A pressure ulcer, also known as a pressure sore, is currently a common medical condition among the patient population in nursing facilities. According to Borojeny et al. (2020), a pressure ulcer is “a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear” (para. 2). Considering the fact that the prolonged pressure on the skin is caused primarily by mobility limitation and long-time stay in bed, the most vulnerable population for the present issue includes bed-confined patients and geriatric patients who have little or no ability to move around without assistance.
The relevance of such a problem is also reinforced by the local and worldwide statistics. On the global scale, pressure ulcers are recognized among the five primary reasons of harm cause for clinical patients (Shiferaw et al., 2020). Another statistic reveals the prevalence of pressure injuries of 5-15%, with a tendency rising in the long-term care units such as nursing facilities and intensive care units (ICUs) (Mervis & Phillips, 2019).
Since nurses play the most important role in maintaining the mobility of such patients and releasing the skin pressure, it is of paramount importance for nurses to have an action framework in order to mitigate the risk of pressure ulcer incidence (De Meyer et al., 2019). Hence, the purpose of the present project is to analyze the risk factors and precursors of pressure ulcer incidence among the patients and present a functional preventive framework for nurses to either eliminate or decrease the aforementioned risk factors and improve patient outcomes.
Statement of Problem
The primary problem tackled in the present proposal is the issue of a high prevalence of pressure ulcers among the population with limited abilities to move around. Considering the fact that patients are incapable of autonomously prevent the risk of pressure ulcer incidence, the primary responsibility is placed on nurses. Since the rates of pressure ulcers remain high, it is reasonable to assume that the nurses are either unwilling to pay enough attention to the problem or unaware of the ways that might prevent the condition occurrence. In a study conducted by Ünver et al. (2017), the authors attempted to define the surgical nurses’ attitude to pressure injury prevention among surgical and ICU patients.
The results of the study demonstrated that the vast majority of nurses recognized the adverse effects pressure injuries might have on patients, and their attitude towards pressure injury prevention was mostly positive (Ünver et al., 2017). The attitude rates were especially high in the context of pressure ulcers’ impacts on patients.
However, as far as the confidence in the effectiveness of pressure injuries prevention was concerned, the attitude rates were significantly lower, meaning the nurses’ insecurity in terms of providing quality pressure injury prevention care. The most significant finding of the present research demonstrated a positive correlation between nurses’ previous education on the matter of pressure ulcer prevention and attitude to the issue (Ünver et al., 2017). Hence, it may be concluded that the problem of pressure ulcer prevalence might be addressed with the help of introducing quality training programs for nurses on the facility premises.
Significance of the Project
The issue of preventing pressure ulcers in different types of patients is undeniably a complex endeavor. Hence, there is no objective reason to blame nurses for their inability to assist patients in order to secure timely prevention of the injury. When addressing the treatment of pressure ulcers, the primary issue concerns the individuality of the approach for each patient. Moreover, scholarly evidence presents a direct correlation between the nurses’ workload and job satisfaction and attitude towards pressure ulcer prevention.
For example, if the aforementioned study conducted by Ünver et al. (2017) was conducted in Turkey and demonstrated a predominantly positive attitude to injury prevention, the research conducted by Etafa et al. (2018) in Ethiopia revealed a negative tendency in the nurses’ perception of pressure ulcer prevention. Etafa et al. (2018) claim heavy workload, lack of time, staff and equipment shortage, and inadequate training to be major limitations in the way of efficient pressure ulcer prevention. Similar findings on the negative attitude towards pressure ulcer prevention were defined by Khojastehfar et al. (2020). Hence, it becomes evident that nurses who pay limited or no attention to pressure ulcer prevention among patients are not necessarily ignorant but need support and supervision from their management.
Another important issue concerns the fact there is no universal approach to the early detection and prevention of pressure ulcers. Thus, instead of being provided with a handbook on how to deal with pressure injuries, nurses are to be taught how to choose a certain prevention strategy regarding the patient’s background and hospital setting. While there are no definite options for pressure ulcer prevention, various scholars outline their assumptions of the most efficient preventive practices. For example, Kottner et al. (2018) outline such strategies as “repositioning, use of special support surfaces, cushions, and prophylactic dressings,” and the control over temperature and humidity in order to keep the patient’s skin dry and cool (p. 62). Gefen (2018), on the other hand, outlines more technology-oriented strategies, including subepidermal moisture scanners and polymeric membrane dressings. While working with a variety of options to prevent pressure ulcers, the primary issue is the fact that it is not clear when each of them should be used.
Considering the challenge of defining a quality intervention strategy, it is imperative to recognize the early risks of limited mobility in order to secure a comfortable hospital setting, including temperature, humidity, and bed surfaces. According to Borojeny et al. (2020), the risk factors include diabetes, which presents a doubled risk of ulcer occurrence, low blood flow, hip fracture, use of opioid drugs as painkillers for severe conditions, and dehydration.
