Nursing interventions to decrease the incidence of pressure ulcers in the critical care patient
Background information
Pressure ulcers refer to injuries brought about by unrelieved pressure that destroys the body coat and its underlying tissue (Campell et al, 2006). They are also referred to as bed sores and they usually range from severe to minor ones. When unrelieved pressure is applied on the skin for an increased period of time, it will squeeze the blood vessels which provide the skin with oxygen and nutrients. This makes the skin to starve of the required nutrients thus causing the death of the tissues and this result to the formation of a pressure ulcer. The area of the skin that is affected by pressure ulcers tends to feel warmer than the surrounding areas and it may as well turn red (Campell et al, 2006). Pressure ulcers cause increased skin infections, increased cost of medical care and negative psychological feelings which scare the affected person.
Pressure ulcers are common among patients in the critical care patient. This shows that good interventions are required in order to decrease the incidence of pressure ulcers in the critical care patient. The patients who have been admitted in the critical care for four days and more are at a higher risk of developing pressure ulcers. Such patients require mechanical ventilation and extracorporeal membrane oxygenation. Doctors and other medical practitioners make use of different practices in order to reduce the incidence of pressure ulcers in the critical care patient. Some of these practices include the use of foam overlays, specialty beds, disposal under-pads, better nutrition, pillows, body lotions, gel pads and constant change in body positions after every two to four hours. It is good to protect the skin because it is the greatest organ of the body that provides protection against bacteria and germs. It is also involved in body functions such as immunity and communication and this explains why interventions in order to prevent skin damage (Campell et al, 2006). Although doctors make use of interventions in order to reduce the incidence of pressure ulcers in the critical care patient, a better intervention is required in order to offer better practice that will help to ensure that there are reduced incidences of pressure ulcers among the patients in the critical care unit. This paper will thus explore the new nursing interventions which will help to decrease the incidence of pressure ulcers in the critical care patient.
The current practice
The current nursing practice in the efforts to reduce the incidence of pressure ulcers in the critical care unit include use of support services, use of air loss beds and patient specialty beds which make it easier for the patient to turn without putting more pressure to the skin (Christine, 2011). In addition, the patient can be turned more often in order to ensure that pressure is not exerted at one point of the body. The use of blanket rolls and pillows can also help to reduce the incidence of pressure ulcers among patients in the critical care unit. These interventions are crucial because they lower the incidence of pressure ulcers among patients in the critical care unit. They help nurses to make sure that patients do not develop bed sores during the time they are in the hospital. In addition, they help to enable patients to get well faster while maintaining a lower medical cost for the patients. However, although these interventions are associated with the reduction of the incidence of pressure ulcers, there is no sufficient data to show how effectively they can help to reduce pressure ulcer occurrences (Christine, 2011). In this connection, there is need for use of better nursing interventions in order to reduce the incidence of pressure ulcers among patients in the critical care unit. Better nursing interventions need to be implemented in order to ensure that nursing practices effectively reduce the incidences of pressure ulcers among patients in the critical care unit. If better interventions are not used in the prevention of pressure ulcers in the critical care unit, cases of pressure ulcers are likely to increase. The development of pressure ulcers need to be reduced in order to lower the cost of medical care and reduce the sickness pain for the patient. Reduction in the incidence of pressure ulcers can show how the nurses have been careful in handling a patient during the hospitalization period (Christine, 2011). In this connection, there is need to change the current nursing practices in order to implement interventions which help to reduce the incidence of pressure ulcers among patients in the critical care unit.
The new nursing intervention to be implemented
Hospitals require the implementation of nursing interventions which prevent the development of pressure ulcers in patients. The development of pressure ulcers in patients in the critical care unit is not a failure of the nursing care but it is a failure of the whole healthcare care system (Hughes, 2008). In this connection, every hospital should ensure full cooperation and support of the use of good nursing skills which will help in the prevention pressure ulcers among patients in the critical care. Nurses play the main role in the prevention of pressure ulcers and thus they should be at the fore front in identifying the best skills which will help in the prevention of pressure ulcers. Nurses need to assess the risk of developing pressure ulcers among patients in the critical care, practice good skin care, mechanical loading and education of patients and other clinical staff on the prevention of pressure ulcers among patients (Hughes, 2008). These nursing interventions will help to reduce the development of pressure ulcers in patients in the critical care.
Literature review to support the change
The available literature shows that following the suggested processes help in the prevention of pressure ulcers. Assessment of risk of pressure ulcers development in the patients in the critical care can help to ensure that measures are put in place to prevent the patients at risk of pressure ulcers from developing such ulcers. This is because, the nurses will be able to use nursing practices which do not expose people at pressure ulcers development risks to practices that lead the incidences of pressure ulcers. Previous research also shows that nurses can function as a team and help one another to reduce the incidence of pressure ulcers among patients in the critical care unit (Hughes, 2008). Risk assessment should be done in order to determine the number of risk factors that exposes patients to pressure ulcers. Moreover, it will help to identify the patients at a greater risk of developing pressure ulcers in order to offer better nursing care to them.
