Pressure Ulcer Prevention in Difficult-to-Treat Patients

Topic: Health Words: 2431 Pages: 6 Nov 9, 2022

Introduction

Timely diagnosis and treatment of pressure ulcers will ensure a life without arduous rehabilitation. This work is aimed at studying the problem of bedsores in difficult-to-treat patients and finding solutions to it. In addition, it is possible to achieve significant improvement by applying for high-quality care programs. No less important may be that it is possible to exchange experience between doctors and specialists within the framework of this problem.

To prevent injuries on the body in bedridden patients, it is crucial to understand the causes of their occurrence. Kottner et al. (2018a) note that “the skin microclimate, such as temperature, humidity, and airflow next to the skin surface, is an indirect pressure ulcer risk factor” (p. 62). It should be understood that bedsores are damage to the skin in bedridden patients. They occur due to the pressure of a hard surface on the protruding bone fragments on the body, excessive humidity, and non-compliance with hygiene.

Problem

Pressure ulcers can be life-threatening if patients do not receive appropriate treatment. Factors contributing to the formation of bedsores: immobility of the body, a hard surface, contamination of the skin, and careless manipulations of nurses. Patients themselves need to be willing to follow pressure ulcer prevention interventions (Ledger et al., 2020). Thus, it is essential to note that the treatment and prevention of bedsores are inextricably linked with a whole range of measures to care for a sick person.

Almost complete immobility leads to the fact that the soft tissues of the back and limbs are under constant pressure from the body weight. Thus, blood circulation is disrupted, and skin necrosis occurs. Bedsores form on the body, which is the entrance gate for infection. Their presence significantly complicates the care of bedridden patients and is a danger to their bodies. For the prevention of bedsores, competent professional care of the patient is critical.

By addressing the problem of pressure ulcers in medical patients, the goal is to form a complete picture of effective prevention methods and work with them in case of occurrence. To prevent ulcers, patients need to be provided with proper care. Martin et al. (2017) emphasize that pressure ulcers usually cause “high human and economic costs with a lower quality of life, diminished functional autonomy, serious infections, and more extended hospital stays with extra costs to the healthcare system” (p. 473). Many patients do not complain of discomfort, trying to disturb their loved ones or nurses as little as possible and, as a result, worsening their condition. The task of the caregiver is to constantly monitor the conditions and the health of the patient.

Search Strategies

Independent information search, focused on problem analysis, scientific research, and creativity, should solve such tasks as they search for relevant information and analog information in related fields. Salvador-Oliván et al. (2019) note that “to improve the quality of searches and avoid errors, it is essential to plan the search strategy carefully (p. 219). In addition, it is necessary to generalize and clarify the information received. Moreover, analysis and evaluation of the information based on the actual tasks were done.

For an effective search of information about the problem, separate phrases and keywords were used. Examples of phrases used in the search are “pressure ulcer”, and “pressure injury”, “prevention of pressure ulcer” and search terms “pressure nuclear and nursing care”, “attitude toward pressure nuclear” and “pressure nuclear methods of treatment”. To search for the necessary articles and research, the online resource Google Scholar was used. Articles written more than five years ago were not considered for research. In most cases, the choice was given to articles that were fully available in electronic form. Both the analytical information processing strategy and obtaining ready-made information were applied. The first corresponds to a high level of information and communication knowledge. It should be noted that the strategies mentioned earlier are situational, and depend on the nature of the information required.

Level of Evidence

During the analysis of information, the level of evidence-based information can be assessed as sufficiently high. A relatively large amount of information about the problem is available. Nevertheless, some studies show insufficient education of medical personnel in bedsore prevention. Despite having advanced technology, pressure ulcer in hospitals is a serious problem that causes physical and psychological issues for patients (Galvão et al., 2017). Furthermore, it raises the level of expenditures on health resources.

Patients also play a role in a successful disease prevention strategy. Robineau et al. (2019) conclude that patients’ education has a considerable impact on skin management ability. Strategies for improving patient literacy and the decision-making process should be the foundations of health policy. It is essential to know that bedsores can appear in people of any age if they cannot move independently. To avoid the problem, people need to take care of their skin, and keep it clean.