Thus, once noted, these risks may alarm the nurses to pay closer attention to the skin condition of the patients. Moreover, according to Gefen (2018), the patients at risk of pressure ulcers develop tissue breakdown in a short time and require immediate intervention. Hence, by introducing preventive training, the nurses may be able to recognize the risk of pressure ulcers and prepare the necessary tools such as support surfaces in advance.
Finally, the educational intervention may help recognize the severity of pressure ulcers for patients. According to Borojeny et al. (2020), the potential patient outcomes include death, prolonged treatment, increased treatment costs, and physical and emotional complications for the patients and their caregivers. Hence, it is the nurse’s primary responsibility to mitigate the risks at all costs. Communication with the patient is also extremely important in these situations in order for them to understand the risks of immobility. For example, in the meta-analysis presented by Shi et al. (2018), it was demonstrated that hospital matrasses were more comfortable yet did not reduce the risk of pressure ulcers. For this reason, communicative strategies should also be included as a part of education.
The present project will make an attempt to define the educational framework relevant for nurses taking care of limited mobility patients. Using both primary and secondary data available on the topic, it can be possible to create a roadmap of preventive actions. Considering the severity of the issue, the project will be important for both nurses and the well-being of patients at risk of pressure ulcers. The implementation of training programs as part of continuous professional development will also benefit the overall nursing evidence-based practice. As a result, this project will be able to bring a meaningful change to the perception of treating long-term care and ICU patients.
A pressure ulcer is rightfully considered a severe challenge for global health care. The statistics show that approximately 60,000 deaths are caused annually by pressure ulcers, creating a demand for educational intervention for nurses (Borojeny et al., 2020). In terms of the present project, the first aspect that should be taken into account concerns the ambiguity around the universal approach to pressure ulcer prevention that should not stop nurses from helping patients. The second important aspect addresses the individual peculiarities in terms of ulcer preventive care that should be accounted for by studying the patient’s medical history.
Finally, it should be noted that the meaningful change in pressure ulcer prevention treatment does not exclusively concern nurses, as their willingness to help patients depends directly on the job satisfaction rate. Hence, considering all the facts provided, it may be concluded that the project aiming to reduce the risk of pressure ulcers among patients is an extremely relevant matter in today’s medical context.
Borojeny, L. A., Albatineh, A. N., Hasanpour Dehkordi, A., & Ghanei Gheshlagh, R. (2020). The incidence of pressure ulcers and its associations in different wards of the hospital: A systematic review and meta-analysis. International Journal of Preventive Medicine, 11, 171. Advance online publication. Web.
De Meyer, D., Verhaeghe, S., Van Hecke, A., & Beeckman, D. (2019). Knowledge of nurses and nursing assistants about pressure ulcer prevention: A survey in 16 Belgian hospitals using the PUKAT 2.0 tool. Journal of Ttissue Viability, 28(2), 59-69. Web.
Etafa, W., Argaw, Z., Gemechu, E., & Melese, B. (2018). Nurses’ attitude and perceived barriers to pressure ulcer prevention. BMC Nursing, 17(1), 1-8. Web.
Gefen, A. (2018). The future of pressure ulcer prevention is here: Detecting and targeting inflammation early. European Wound Management Association Journal, 19(2), 7-13.
Khojastehfar, S., Ghezeljeh, T. N., & Haghani, S. (2020). Factors related to knowledge, attitude, and practice of nurses in intensive care unit in the area of pressure ulcer prevention: A multicenter study. Journal of Tissue Viability, 29(2), 76-81. Web.
Kottner, J., Black, J., Call, E., Gefen, A., & Santamaria, N. (2018). Microclimate: A critical review in the context of pressure ulcer prevention. Clinical Biomechanics, 59, 62-70. Web.
Mervis, J. S., & Phillips, T. J. (2019). Pressure ulcers: Pathophysiology, epidemiology, risk factors, and presentation. Journal of the American Academy of Dermatology, 81(4), 881-890. Web.
Shi, C., Dumville, J. C., & Cullum, N. (2018). Support surfaces for pressure ulcer prevention: a network meta-analysis. PloS One, 13(2), e0192707. Web.
Shiferaw, W. S., Aynalem, Y. A., & Akalu, T. Y. (2020). Prevalence of pressure ulcers among hospitalized adult patients in Ethiopia: A systematic review and meta-analysis. BMC Dermatology, 20(1), 1-10. Web.
Ünver, S., Fındık, Ü. Y., Özkan, Z. K., & Sürücü, Ç. (2017). Attitudes of surgical nurses towards pressure ulcer prevention. Journal of Tissue Viability, 26(4), 277-281. Web.