Prevention and care of pressure ulcers Essay


Pressure ulcers are a normally seen job among aged hospitalized patients. Despite new findings about the causes and attacks to intervention. the incidence of these lesions is still increasing. Scott. Gibran. Engrav. Mack and Rivara ( 2006 ) revealed that during the 13 old ages of their survey. the incidence of force per unit area ulcer development has more than doubled. As our aged population becomes greater in figure. and older in age. this job is expected to intensify. It is of great importance for the patients every bit good as for the establishments to happen the best pattern guidelines to command the happening of preventable lesions. Many infirmaries incorporate rigorous bar steps with good effects. and others are more concentrated on handling the job after it occurs. without paying much attending to bar. In XY infirmary. patients at hazard do non have the necessary preventative attention. and many patients’ bing lesions frequently become septic. and alternatively of mending. they deteriorate. This paper will reexamine the research sing the best bar methods. every bit good as the best grounds based intervention of force per unit area ulcers. followed by suggestions how to implement those findings in XY infirmary.


In aged and immobile patients. what are the most effectual bar and intervention methods to cut down the happening and complications of force per unit area ulcers. compared to no bar and standard wet-to-dry dressings?


Effective direction of force per unit area ulcers begins with a comprehensive appraisal of the patient. with careful consideration of the hazard factors. Hess ( 2004 ) reported that the Braden Scale is the most normally used hazard appraisal tool. Besides. it is of import to regularly inspect the tegument of the patients found to be at hazard. Such review should concentrate peculiarly on the countries around bony prominences. Bethell ( 2005 ) argues that one time present one force per unit area ulcer develops. the irreversible harm to the tissue signifiers. and this will come on to open. deeper lesion if force per unit area is non relieved. Stage one is defined as a alteration of integral tegument in one or more of the followers: skin temperature. colour. tissue consistence and/or esthesis ( Hess ) .

Unfortunately. the staff at XY infirmary is merely concerned with skin dislocation. when measuring for force per unit area ulcers. No bar schemes are implemented for patients at hazard until they develop stage two ulcers. when skin dislocation is seeable. One article notes that educational in-service for the staff is effectual. and consequences in the professionals’ better apprehension and ability of presenting force per unit area ulcers ( Thompson. Langemo. Anderson. Hanson and Hunter. 2005 ) . It is necessary that bar techniques are implemented for all patients at hazard from the minute that hazard is identified. whether there is an bing tissue hurt or non.

Another survey indicates that the organic structure can digest great sum of force per unit area for short clip periods. but low force per unit area for a long sum of clip causes important tissue harm ( Maklebust. 2005 ) . Shifting of patients should be performed at least every two hours or more frequently if necessary. The writer suggests that when shifting the patient onto the side. he or she should be supported in a 30-degree sidelong place instead than at a 90-degree angle. Such place avoids the force per unit area of the bony prominences on the softer tissues. Besides. the caput of the bed should be maintained at less than 30 grades to avoid the shearing forces caused by patient’s sliding in bed ( Maklebust ) .

Furthermore. surveies advise that appropriate lifting devices should be used to forestall clash during transportation and repositioning ( Grey. Harding and Enoch. 2006 ) . Besides. patients’ heels are frequently subjected to force per unit area and clash. The staff at XY infirmary on occasion elevates patients’ heels by puting them on folded covers. Literature suggests that the heels should be suspended. with a pillow or a cover placed under the lower legs ( Maklebust ) . Additionally. the usage of force per unit area alleviating mattress is encouraged. but it does non extinguish the demand for frequent place alterations ( Hess. 2004 ) .

Furthermore. another factor making a hazard for force per unit area ulcer development is malnutrition. Wysocki ( 2002 ) observed that 10 to 50 % of hospitalized patients are malnourished. Nurses should be watchful to inadequate nutrition and its effects. Besides. Cobb and Warner ( 2004 ) noted that when 30 per centum of weight is lost. self-generated force per unit area ulcers begin to develop. and bar schemes might non work. In add-on. urinary and faecal incontinency are besides important hazard factors. Incontinence consequences in extra wet. and annoyance of the tegument. The nurses and assistive forces in XY infirmary frequently do non help their incontinent patients for long periods of clip. and they do non use the available tegument protectants.

Surveies confirmed the effectivity of no-rinse cleansing agents and wet barrier picks. and found that they were less likely to harm tegument unity than soap and H2O ( Thompson. et Al. . 2005 ) . The findings besides advise that look intoing the patients for dirtying every two hours adds to the effectivity. Although non all force per unit area ulcers are preventable and curable. the literature provides supportive grounds that appropriate bar protocols decrease the incidence of phase one and two force per unit area ulcers. and in bend lessening the figure of force per unit area ulcers that could come on to present three and four ( Thompson. et al. ) .

