Introduction
Extended immobility is 1 of 1 of the most typical variables that create Pressure ulcers in individuals in the emergency hospital. Generally, these accidents are fallen in the clinic in addition to caused by insufficient skin remedy. The consequences of stress abscess could be essential since, together with external cells, the inside body organs are also flawed. This problem is acute for public health as well as demands the delivery of proper preventive measures. Pressure ulcers turn up on skin due to prolonged stability, and in intensive care units (ICU) this difficulty is particularly intense. Due to the strain on cells that are soft in addition to bones, a number of areas of the body are warped. Gefen et al. (2020) analyze the symptoms of this particular problem and also view that an anxiety ulcer is “local damages to the main skin as well as soft tissues, typically on bone prestige or maybe associated with an other or clinical tool” (p. S5). Due to this particular, the framework of exterior cells adjustments as well as infections are able to build, which similarly affects the functionality of internal organs. Pressure ulcers are a health risk, and in intensive care units they’ve serious consequences for customers. The evaluation of the indications of its, epidemiology, reason behind growth as well as health-related analysis causes it to be easy to obtain an evaluation of the motif in addition to suggest relevant treatment formulas. According to the information received, to perform an effective treatment, a PICOT problem might be something to look at a particular improvement train. The matter is: in individuals recognized as having a top threat of starting an pressure ulcers (P), the setup of a stress ulcer protocol began in the emergency department (I) contrasted to people getting regular care (C), reduces the occurrence of pressure ulcers (O) by seven days (T)?
Background Information
Pressure sores are injuries to the skin or tissue that occur due to decreased blood circulation caused by pressure in a specific area. If bedsores develop, the reason generally relates to impaired blood circulation and the absence of oxygen access to each skin surface (Liao et al., 2019). Decubitus patients are in the same position for long periods; that is why the bones press on the soft tissues in some places, which results in a disturbance of blood flow. The roots of pressure sores also include the fact that the sick person is depleted in the fat layer (Liao et al., 2019). Other factors are poor hygiene and co-morbidities such as diabetes or involuntary muscle spasms.
It is confirmed that the symptoms of pressure sores depend directly on the degree of neglect of the pathological process. There are four main stages of the disease; the skin at the pressure points becomes red at the initial phase (Liao et al., 2019). The second phase gradually develops if the pressure sores are not treated immediately. At the place of redness, the epidermis began to exfoliate sometimes; there were blisters with fluid and peeling. In the third stage, wounds grow deeper; the infection is often accompanied by pus, and the necrosis site smells unpleasant because the tissues are dead (Liao et al., 2019). In the last phase, the injury becomes deep, and bone or tendons can be observed at the bottom of the hole.
I am concerned about a concise and effective algorithm for preventing bedsores. Basically, I know that a complex of treatment procedures is developed depending on the stage of decubitus progression, and it can be divided into three blocks. That is, it includes prevention of pressure sores, treatment, and care (Chiang et al., 2018). Naturally, it is simpler to do preventive procedures in order not to lead to aggravations. Although, there are gaps in my knowledge regarding the specific steps in each phase of treatment. Furthermore, there is currently no method of therapy in medicine that provides a guarantee of a patient’s recovery.
Literature Search Strategies
This literature review will be devoted to analyzing and generalizing the available data on pressure sores published recently. The literature review was conducted using electronic information sources and the Internet. The relevant medical journal was consulted to collect the data used. Google Scholar was the leading search engine for finding selected articles in addition to the PubMed and CINAHL databases. Keywords used to search for specific jobs to be discussed pressure injury, pressure injury care, prolonged immobility, abscess, pressure sores. All available information is additionally sorted by language and year of publication (Abhishek et al., 2018).Twenty articles were found in PubMed and CINAHL databases between 2018 and 2022. In addition, the articles were sorted according to criteria such as the relevance of information about bedsores, the novelty of the study, and the quality of the literature used. Papers that do not contain any constructive information or refer to primary sources were excluded.Of the articles found, five were saved since the data in several articles was repeated and had no practical significance for this study.
Literature Review
An examination of the contemporary body of literature has revealed an increased level of attention to pressure ulcer incidence and prevention, especially among elderly and terminal patients. Based on this knowledge, it will be possible to outline specific interventions that are promising in the current environment. First of all, device-related pressure ulcers are among the leading variants of this condition today. Gefen and Ousey (2020) associate the onset and fallout of the COVID-19 pandemic with this particular issue. The recent years have included an increased use of personal protective equipment that causes more pressure ulcers of the type that previously were not as prevalent. In order to address the problem, a range of experts have introduced the SECURE framework that deserves further investigation.
