Martyn-St James, M., Schnabel, A. & Debus, S. E. (2012). Hyperbaric Oxygen Therapy for Chronic Wounds. The Cochrane Database of Systematic Reviews, 18 (4). DOI: 10.1002/14651858.CD004123.pub3.
Liu, R., Li, L., Yang, M., Boden, G. & Yang, G. (2013). Systematic Review of the Effectiveness of Hyperbaric Oxygenation Therapy in the Management of Chronic Diabetic Foot Ulcers. Mayo Clinic Proceedings, 88 (2), 166-175. National Health Service UK (NHS UK). Pressure Ulcers (Pressure Sores). Retrieved 21 st November 2017 from https://www.nhs.uk/conditions/pressure-sores/
Stevens, K. R. (2013). The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas. Online Journal of Issues in Nursing, 18 (2), 4.