Furthermore. an of import portion of bing wound direction is wound bed readying. and usage of appropriate dressings. Cobb and Warner ( 2004 ) suggest that using dressings without debriding will non mend the lesion. and constitutes wasted clip and attempt. The writers besides point out that: “debridement must be thought of as an on-going procedure. Initial debridement should be followed by care debridement” ( Cobb & A ; Warner ) . Necrotic tissue and extra slough encourage bacterial proliferation. therefore the dust has to be removed in order to advance healing. Three types of debridement. as described by McGuckin. Goldman. Bolton and Salcido ( 2003 ) . can be performed or applied by a registered nurse. Mechanical debridement. which is performed with wet-to-dry dressings. although effectual. can be painful when dry gauze is pulled off. and can besides take healthy tissues. Enzymatic debridement is the application of enzymatic unctions that digest the dead tissue. but can besides digest the feasible tissue.

The last. autolytic debridement. involves the action of natural enzymes under hydrocolloid or movie dressings. One of such dressings. Polymem. is available in XY infirmary. The merchandise contains a lesion cleansing agent. a bacteriostatic. a moisturizer. and an absorbing agent which absorbs ten times its ain weight in exudation. Polymem besides promotes preparation of granulation tissue ( McGuckin. et al. ) . Another utile dressing available in XY infirmary is Aquacel Ag. an absorptive dressing composed of hydrofiber impregnated with ionic Ag. Research findings urge it for autolytic debridement. every bit good as for the bar and intervention of infection ( Dowsett. 2004 ) . In the presence of wet in the lesion. Ag ions are released and adhere to cells including bacteriums. It is recognized as an effectual broad-spectrum antimicrobic dressing ( Dowsett ) .

In add-on. Ovington ( 2001 ) pointed out the differentiation between the standard wet-to-dry and wet-to-moist dressings. which are frequently mistakenly considered as one. Wet-to-dry is intended for debridement. and the gauze should be allowed to dry before it is removed. Wet-to-moist is intended to stay damp until remotion. but it frequently becomes wet-to-dry in pattern. However. the writer indicates that the standard moisture gauze dressing is non an optimal lesion attention. but despite 100s of new more good merchandises. gauze is still widely used. In vitro surveies have shown that bacteriums were capable of perforating up to 64 beds of dry gauze. and damp gauze nowadayss even less barrier to bacteriums. It has been besides shown that infection rates in lesions with damp gauze dressings are higher than in lesions with movie or hydrocolloid dressings ( Ovington ) . New dressings become widely available. and on-going research is needed to supply the grounds for the most effectual options.


Successful leaders thrive on uninterrupted alteration. Execution of a alteration is ne’er a individual action but involves a well designed. comprehensive program. and a bit-by-bit procedure. The first measure of implementing alteration is to place the job. The staff in XY infirmary has to be cognizant of the demand to alter their pattern related to force per unit area ulcers. Harmonizing to Lewin ( Marquis & A ; Huston. 2006. p. 173 ) this is called dissolving. Showing statistical informations of force per unit area ulcer happening on the unit. and comparing it to other units or infirmaries. and to province or national ends reveal the bing job. The staff has to acknowledge and understand the issue. and be motivated to make something about it. Educating the staff on the topic through verbal and written communicating will ease directing the message.

The 2nd stage is motion ( Marquis & A ; Huston. 2006. p. 173 ) . This following measure starts with making an instability by increasing the drive forces. which lead people toward the alteration. or cut downing restraining forces. which repel alteration. It requires developing an action program. specifying aims. and set uping ends. The appropriate schemes have to be planned and implemented bit by bit. A careless attack to deciding the affair can do defeat. Educational in-service for the staff informing about preventative guidelines described in research. normally seen jobs. and most effectual grounds based schemes will originate the exchange of thoughts.

The leader has to admit that people might react to alter in assorted ways. Some will experience motivated and energized. while others will experience threatened and disgruntled. Marquis and Huston ( 2006. p. 180 ) inform that it is most effectual when all those affected by a alteration are involved in planning that alteration. Collaboration and duologue with staff are needed to derive an apprehension of what they value and keep as of import. Gearing the communicating toward a common desire will take to set uping an effectual and accomplishable program. As was antecedently done on the unit in XY infirmary. a notice could be posted in the staff interruption room promoting all to compose thoughts and suggestions on how to implement the needful alterations. Then. action stairss utilizing those thoughts should be structured hand in glove.

With the program in manus. the leader should originate the alteration procedure. Marquis and Huston ( 2006. p. 181 ) province that leaders must be engaged in alteration by function mold and helping staff to promote them. The nurses and the assistive forces should be reminded and encouraged to look into incontinent patients more often to guarantee that they are non wet and soiled for drawn-out periods of clip. but the leader should originate these actions him/herself. Asking staff to assist administer the tegument protection supplies to each incontinent patient’s room will ease the passage. It is necessary to demo committedness and consistence in implementing the alteration to avoid disheartenment. Furthermore. the inventions which will ensue in easier and less work can be expected to be adopted about instantly.