Device-related pressure ulcers appear after the prolonged use of personal protective and treatment equipment in the clinical setting, which makes it a variation of a hospital-acquired pressure ulcer condition. Gefen et al. (2020) state that such devices include “endotracheal and nasogastric tubes, oxygen tubing, non-invasive ventilation masks, urinary catheters, cervical collars and casts” (para. 1). In other words, these are high common pieces of medical equipment that are used across many cases and settings. Evidently, the possibility and degree of a pressure ulcer correlates with the duration of tissue interaction with a medical device, as confirmed by Lustig et al. (2021). In addition, the damage progresses if the deformed tissue is exposed to a contagious environment that causes continuous inflammation. Following the onset of the condition, the damage then continues to progress in a non-linear manner, which makes the development of a pressure ulcer rapid and painful (Lustig et al.). This implies that the most efficient intervention should target the mechanical component of the condition mechanism which results from the pressure applied directly upon the skin tissue.
In light of the COVID-19 pandemic spread, when the use of protective devices has become common, the issue of device-related pressure ulcers (DRPU) became more common. In this regard, the SECURE framework has been proposed as one of the effective mechanisms against it. This abbreviation means skin, education, collaboration, understanding, report, evaluate (Gefen et al., 2020). This is a multi-tier pathway framework that is expected to lead to a decrease in the prevalence of DRPU. It starts by the direct intervention aimed at improving the tissue resistance to damaging interactions. Next, through collaboration and learning, both patients and nursing staff are educated in terms of DRPU prevention. The final components are reactive in nature, as they imply reporting and addressing the degree of tissue damage when it occurs. It may be effective to emphasize the first elements of the SECURE framework to address the issue proactively by preventing it to the best degree possible.
In this regard, researchers and experts continue to examine the various techniques of reducing the damage inflicted on the patient’s tissue by medical devices. Cai et al. (2019) explore the benefits of using hydrocolloid dressing when patient ventilation is necessary. It is noted that such procedures are among the leading causes of device-related pressure ulcers, especially in age risk groups. The results indicate major improvements in this regard when hydrocolloid dressing is applied. A similar study was conducted by Grigatti and Gefen (2021) who investigated the effect of hydrogel-based dressing. They highlight the thermal properties of this solution that corresponds with the properties of the human skin in both dry and moist conditions. Such interventions have been confirmed as effective, but the results may be significantly improved by viewing them as merely a component of a larger SECURE framework. The proposed study will seek to eliminate this gap by addressing the prevention of the issue on a larger scale with hydrogel-based dressing as the S of the SECURE framework.
PICOt Question
- Population(P): In patients recognized as having a top threat of starting an pressure ulcers
- Intervention (I): the setup of a stress ulcer protocol began in the emergency department
- Comparison (C): contrasted to patient getting regular care when out of the emergency
- Outcomes (O): reduces the occurrence of pressure ulcers and complications time (t):by 30 days?
P (Target Population)
Based on the literature review, the study defined that the primary populations affected by pressure ulcers are elderly and terminal patients. In addition, the pressure ulcers issue is also associated with common among patients with comorbidities such as diabetes or involuntary muscle spasms. According to CDC (2020), diabetes is more common among Black, Asian, and Hispanic men and women older than 65 years. However, the diabetes rates among the elderly White population are not substantially lower. Therefore, the target population for the study is elderly patients with comorbidities. The ideal setting for implementing the SECURE framework is the emergency department.
I (Intervention)
The project aims to investigate the outcomes of implementing the SECURE framework identified in the study conducted by Gefen et al. (2020). In particular, the project is planning to implement the use of hydrogel-based dressing as a prevention measure for pressure ulcers on a larger scale. Currently, no policies allow advanced measuring of the risk of pressure ulcers development in each patient in the emergency department. Applying the SECURE framework will provide the necessary education for the nursing staff about pressure ulcer prevention measures and the patient’s tendency to develop DRPU depending on their condition and comorbidities.
Two potential actions will be applied in this practice change. Firstly, the framework will address the important issue of device-related pressure ulcers development in patients through the use of hydrogel-based dressing as a preventative measure. Next, the project will raise the awareness of nursing staff and patients about DRPU and health factors that influence the patients’ risk for pressure ulcers development. Informing the patient about the issue will increase the collaboration between the patient and nursing staff. Thus, the potential actions in practice change focus on improving the current situation and reducing the prevalence of DRPU through the application of available preventative measures.