In addition, many studies note the importance of proper nutrition. Improper nutrition and insufficient food intake are key risk factors for developing pressure sores and impaired wound healing (Saghaleini et al., 2018). Frequent weight loss or gains are also the main risk factors. Uncorrected nutrition impairs the functioning of the immune system, thereby disrupting the synthesis of collagen and the strength of the skin. Hydration and the intake of nutrients and vitamins play a vital role in maintaining the integrity of the skin.

Literature Review

The analysis of scientific literature was done to examine the data about pressure ulcers and their prevention. The work Results on pressure ulcer is aimed at improving the quality of evidence obtained during pressure ulcer prevention studies by developing core outcome sets (Lechner et al., 2021). There are many clinical trials testing strategies for the prevention of the disease. However, the heterogeneity and inconsistency of the results in preventing pressure ulcers seem to be the characteristic feature. Qualitative studies are of particular importance since they identify potential results that are important for patients.

Pressure ulcers can be very dangerous for patients if they are not cured in a timely manner. The literary review showed that powered active air surfaces have a higher probability of decreasing the disease incidence (Shi et al., 2018). Nevertheless, they can be less comfortable than standard hospital support surfaces. Most prevention evidence was of low certainty, and more research is required to reduce it. The poor quality of the existing evidence-based research makes it specifically crucial that new researches ensure study strictness.

Treatment and prevention of bedsores are inextricably linked with a whole range of measures. In this process, nurses are given one of the most critical roles. However, nurses’ knowledge of pressure ulcer prevention is lower than the recommended level of 60% (Dalvand et al., 2018). As a solution, it is proposed to conduct training courses and review the basic principles for preventing the disease. Possession and knowledge of modern methods of preventing bedsores allow providing high-quality and timely assistance.

Pressure ulcers have been regarded as a degree of a person’s quality of nursing care and health. The article Nurses’ Attitude showed that most nurses have a negative attitude towards disease prevention. The work identified a few barriers that needed to be resolved. Its elimination will allow using specific strategies for pressure ulcer prevention. These limitations are heavy workload and inadequate staff, shortage of resources and equipment, and inadequate training (Etafan et al., 2018). Changing attitude toward the disease is vital for improving these aspects of life.

The article The Future of Pressure Ulcer Prevention considers technology-based ways to prevent the problem. The author emphasizes the concern about the lack of advanced biomedical technologies, which would assess the risks and detect the disease immediately (Gefen, 2018). This is especially alarming, given the current level of progress that society has achieved. The paper describes the sequential actions and characteristics of the cascade of damage in a pressure ulcer. A complete understanding of the cascade of mechanobiological injuries will make it possible to conduct an early intervention.

Solutions

In providing methods to the problem of treatment, e-health offers several approaches. The solutions that can be useful in curing pressure ulcers are wearable computing and repositioning strategies. However, these methods are not very accurate and are not always able to work effectively. The researchers suggest using inertial sensors, which can be used to assess the position of patients and send an alarm signal if the patient remains in the same position for too long (Cicceri et al., 2020). Wearable technologies introduce a new step in digital innovations, but their disadvantage is their invasive and expensive nature.

One of the best ways to prevent the formation of bedsores is a frequent change of body position. However, this process is not as simple as it may seem. Studies show that training on preventing pressure ulcers should include practical demonstrations of repositioning (Woodhouse et al., 2019). Clear instructions are needed regarding the optimal repositioning technique. In addition, it is recommended to conduct a soft massage of the surface tissues to prevent blood stagnation.

Conclusion

In this work, the main factors of the occurrence of bedsores were identified, the related literature was evaluated, and prevention measures were considered. Moreover, the literary sources were analyzed in more detail. It showed that there are many methods and strategies to prevent pressure ulcers. There are several articles about nurses’ attitudes towards the problem. The change to a positive approach instead of the negative one plays a vital role in providing medical help.

Diseases lead to limited movement, which puts the patient at risk of bedsores. Good medical care aimed at alleviating suffering and curing diseases is necessary (Gefen, 2018). It includes measures for the prevention and treatment of pressure ulcers. Therefore, to prevent the appearance of bedsores, it is necessary to regularly turn the patient over, introduce new healthcare technologies and monitor nutrition. In addition, it is essential to examine the patient’s body, paying particular attention to those areas where bedsores occur most often.

