This paper focuses on pressure ulcer prevention in the hospital setting. Pressure ulcers are common injuries to the skin and underlying tissues due to extended pressure on the skin and develop on the skin in bony regions such as tailbone, heels, hips, and ankles. Individuals with pressure ulcers have health conditions that reduce their ability to change positions, making them spend a long time in bed. Pressure ulcers are common hospital-acquired infections. It is a significant issue in patient care and has detrimental outcomes for the patients and the medical facility. The development of this medical condition prolongs hospital stay by at least one week. Between 2017 and 2020, hospital stays increased by 60% due to pressure ulcers, among other diagnoses (Zdzioch, 2017). Patients with pressure ulcers reported increased pain and suffering. The condition complicates the healing procedures and increases the mortality rates for inpatients. Between 2017 and 2020, Pressure ulcers led to more than 150, 000 fatalities (Zdzioch, 2017). The condition is also costly, and it goes up to $4 billion yearly of the country's Gross Domestic Product (GDP (Zdzioch, 2017). Medical practitioners need to find long-term solutions for the condition and implement a preventive program that all nurses can adapt effectively. The combination of unique skin material, silicone dressing, and a 5-hour repositioning schedule will completely prevent pressure ulcers. Pressure ulcers can be prevented by increasing knowledge on proper skincare by nurses and benefiting patients and healthcare facilities from liabilities.
Significance of Pressure Ulcer Prevention as an APN
APN has a central role in pressure ulcer prevention and the healthcare practice. All clients are possibly at danger of developing it. It is a global concern for medical professionals because it increases the expenses of managing it and the related complications. When APN assess the patient's risk status and plan medical care appropriately, the hospital cases will gradually reduce. Numerous healthcare providers have been under court due to medical negligence of hospital-acquired infections. When there is complete pressure ulcer prevention, the court cases will reduce. Additionally, the fundamental role of nurses is to offer maximum patient safety. Pressure ulcer prevention will reduce numerous issues such as mobility impairment, neurological conditions, pain, deformity, psychological conditions, social issues, and many more among patients. Nursing knowledge is an essential aspect for all nurses (Etafa et al., 2018). Understanding the causes and strategies to reduce pressure ulcers will enhance their duties and responsibilities. For instance, when it comes to repositioning techniques, they should ensure that pressure is eradicated or redistributed, and the utilization of transfer aids decreases friction and shear.
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PICO
To identity a need for pressure ulcer prevention in this practice project, the following PICO was created.
Patient- adult cardiac patient
Intervention: utilization of natural cleanser, foam dressings, 5-hour reposition schedule
Comparison: 2-3 hour reposition schedule, use of lotions and soaps alone, no dressing
Outcome- reduction of pleasure ulcer development within four months
The PICO question for this change in practice project is: In adult cardiac patients, how do the preventative utilization of organic cleaners, foam dressing, and 5-hour reposition schedule compare to the utilization of soaps and lotion alone and 2-3 hours reposition schedule reduce the pressure ulcer creation within four months?
Critique of Guideline/Position Statement
The paper will utilize evidence-based clinical guidelines to support the techniques of pressure ulcer prevention. The clinical guideline utilized in the study is increasing nurses` knowledge on pressure ulcer prevention. The study found that pressure ulcers are often avoidable in numerous hospital settings, but the prevalence rate continuously increases. Nurses are the fundamental medical practitioners who can advance the best techniques towards eradicating pressure ulcers in hospitals. Therefore, they should understand and be aware of pressure ulcers' signs and symptoms, a defensive approach to decrease its rate. The study aims to recommended how nurses can gain knowledge on how to stop pressure ulcers in Ethiopia. The authors argue that pressure ulcers are complex issues in hospitals across Ethiopia (Muhammed et al., 2018). It causes loss of productivity, financial implication, human suffering, pain, tissue necrosis, and sometimes death (Muhammed et al., 2018). The clinical guideline is well clear because there are a clear justification and background of the study. For instance, they found an increasing 80% prevalence rate in the past 13 years of research (Clarkson et al., 2017). They also found inadequate data on healthcare providers' understanding and its associate variables towards pressure ulcer deterrence. That is why there is a strong need to focus on the study. Information emanating from the research is a practical reason for developing suitable instructive techniques and training in Ethiopia.
The clinical study has clear objectives that focus on increasing nursing awareness towards pressure ulcer prevention. The study's general aim is to evaluate the healthcare providers` awareness towards pressure ulcer eradication and its related variables in Hawassa University Comprehensive Specialized Hospital in Ethiopia. The precise objective is to assess nurses` awareness of pressure ulcer eradication at the facility. The other specific purpose is to evaluate associated variables with nurses' understanding of pressure ulcer prevention at the facility. From the highlighted objectives, the authors are transparent about what they want to consider. They clearly understand the target audience and the area that the study has not been done for the past years. The objectives are measurable and specific to the research that all the readers will understand what the study will focus on and what results should be expected.