O (Outcomes to be measured)
The main expected outcome of the project is the reduction of DRPU among elderly patients with an increased risk of pressure ulcers development. The other expected outcomes include positive results of hydrogel-based dressing as a preventative measure of pressure ulcers development and raising the awareness of nursing staff and patients about pressure ulcers. The project will compare the data and conduct a survey of nursing staff with the use of statistical tools and data analysis. In particular, to measure the decline in the number of DRPU cases, the project will compare the predictive data and the actual descriptive data; the result will validate the project’s success. According to Borojeny et al.(2020), the incidence of pressure ulcers in clinical settings ranges from 4% to 38%. Therefore, if the DRPU incidence rate decreases by 10% from the predictive data at the end of the project, the intervention will be a significant change.
Conclusion
The MSN Capstone Project focuses on improving the situation with the acute problem of pressure ulcers in the public health system. Pressure ulcers present a serious risk to patients’ health because of their severe consequences. Furthermore, as there is no available treatment that addresses the issue of pressure ulcers, it is necessary to develop a system of preventative measures to ensure patients’ safety. Through the literature review, the project defined that pressure ulcers predominantly develop from the tissue damage caused by medical devices. Moreover, in the existing body of knowledge, the effective prevention measures focused on increasing the awareness of nursing staff and patients about DRPU through the SECURE framework and application of hydrocolloid dressing. Thus, to provide a more effective solution, the project combines the identified prevention measures with hydrocolloid dressing as an element of the SECURE framework for a policy change. The literature review determined that the older population with comorbidities is more prone to the development of pressure ulcers. Thus, the implementation’s expected outcomes include decreased DRPU incidence rate in the target group of older adults in a clinical setting.
In implementing this project, I expect to use several core competencies of health care professionals. Firstly, the project supports the competency of providing patient-centered care and the prevention of diseases. Next, the project employs evidence-based practice acquired from literature research on pressure ulcers prevention and practical measures such as implementation of a preventative framework. Lastly, the project allows quality improvement through intervention and change of care processes.
References
Abhishek, J., Ping, S., Nirav B. P., & Michael S. W. (2018). Pressure sores and systemic inflammatory response syndrome: UC Davis Quality Improvement Initiative. Annals of Plastic Surgery, 80(5S), S308-S310.
Borojeny, A. L., Albatineh, A. N., Dehkordi, H. A., & Gheshlagh, G. 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, 1-7. Web.
Cai, J. Y., Zha, M. Z., & Chen, H. L. (2019). Use of a hydrocolloid dressing in the prevention of device-related pressure ulcers during noninvasive ventilation: A meta-analysis of randomized controlled trials. Wound Management and Prevention, 65(2).
CDC. (2020). National diabetes statistics report: Estimates of diabetes and its burden in the United States. Web.
Chiang, I. H., Wang, C. H., & Tzeng, Y. S. (2018). Surgical treatment and strategy in patients with multiple pressure sores. International Wound Journal, 15(6), 900-908.
Gefen, A., & Ousey, K. (2020). Update to device-related pressure ulcers: SECURE prevention. COVID-19, face masks and skin damage. Journal of Wound Care, 29(5). Web.
Gefen, A., Alves, P., Ciprandi, G., Coyer, F., Milne, C. T., Ousey, K., Ohura, N., Waters, N. & Worsley, P. (2020). Device-related pressure ulcers: SECURE prevention. Journal of Wound Care, 25(2). Web.
Gefen, Milne, F., Coyer, G., Ciprandi, P., Alves, A., C. T., Ousey, K., Ohura, N., & Worsley, P. (2020). Pressure abscess attached to the tool: Secure prevention. Log of Wound Treatment, 29(Sup2a). Web.
Grigatti, A., & Gefen, A. (2021). What makes a hydrogel-based dressing advantageous for the prevention of medical device-related pressure ulcers. International Wound Journal, 19(3), 515-530. Web.
Liao, X., Ju, Y., Liu, G., Zhao, X., Wang, Y., & Wang, Y. (2019). Risk factors for pressure sores in hospitalized acute ischemic stroke patients. Journal of Stroke and Cerebrovascular Diseases, 28(7), 2026-2030.
Lustig, A., Margi, R., Orlov, A., Orlova, D., Azaria, L., & Gefen, A. (2021). The mechanobiology theory of the development of medical device-related pressure ulcers revealed through a cell-scale computational modeling framework. Biomechanics and Modeling in Mechanobiology, 20, 851-860. Web.