It is necessary to carefully eliminate all the causes that lead to these severe complications and contribute to their progression. Many indicators indicate the importance of measuring the quality of prevention of pressure ulcers (Kottner et al., 2018b). There is a need to develop scientific indicators that will help improve patient care. Care and prevention should be carried out daily. This improves the quality of life, psychological status, and self-esteem of the patient.

Description of the Evidence According to the AACN Guidelines

Name of the article	Evidence Quality
Cicceri, G., De Vita, F., Bruneo, D., Merlino, G., & Puliafito, A. (2020). A deep learning approaches for pressure ulcer prevention using wearable computing.	A The article has a solid evidence base. There are also about related work sections and a section with the conducted research.
Dalvand, S., Ebadi, A., & Gheshlagh, R. G. (2018). Nurses’ knowledge on pressure injury prevention: a systematic review and meta-analysis based on the Pressure Ulcer Knowledge Assessment Tool.	B It is a well-designed and controlled study with details of the research.
Etafa, W., Argaw, Z., Gemechu, E., & Melese, B. (2018). Nurses’ attitude and perceived barriers to pressure ulcer prevention.	A The article contains well-thought through evidence, background information and thoroughly described methods.
Galvão, N. S., Serique, M. A. B., Santos, V. L. C. D. G., & Nogueira, P. C. (2017). Knowledge of the nursing team on pressure ulcer prevention.	B It is a qualitative study with consistent results and well-discussed conclusion and limitations.
Gefen, A. (2018). The future of pressure ulcer prevention is here: detecting and targeting inflammation early.	A This article is of particular value because it has a well-founded evidence base, a detailed description of the problem, an example of the technologies used to treat the disease and reasonable conclusions.
Kottner, J., Black, J., Call, E., Gefen, A., & Santamaria, N. (2018a). Microclimate: a critical review in the context of pressure ulcer prevention.	B Article provides the information about the effects of microclimate on the skin and microclimate and pressure ulcer development and how to improve the skin climate. It provides well-designed research and consistent support for results.
Lechner, A., Kottner, J., Coleman, S., Muir, D., Beeckman, D., Chaboyer, W.,… & Balzer, K. (2021). Outcomes for Pressure Ulcer Trials (OUTPUTs) project: review and classification of outcomes reported in pressure ulcer prevention research.	B The article provides real data on the conducted research. The search strategy and the eligibility criteria are also described.
Ledger, L., Worsley, P., Hope, J., & Schoonhoven, L. (2020). Patient involvement in pressure ulcer prevention and adherence to prevention strategies: An integrative review.	B The study cites the sources of information used during the work, the review methods and the search strategy. However, the article does not give accurate results, emphasizing the need for further research.
Martin, D., Albensi, L., Van Haute, S., Froese, M., Montgomery, M., Lam, M., Gierys, K., Lajeunesse, R., Guse, L., & Basova, N. (2017). Healthy skin wins A glowing pressure ulcer prevention program that can guide evidence‐based practice.	C The authors emphasize that due to the small sample size, further research is required. However, the article has sufficient information about the methods of research and about the use and effectiveness of treatment methods.
Robineau, S., Nicolas, B., Mathieu, L., Duruflé, A., Leblong, E., Fraudet, B.,… & Gallien, P. (2019). Assessing the impact of a patient education program on pressure ulcer prevention in patients with spinal cord injuries.	B The study provides data on the impact of special programs in the training of specialists, showing the results in real cases. Materials and research methods are also provided.
Saghaleini, S. H., Dehghan, K., Shadvar, K., Sanaie, S., Mahmoodpoor, A., & Ostadi, Z. (2018). Pressure ulcer and nutrition.	A The authors speak about prevalence, incidence, and healthcare burden of pressure ulcers, providing well-thought-out evidence. Results consistently support the research discussion.
Salvador-Oliván, J. A., Marco-Cuenca, G., & Arquero-Avilés, R. (2019). Errors in search strategies used in systematic reviews and their effects on information retrieval.	B The article provides data extraction, selection criteria and process and data analysis. Results include search errors and it is a controlled study with supporting information.
Shi, C., Dumville, J. C., & Cullum, N. (2018). Support surfaces for pressure ulcer prevention: a network meta-analysis.	A The strength of the study is the inclusion of a section on the risk of biased assessment and risk of bias assessment. Well-provided evidence-based information accompanied by statistical data.
Woodhouse, M., Worsley, P. R., Voegeli, D., Schoonhoven, L., & Bader, D. L. (2019). How consistent and effective are current repositioning strategies for pressure ulcer prevention?.	B Article gives sufficient background information and methods data. Participant characteristics and volunteer assessment findings are also of great importance. The article is supported by an advantageous number of studies.