The clinical guideline authors are Ezedin Molla Muhammed, Tarkie Abebe Walle, Berhanu Boru Bifftu, and Yemataw Zewdu Temach. All the authors are senior lecturers at various universities. Ezedin Molla Muhammed is a senior lecturer at Hawassa University, while the rest work at the University of Gonda, Ethiopia. In terms of credentials, Muhammed has a Bachelor of Science Degree in Nursing and a Masters in Surgical Nursing Specialization. Bifftu has a Bachelor of Science Degree in Nursing and a Masters in Psychiatry Specialization, and Walle has a Bachelor of Science Degree in Nursing and a Masters in emergency medical and acute care nursing specialization. Temach has a Bachelor of Science Degree in Nursing and a Masters in Surgical Nursing Specialization. The authors did not receive any funding for the publication of the research. Since all the authors work in nursing school, it is clear that they have a great interest in the topic. They work in the same area where the study was carried, implying that they understand the nature of the surroundings and what healthcare facilities face regarding hospital-acquired infections.
The authors utilized the Institutional-based cross-sectional study design and investigated the phenomenon from March 25 to April 23, 2018, at Hawassa University Comprehensive Specialized Hospital. The sampling population was all healthcare providers at the facility. The authors utilized a simple random sampling technique. The nurses were chosen from every ward or unit from the compilation of healthcare providers in every stratum. They categorized nurses into two categories: Those with poor knowledge on pressure ulcers are healthcare providers who scored mean and above the proficiency queries toward pressure ulcers, and those with good experience are healthcare providers who scored above mean sore of the awareness queries of pressure ulcers. The authors recommended improving healthcare providers` knowledge of pressure ulcers by providing training and reducing the long working hours. There should also be a nursing curriculum and guide to increase their salary to avoid frustration and burnout. From the method of collection to the recommendation, the study is termed valid. They chose nurses with either bachelor's degree or diploma. Such a sampling population understands what a research study would be like to increase the patient's safety in the hospital. This aspect means that there will be no bias or any form of illiteracy among them. The recommendations provided by the authors are also valid because what makes nurses lose morale in their work is usually lack of training, low salary, and long working hours.
The authors utilized numerous studies as evidence towards pressure ulcer prevention. The first evidence used by the authors is an article by Dugaret et al. (2014). The study argues that most older patients continuously increase in number in the emergency department with numerous underlying conditions such as pressure ulcers. These underlying conditions increase their hospital stay. The research was carried out in the emergency unit in France, and it comprised 602 patients. The discharge and readmission records were studied, and the authors found out that the patients acquired hospital infections during their stay in the facility. This study is vital because of the sufficient sampling size. Learning patients` perceptions is also essential in understanding their knowledge regarding pressure ulcers. All the material that supported the study influenced the overall recommendations because the authors connected the widespread problems experienced in the hospital setting to how they influence the spread of pressure ulcers. The number of resources utilized in the study was 3, helping the authors provide concrete recommendations without generalizing the solutions.
The overall quality of evidence utilized in the study is high. The literature used in the study is relevant and authoritative. The weight of the points highlighted in the evidence is strong and focuses on pressure ulcers, which is the main topic that the authors are trying to investigate. The literature also addresses the research question and the theoretical framework. The study contains articles and books from reputable sites and has strong points and organization of the literature. The articles are also peer-reviewed.
Quality Improvement
Pressure ulcers are acts of nursing negligence. Patients at risk of pressure ulcer exposure and who do not want the recommended techniques should be given a voluntary choice because they control their lives concerning autonomy. As such, patients should be educated on making wise medical decisions, understand the consequences, and comply with the clinical guidelines. Additionally, nurses should understand the legal implication of treating the patient wrongful based on their behaviors regarding justice. Nurses should be aware of pressure ulcer prevention techniques and always utilize clinical guidelines to support their cases. They should be educated on the necessary information on eradicating pressure ulcers among hospitalized patients to avoid medical ignorance. Every healthcare provider must be aware of the patient 's case and keenly evaluate all the information gathered. To avoid any form of litigation, the hospital facility should document and accurately record-keep to provide evidence when required.
Conclusion
Pressure ulcers are a common infection acquired in hospitals. It increases hospital stay, cost burden and increases the mortality rates among patients. It is a common hospital-acquired infection, but there has been no more medical attention towards it. The recommended techniques in pressure ulcer prevention are organic cleaners, foam dressing, and a 5-hour reposition schedule instead of utilizing soaps and lotion alone and a 2-3 hour reposition schedule. The clinical guideline is how to increase nurses` knowledge on pressure ulcer prevention. The guideline recommended a reduction in working hours, increased training, and increasing salary among nurses to gain morale in tackling cases of pressure ulcers. The article that provides evidence on the area of specialization is strong and valid.
References
Clarkson, P., Bader, D., Schoonhoven, L., & Worsley, P. (2017). A multidisciplinary approach to pressure ulcer prevention: Exploring healthcare professionals’ knowledge and attitudes to pressure ulcer prevention in the community. Physiotherapy , 102 , e256-e257. https://doi.org/10.1016/j.physio.2016.10.322
Etafa, W., Argaw, Z., Gemechu, E., & Melese, B. (2018). Nurses’ attitude and perceived barriers to pressure ulcer prevention. BMC Nursing , 17 (1). https://doi.org/10.1186/s12912-018-0282-2
Muhammed, E. M., Bifftu, B. B., Temachu, Y. Z., & Walle, T. A. (2019). Nurses’ knowledge towards pressure ulcer and its associated factors at Hawassa University comprehensive specialized hospital Hawassa, Ethiopia, 2018. https://doi.org/10.21203/rs.2.13562/v1
Zdzioch, M. (2017). Pressure ulcer prevention. Nursing Standard , 31 (21), 64-65. https://doi.org/10.7748/ns.31.21.64.s46