For illustration. using Polymem and Aquacel Ag is much easier and faster than clip devouring wet gauze dressings. It can besides be expected that the most hard portion of the program would be implementing bar schemes for patients at hazard. but without force per unit area ulcers. Shifting patients. raising them suitably. look intoing for wetness. and appropriate eating are clip devouring and labour intensive. The leader has to be able to stimulate others. and be systematically interested and committed to the program. until completed. Each of the schemes has to be introduced one at a clip. to let slow accommodation. Marquis and Huston ( p. 173 ) advise that to be accepted. alteration needs at least three to six months.

The last stage of the alteration theory is refreezing. The alteration has to be stabilized and integrated into the position quo ( Marquis & A ; Huston. 2006. p. 173 ) . Acknowledging and admiting the difficult work of the staff should ne’er be forgotten. Thanking for the committedness improves work public presentation and satisfaction. Besides. reevaluation is necessary to modify and better the alteration as needed. Prevention schemes to cut down the incidence of force per unit area ulcers need to be a squad attempt in order to be effectual.


Pressure ulcers remain a serious type of lesion seen among many infirmary patients. Despite the freshly developed schemes to forestall and pull off those lesions. their incidence is still turning. Measuring hazard factors and placing optimum bar techniques are the first line of defence. Regular alleviation from force per unit area. usage of lift sheets. usage of incontinency tegument barriers. and care of equal nutrition are the chief preventative intercessions. Nevertheless. some patients may develop clamber breakdown despite high quality attention. Optimal lesion attention requires an on-going debridement of devitalized tissue. and appropriate dressings which promote healing.

Healthcare professionals have a broad assortment of new intervention options from which to take from. and should be traveling off from utilizing the uneffective and labour intensive gauze dressings. Implementing appropriate methods to better control force per unit area ulcers based on up-to-date grounds requires good leading accomplishments. The cardinal facets of carry throughing the end are: developing a good program. deriving involvement of the staff. and being committed to the terminal. To implement any alteration successfully. leaders have to near it with dedication and enthusiasm. After all. the terminal ends of our ongoing clinical challenges ever are to advance the patient’s healing. to cut down gratuitous agony. and to better the quality of life.


Bethell. E. ( 2005 ) . Wound attention for patients with darkly pigmented tegument. _Nursing Standard. 20_ ( 4 ) . 41-49. Retrieved April 14. 2006. from OVID MEDLINE database.

Cobb. D. K. . Warner. D. ( 2004 ) . Avoiding malpractice: the function of proper nutrition and wound direction. _Journal of the American Medical Directors Association. 5_ ( 4 Suppl ) . H11-6. Retrieved April 14. 2006. from OVID MEDLINE database.

Dowsett. C. ( 2004 ) . The usage of silver-based dressings in lesion attention. _Nursing Standard. 19_ ( 7 ) . 55-58. Retrieved April 14. 2006. from OVID MEDLINE database.

Grey. J. E. . Harding. K. G. . Enoch. S. ( 2006 ) . Pressure ulcers. _BMJ. 332_ ( 7539 ) . 472-5. Retrieved April 14. 2006. from OVID MEDLINE database.

Hess. C. T. ( 2004 ) . Care tips for chronic lesions: force per unit area ulcers. _Advances in Skin and Wound Care. 17_ ( 9 ) . 477-9. Retrieved April 14. 2006. from OVID MEDLINE database.

Maklebust. J. ( 2005 ) . Choosing the right support surface. _Advances in Skin and Wound Care. 18_ ( 3 ) . 158-61. Retrieved April 14. 2006. from OVID MEDLINE database.

Marquis. B. L. . Huston. C. J. ( 2006 ) . _Leadership functions and direction maps in nursing. _ Philadelphia. Dad: Lippincott Williams and Wilkins.

McGuckin. M. . Goldman. R. . Bolton. L. . Salcido. R. ( 2003 ) . The clinical relevancy of microbiology in ague and chronic lesions. _Advances in Skin and Wound Care. 16_ ( 1 ) . 12-23. Retrieved April 14. 2006. from OVID MEDLINE database.

Ovington. L. G. ( 2001 ) . Hanging wet-to-dry dressings out to dry. _Home Healthcare Nurse. 19_ ( 8 ) . 477-83. Retrieved April 14. 2006. from OVID MEDLINE database.

Scott. J. R. . Gibran. N. S. . Engrav. L. H. . Mack. C. D. . Rivara. F. P. ( 2006 ) . Incidence and features of hospitalized patients with force per unit area ulcers: province of Washington. 1987 to 2000. _Plastic and Reconstructive Surgery. 117_ ( 2 ) . 630-34. Retrieved April 14. 2006. from OVID MEDLINE database.

Thompson. P. . Langemo. D. . Anderson. J. . Hanson. D. . Hunter. S. ( 2005 ) . Skin attention protocols for force per unit area ulcers and incontinency in long-run attention: a quasi-experimental survey. _Advances in Skin and Wound Care. 18_ ( 8 ) . 422-9. Retrieved April 14. 2006. from OVID MEDLINE database.

Wysocki. A. B. ( 2002 ) . Measuring and pull offing unfastened tegument lesions: colonisation versus infection. _AACN Clinical Issues. 13_ ( 3 ) . 382-97. Retrieved April 14. 2006. from OVID MEDLINE database.