References

Cicceri, G., De Vita, F., Bruneo, D., Merlino, G., & Puliafito, A. (2020). A deep learning approach for pressure ulcer prevention using wearable computing. Human-centric Computing and Information Sciences, 10(1).

Dalvand, S., Ebadi, A., & Gheshlagh, R. G. (2018). Nurses’ knowledge on pressure injury prevention: a systematic review and meta-analysis based on the Pressure Ulcer Knowledge Assessment Tool. Clinical, cosmetic and investigational dermatology, 11, 613-620

Etafa, W., Argaw, Z., Gemechu, E., & Melese, B. (2018). Nurses’ attitude and perceived barriers to pressure ulcer prevention. BMC nursing, 17(1).

Galvão, N. S., Serique, M. A. B., Santos, V. L. C. D. G., & Nogueira, P. C. (2017). Knowledge of the nursing team on pressure ulcer prevention. Revista Brasileira de enfermagem, 70(2), 294-300.

Gefen, A. (2018). The future of pressure ulcer prevention is here: detecting and targeting inflammation early. EWMA J, 19(2), 7-13.

Kottner, J., Black, J., Call, E., Gefen, A., & Santamaria, N. (2018a). Microclimate: a critical review in the context of pressure ulcer prevention. Clinical Biomechanics, 59, 62-70.

Kottner, J., Hahnel, E., Lichterfeld‐Kottner, A., Blume‐Peytavi, U., & Büscher, A. (2018). Measuring the quality of pressure ulcer prevention: a systematic mapping review of quality indicators. International wound journal, 15(2), 218-224.

Lechner, A., Kottner, J., Coleman, S., Muir, D., Beeckman, D., Chaboyer, W.,… & Balzer, K. (2021). Outcomes for Pressure Ulcer Trials (OUTPUTs) project: review and classification of outcomes reported in pressure ulcer prevention research. British Journal of Dermatology, 184(4), 617-626.

Ledger, L., Worsley, P., Hope, J., & Schoonhoven, L. (2020). Patient involvement in pressure ulcer prevention and adherence to prevention strategies: An integrative review. International journal of nursing studies, 101, 103449-103473.

Martin, D., Albensi, L., Van Haute, S., Froese, M., Montgomery, M., Lam, M., Gierys, K., Lajeunesse, R., Guse, L., & Basova, N. (2017). Healthy skin wins A glowing pressure ulcer prevention program that can guide evidence‐based practice. Worldviews on Evidence‐Based Nursing, 14(6), 473-483.

Robineau, S., Nicolas, B., Mathieu, L., Duruflé, A., Leblong, E., Fraudet, B.,… & Gallien, P. (2019). Assessing the impact of a patient education program on pressure ulcer prevention in patients with spinal cord injuries. Journal of tissue viability, 28(4), 167-172.

Saghaleini, S. H., Dehghan, K., Shadvar, K., Sanaie, S., Mahmoodpoor, A., & Ostadi, Z. (2018). Pressure ulcer and nutrition. Indian Journal of Critical Care Medicine: Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine, 22(4), 283-289.

Salvador-Oliván, J. A., Marco-Cuenca, G., & Arquero-Avilés, R. (2019). Errors in search strategies used in systematic reviews and their effects on information retrieval. Journal of the Medical Library Association: JMLA, 107(2), 210-221.

Shi, C., Dumville, J. C., & Cullum, N. (2018). Support surfaces for pressure ulcer prevention: a network meta-analysis. PloS, 13(2).

Woodhouse, M., Worsley, P. R., Voegeli, D., Schoonhoven, L., & Bader, D. L. (2019). How consistent and effective are current repositioning strategies for pressure ulcer prevention?. Applied Nursing Research, 48, 58-62.