The care plan
Aging is a natural process associated with increased disease burden, frailty, and disability. Notably, nurses play a significant role in developing an individualized care plan for their clients. In Mrs. Smith’s case, an individualized care plan will ensure effective care delivery to enhance the healing of pressure injury. The care plan is carefully developed, considering that she also suffers from depression and osteoarthritis, which has significantly caused pain, stiffness, and disability. Thus, pain management, pressure area care, and wound management are the three nursing care priorities for this patient.
Pain management
Multiple comorbidities associated with ageing result in persistent pain in the older population. According to Holloway et al. (2018), pain is often poorly identified, assessed, and managed in older patients; thus, it negatively affects their health, leading to disability and poor quality of life. Bechert and Abraham (2009) share a similar viewpoint, arguing that pain management is often ignored in the healing process of wounds. Therefore, pain management for Mrs. Smith requires pain assessment to establish the type of pain, the severity, location, onset, duration, and relieving factors. A comprehensive pain assessment for Mrs. Smith is crucial, as it allows the nurse to understand the best possible management strategy.
Based on the patient’s condition, pharmacological intervention is an ideal intervention for relieving the pain. The use of pharmacotherapy in pain management is well documented in Australia. Veal et al. (2015) indicate about 91% of Australian residents in aged care facilities with pain problems are prescribed analgesics. The study found that regular use of opioids and anxiolytic helps manage pain in older people. Therefore, this care plan also recommends pharmacotherapy as an effective intervention for Mrs. Smith.
The proposed evaluation strategy is reassessing the pain upon intervention. Reassessing the pain helps to measure the effectiveness of the pain after implementation of the intervention. After the intervention, the nurse will ask Mrs. Smith to rate the intensity of the pain at repeated intervals to compare with the previous rating. Her feedback will form the basis for continuing or adjusting the plan of care.
Pressure Area care
Pressure injury is one leading health concerns in Australia. Australian Commission on Safety and Quality Health Care (2018) indicates that a significant number of Australian patients experience pressure injuries. The Commission reveals 4313 cases occurred in hospitals in 2015-16, with the rate of hospital-acquired pressure injuries during the period being 9.7 in every 10,000 hospitalizations. The pressure injury in the left natal is a significant health concern for Mrs. Smith. Therefore, managing pressure injury a nursing care priority.
An individualized care plan is developed in partnership with the patient, care providers, and the family. The proposed intervention is removing pressure from the affected area. A study by Carville (2018) indicates that off-loading pressure from the affected area, through the use of appropriate support surfaces, helps manage pressure injury. Since Mrs Smith’s pressure injury is still small and in its second stage, removing pressure from the wound minimizes breaking through the skin surface. Repositioning the patient and using pressure redistributing equipment will help in managing the pressure load to the integumentary system.
The evaluation will be based on the Glamorgan Pressure Injury Risk Assessment Tool. Consistent with Alberti’s (2019) assertions, the patient’s score on the Glomargan screening tool after three days-three weeks of intervention will reveal the intervention’s effectiveness.
Wound Management
Wound healing is prerequisite for survival. Chronic wounds, particularly, are a significant problem in Australia; their health-related cost exceeds AUD 3.5 billion, which is about 2% of the national health care expenditure (McCosker et al., 2018). If untreated, wounds can have significant adverse effects on the quality of life of the affected persons. Since Mrs. Smith has a small pressure injury in stage 2, wound management is a nursing care priority in this individualized plan. Finding the underlying cause of the wound is essential in establishing an appropriate intervention.
The proposed intervention follows the TIME approach to wound management, a principle promoted by the Wound Healing Society. TIME is an acronym for tissue, infection, moisture, and edge (Werdin et al., 2009). This intervention focuses on identifying and eliminating specific tissue deficit and excessive bacteria burden, ensuring moisture balance, and monitoring the wound edge to assess the change in the ulcer size.
Bates-Jensen Wound Assessment Tool (BWAT) will be used to evaluate the effectiveness of the intervention. This tool assesses wound healing progress by analyzing the wound size, edges, depth, necrotic tissue type, undermining, granulation and epithelialization tissue, amount of necrotic, the type and amount of exudate, surrounding skin colour, induration, and edema (Bates-Jensen et al., 2019). The Australian Wound Management Association (2020) indicates that rating BWAT item scores on a Likert scale of 1-5 (where 1 is the best score) allow a detailed reassessment and monitoring of the wound healing process.