The use of good skin care in patients in the critical care unit has also been found to serve as a better intervention in the prevention of pressure ulcers. There is a relationship between good skin care and the development of pressure ulcers among patients in the critical care unit (Hughes, 2008). The patient’s skin has to be cleansed well through the use of body wash and skin guard products. Moreover, keeping the skin dry prevents irritation on the skin or excess moisture which may increase frictional forces thus leading to pressure ulcers. Nurses can also perform frequent skin assessments in order identify the development of pressure ulcers when it is at its early stages. In this connection, research shows that the use of good skin care practices can help in the prevention of pressure ulcers among patients in the critical care.
Mechanical loading is the other intervention that helps to reduce the incidence of pressure ulcers in patients in the critical care. Nurses can reduce mechanical load of patients at a higher risk of developing pressure ulcers. This is because, if patients cannot turn or reposition themselves in the hospital beds, they are at a greater risk of developing pressure ulcers (Kimberly, 2007). In this connection, it is important for the nurses to help in reducing the mechanical load for the patients. For example, research suggests that nurses can increase the number of times they change the patients who are not able to change their positions in order to lower the chances of developing pressure ulcers. Literature review also shows that patients and other clinical staff should be educated on the best practices that will help in the prevention of pressure ulcers (Kimberly, 2007). This will help the patients to help the nurses and other health practitioners in preventing pressure ulcers for the patients in the critical unit. In this connection, the available literature supports the implementation of the nursing interventions which will help in reducing pressure ulcers in patients in the critical care.
Required resources
The implementations of the interventions which will help in reducing incidence of pressure ulcers in patients in the critical care require various resources. One of these resources is the risk assessment tool that will help to identify patients who are at a higher risk of developing pressure ulcers. A braden scale will help nurses to make sure that risk assessment has been completed in order to prevent patients from developing pressure ulcers (Kimberly, 2007). The other resources required in implementing these new interventions are financial resources. Finances are needed to higher more nurses who will help to reduce mechanical loading for the patients and also finance the training of both staff and patients to practice nursing practices that will help in the reduction of the incidences of pressure ulcers in patients in the critical care. Finally, resources such as certain oils will be required to help in good skin care for the patient. In this connection, the nurses will have to make sure that all the required resources are availed in order to help in the implementation of the new nursing interventions.
Advantages of the change in nursing practice
The change in nursing practices is essential in reducing the incidences of pressure ulcers in the critical care. It will help to ensure that patients o not develop pressure ulcers because those at risk will be identified early in advance in order to improve their nursing care (Courtney, 2010). This will help to improve the conditions of the patients while they are in the critical care to ensure that they do not develop pressure ulcers. Moreover, such patients will also be in a position to stay in the hospital for a shorter duration because pressure ulcers tend to increase the length of time the effected patients spend in the hospital. The other advantage of the change in practice in the prevention of pressure ulcers is that it will lower the cost of medical care in the critical care. There is an approximately $2,000 decrease in cost of healthcare in the critical care in all the hospitals that will practice the implementation of the new nursing interventions (Courtney, 2010). This change will also impact on the patients’ outcome because it will help in the management of pain. In order to measure the improvement that results from the implementation of the evidence based practice, one critical care unit will be identified and data will be compared when the implementation was started and the data prior to the implementation in order to know the rate of pressure ulcers at both times (Courtney, 2010). In this connection, the implementation of the change in practice will be useful in the hospitals.
Summary
Pressure ulcers develop when more pressure is exerted at one part of the body. There is a need to implement new nursing strategies that will help in reducing pressure ulcers in patients in the critical care. The change in nursing practices involves risk assessment, practice of good skin care, mechanical loading and education of both patients and nurses on the importance of good nursing practices. The implementation of these nursing interventions will help to ensure that there are reduced incidences of pressure ulcers in patients in the critical care. In this connection, this project will help to improve the science of nursing by reducing the incidences of pressure ulcers in patients in the critical care.
References:
Campell K et al. (2006). Health policy and the delivery of evidence-based wound care using
regional wound teams. Health Manage Forum. 2006;19 (2):16–21
Christine A. (2011). Protecting Fragile skin: Nursing interventions to decrease development of
pressure ulcers in pediatric intensive care unit. American Journal of critical care. 2011. Vol. 20. No. 1 26-35
Courtney H. (2010). Pressure ulcers: A patient safety issue. US National Library of Medicine.
PMID
Hughes R. (2008). Patient safety and quality: An evidence based handbook for nurses. New
York. Penguin publishers
Kimberly C. (2007). The Pressure ulcer prevention protocol interventions. American Journal of
Nursing. April 2007
