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Clinical Problem and Associated Changes
Pressure ulcers are areas of the skin of degenerative or necrotizing nature resulting from prolonged compression of the shear or displacement between a person and the bed surface.
As a rule, pressure ulcers occur in the sacrum, buttocks, heels, legs, and at the position of the patient on the back. The treatment measures related to pressure ulcers are inseparably connected with the whole complex of care. Adequate prevention of the emergence and development of pressure ulcers requires appropriate organization activities. In this connection, key changes to be discussed in this paper comprise bed change, nutrition adjustment, and patient-organization interaction.
Evidence-based Solution
The leading factor in the successful treatment of pressure ulcers is the elimination of continuous pressure. Turning a patient in bed every two hours could completely prevent the formation of pressure ulcers, but it is rather difficult to implement because of the workload of the medical staff (Lyder et al., 2012). In this regard, plastic tires, special beds, mattresses, cushions, and pads that are filled with foam, gel, air, water, or a combination of these materials are to reduce the pressure force and to ensure its continuity.
According to Qaseem, Mir, Starkey, and Denberg (2015), the use of advanced static mattresses or overlays was associated with a lower risk of pressure ulcers compared with standard hospital mattresses (p. 365). Patients prone to pressure ulcers need a fairly soft mattress so that their bodies would be partially immersed in bed. The covering of the bedding should be easy to stretch. The mattress should be soft, but not bend like a hammock.
Nutrition of the patients at risk should be balanced and moderate. Since human activity at bed rest is minimized, it requires fewer calories yet more vitamins and minerals. The presence of vitamin C, zinc, and iron in a diet is essential. Estimated daily calorie intake should count 30 to 35 kcal/kg of body weight per day (Qaseem et al., 2015, p. 362). The patients diet should include cereals, meat, fish, dairy products, fruits, vegetables, and nuts. It is better to limit the consumption of animal fats, bakery products, sweets, and fizzy drinks as the patients weight should be normal.
The process used by the Organization to Change
The organization utilizes a quality evaluation process. According to Cano et al. (2015), the analysis of the University of Miami Hospital shows that nurses evaluate patients at risk monthly and provide the corresponding treatment.
The latter includes skincare policies, re-education of staff to initiate the early intervention, and wound, ostomy, and continence (WOC) nurse addition to staff to lead and coordinate the skin maintenance and management programs and to provide continuous education and training for the patient care staff (Cano et al., 2015, p. 580). It was identified that the organization acquires special mattresses and other necessary equipment. Therefore, one might state that change policies are strictly followed in that organization. However, the study indicates no results of patients diet.
What would I do differently?
To provide effective treatment, I would recommend the organization to become more attentive to the patients. In particular, I would recommend massaging tissues in the area of the possible formation of pressure ulcers by mild rotary movements. Areas of skin maceration should be washed with soap and cold water and wiped thoroughly and carefully. If the hands of the patient are active, a mandatory attribute of the patients bed space should be a therapeutic arc or belt-tightening and massager for hands. The patients clothes should be comfortable and seamless as possible excluding buttons and buckles.
In case the patient is not completely paralyzed and retains some minimal activity, a caregiver should encourage him or her to move, even if movements are reduced to the perturbation of fingers and bending arms at the elbow. Sometimes, bedridden patients fall into a depression losing hope. The principal role of the caregivers is to avoid it (Nuru, Zewdu, Amsalu, & Mehretie, 2015). They should personally communicate with the patients talking to them and carefully listening to their requirements and complaints.
The risk to the Organization by not Making the Change
Treatment measures concerning pressure ulcers are of great importance as they allow avoiding the worst consequences such as sepsis. However, they are better to avoid than being treated. If this could not be done, then the pathogenesis is growing rapidly with the formation of foci of necrosis of tissue that is characterized by long-term treatment (Niederhauser et al., 2012). In some cases, pressure ulcers might cause extensive excision of soft tissues and impaired blood circulation in some parts of the body, amputations, and osteomyelitis.
There is a risk of occurring ischemic degenerative changes as well (Agrawal & Chauhan, 2012). It is also of great importance to point out that the development of pressure ulcers complicates the treatment of patients in intensive care units, geriatric departments, as well as during rehabilitation. It is especially dangerous for people with spinal paralysis, complex fractures of limbs, spinal injuries, coma, and other pathologies.
In its turn, complications in patients with pressure ulcers might lead to a decrease in the organizations effectiveness and subsequent poor health care delivery.
References
Agrawal, K., & Chauhan, N. (2012). Pressure ulcers: Back to the basics. Indian Journal of Plastic Surgery, 45(2), 244-254.
Cano, A., Anglade, D., Stamp, H., Joaquin, F., Lopez, J., Lupe, L.,& Young, D. (2015). Improving Outcomes by Implementing a Pressure Ulcer Prevention Program (PUPP): Going beyond the Basics. Healthcare, 3(3), 574-585.
Lyder, C. H., Wang, Y., Metersky, M., Curry, M., Kliman, R., Verzier, N. R., & Hunt, D. R. (2012). Hospital-Acquired Pressure Ulcers: Results from the National Medicare Patient Safety Monitoring System Study. Journal of the American Geriatrics Society, 60(9), 1603-1608.
Niederhauser, A., Lukas, C. V., Parker, V., Ayello, E. A., Zulkowski, K., & Berlowitz, D. (2012). Comprehensive Programs for Preventing Pressure Ulcers. Advances in Skin & Wound Care, 25(4), 167-188.
Nuru, N., Zewdu, F., Amsalu, S., & Mehretie, Y. (2015). Knowledge and practice of nurses towards prevention of pressure ulcer and associated factors in Gondar University Hospital, Northwest Ethiopia. BMC Nursing, 14(34), 1-8.
Qaseem, A., Mir, T. P., Starkey, M., & Denberg, T. D. (2015). Risk Assessment and Prevention of Pressure Ulcers: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine, 162(5), 359-370.
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