CRITICAL APPRAISAL PART B
PREVENTION OF PRESSURE ULCERS
A pressure ulcer, bedsores, or decubitus ulcers are defined u injury to the skin or underlying tissue, often over a bony prominence, that results from unrelieved pressure. According to Ebi, Hirko, & Mijena (2019), pressure ulcers are preventable but it should never occur. Nurses play an important role in preventing pressure ulcers as they are the primary caregivers. The overall interventions identified from the study effective in preventing pressure ulcers are adequate nutrition, exercise, repositioning, treating incontinence, dressing, and using support devices. Repositioning, use of support devices, addressing aims at relieving or reducing pressure. Reposition involves changing patients sleeping positions regularly to relieve pressure and increase blood circulation (Reddy, Gill, & Rochon, 2016). Combination with changing wet linen, and maintaining patient hygiene will effectively prevent pressure ulcers.
Poor nutrition predisposes patients to pressure ulcers due to poor immunity and unhealthy skin. Inadequate nutrition and dehydration cause the skin to dry and increases death cells will impair oxygen supply. The patients such as the post-operative or orthopedic patients should be provided with nutritional supplements. Another intervention described by Tolmie & smith (2015) states that the type of patient plan, patient education, and patient mobilization influences the severity of patient sores. Educating the patient on the importance of daily dressing, hygiene, and nutrition is crucial. Besides, the fact that the study revealed that nurses lacked knowledge on the prevention of pressure sores calls for an increase in training and adequate staffing. Involving the patient in the care process will improve the outcomes of care (Reddy, Gill, & Rochon, 2016). The use of a topical agent enhances the healing of skin injuries within 14 days.
Support devices or pressure-relieving devices lower the risks of ulcers by 60% compared to the standard hospital mattresses (Qaseem, Mir, Starkey, & Denberg, 2015). They include pillows placed in pressure areas, chair cushions, foam wedges, and other devices placed between knees, pressure joints, and heels. It is established that early recognition of risk factors will improve the outcomes of patients. Pressure ulcers have a psychological, economic, and social impact on the individual and the family, hence it should be effectively prevented. The patient risk factors include impaired mobility, nutrition, or skin health, which should be managed used current evidence to improve outcomes and reduce risks. Dressing and the use of topical agents depend on the wound being treated and the size, depth, location, presence, and volume of exudate must be considered (Qaseem et al., 2015). It is important to note that the type of pressure ulcers determines the type of intervention implemented, hence, a thorough assessment is needed. Most of the articles identified promote utilization of EBP to improve health outcomes. Therefore, nurses should be knowledgeable about the critiquing of research articles to identify the best evidence effective in managing patient conditions.
References
Ebi, W. E., Hirko, G. F., & Mijena, D. A. (2019). Nurses’ knowledge to pressure ulcer prevention in public hospitals in Wollega: a cross-sectional study design. BMC nursing, 18(1), 20. Retrieved from: https://link.springer.com/article/10.1186/s12912-019-0346-y
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), 359-369. https://doi.org/10.7326/M14-1567
Reddy, M., Gill, S. S., & Rochon, P. A. (2016). Preventing pressure ulcers: a systematic review. Jama, 296(8), 974-984. doi:10.1001/jama.296.8.974
Tolmie, E. P., & Smith, L. N. (2015). A study of the prevention and management of pressure sores. Clinical Effectiveness in Nursing, 6(3-4), 111-120. https://doi.org/10.1016/S1361-9004(02)00071 -7