Pressure Ulcer Prevention Problem & Opportunity
Pressure ulcer (PU) treatment is among the features of patient therapy in which nursing practice interoperates with healthcare providers. PU is a tiny area of cellular damage or apoptosis generated by compression of an injured area. It is the third most expensive ailment after cancer and cardiovascular disorders (Nussbaum et al., 2018). Since October 2008, hospitals have not received any Medicare reimbursement for ulcer-specific treatment of patients who develop Stage III or IV PUs following inpatient hospitalization (Fehlberg et al., 2017). As a result of policy changes adopted by the Centers for Medicare and Medicaid Services (CMS), facilities now must assess all patients diagnosed with skin problems to identify the likelihood of developing PUs. Using the Pressure Ulcer Knowledge Assessment Tool (PUKAT) scores, nurses must cultivate their clinical skills and knowledge based on evidence-based (EB) approaches for PUs to deliver optimal quality care.
Statement of the Problem/Opportunity
Despite contemporary strategies for PU therapy, nurse knowledge and clinical expertise in this area of study are out of date, and negative stereotypes about prevention efforts are on the ascent. Du et al. (2021), for example, commissioned a survey by comparing traditional didactic approaches that offered information about PUs to a therapeutic scenario simulation-based strategy for developing the competence to identify the risk of PUs.
According to the findings of the study, nursing students in the therapeutic scenario simulation cohort did much better in identifying and estimating the threat of developing PUs. In another study on hospital-acquired PUs prevention conducted by Gaspar et al. (2021), the majority of nurses possessed insufficient knowledge and competency to utilize the Braden scale. In this sense, it is clear that PU prevention is complicated and needs a systematic approach with robust EB information.
Although highly trained and skilled nurses may offer excellent PU care, prior research has revealed the presence of insufficient knowledge of delivering PU optimal care. PU is a painful, expensive, yet theoretically avoidable condition that is common in the geriatric population, individuals with restricted mobility, and patients with poor nutritional diets. The projected cost of PU therapy for each patient ranges from $70,000 to $150,000, with the yearly cost of its medication and treatment ranging from $9 to 11 billion (Etafa et al., 2018).
The condition lengthens hospital stays from 4 to 30 days, reduces the standard of living, and increases discomfort, morbidity, and death (Sayan et al., 2020). Therefore, the ineffective application of information is a prevalent issue in this therapeutic practice. Consequently, nurses may not be fully aware of current care guidelines and may lack sufficient knowledge of contemporary EB techniques.
According to scientific research, the occurrence of PUs varies from nation to nation. For example, the prevalence of PUs in the U.S. and Wales is 17% and 8.9%, respectively (Cowan et al., 2019; Clark et al., 2017). As per Etafa et al. (2018), the most commonly reported impediments are inadequate education for PU prevention (63 percent) and a lack of a unified protocol for its prevention (59.9 percent). Furthermore, 66.7 percent of the 222 staff nurses polled had had no prior training on PU prevention strategies, 86 percent had never read scientific research on PU, and 59.8 percent cited a lack of uniform guidelines as one of the major hurdles to practicing PU therapy (Etafa et al., 2018).
Citing from the study, it is clear that there is a knowledge gap that requires urgent bridging. Therefore, the purpose of this study is to examine nurses’ knowledge of contemporary EB strategies for the control and treatment of PUs.
PU therapy begins with recognizing high-risk patients, performing a comprehensive skin inspection, employing bed and chair support materials, and modifying posture, movement, and dietary assistance. PUKAT and the Braden scale can be used to assist with these principles. Preventive care initiatives suffer as a result of a lack of knowledge about PU prevention (Awad et al., 2020). Given the significance of enhancing nurses’ awareness of PU fall prevention, an understanding of the present level of nursing knowledge remains critical. As a result, the objective of the study is to examine nurses’ general knowledge of PU prevention based on their scores on the PUKAT and its subscales in various contexts to provide up-to-date nursing care.
Awad, W. H. A., & Hewi, S. A. H. (2020). Effect of pressure ulcer preventive nursing interventions on knowledge, attitudes and practices of nurses among hospitalized geriatric patients in Alexandria, Egypt. Journal of Nursing and Health Science, 9(2), 1-12. Web.
Clark, M., Semple, M. J., Ivins, N., Mahoney, K., & Harding, K. (2017). National audit of pressure ulcers and incontinence-associated dermatitis in hospitals across Wales: A cross-sectional study. BMJ Open, 7(8), 1-8. Web.
Cowan, L. J., Ahn, H., Flores, M., Yarrow, J., Barks, L. S., Garvan, C., Weaver, M. T., & Stechmiller, J. (2019). Pressure ulcer prevalence by level of paralysis in patients with spinal cord injury in long-term care. Advances in Skin & Wound Care, 32(3), 122-130. Web.
Du, Y. L., Ma, C. H., Liao, Y. F., Wang, L., Zhang, Y., & Niu, G. (2021). Is clinical scenario simulation teaching effective in cultivating the competency of nursing students to recognize and assess the risk of pressure ulcers? Risk Management and Healthcare Policy, 14(1), 2887-2896. Web.
Etafa, W., Argaw, Z., Gemechu, E., & Melese, B. (2018). Nurses’ attitude and perceived barriers to pressure ulcer prevention. BMC Nursing, 17(1), 1-8. Web.
Fehlberg, E. A., Lucero, R. J., Weaver, M. T., McDaniel, A. M., Chandler, M., Richey, P. A., Mion, L., & Shorr, R. I. (2017). Impact of the CMS no-pay policy on hospital-acquired fall prevention related practice patterns. Innovation in Aging, 1(3), 1-7. Web.
Gaspar, S., Botelho Guedes, F., Vitoriano Budri, A. M., Ferreira, C., & Gaspar de Matos, M. (2021). Hospital‐acquired pressure ulcers prevention: What is needed for patient safety? The perceptions of nurse stakeholders. Scandinavian Journal of Caring Sciences, 1(1), 1-10. Web.
Nussbaum, S. R., Carter, M. J., Fife, C. E., DaVanzo, J., Haught, R., Nusgart, M., & Cartwright, D. (2018). An economic evaluation of the impact, cost, and Medicare policy implications of chronic nonhealing wounds. Value in Health, 21(1), 27-32. Web.
Sayan, H. E., Girgin, N. K., & Asan, A. (2020). Prevalence of pressure ulcers in hospitalized adult patients in Bursa, Turkey: A multicentre, point prevalence study. Journal of Evaluation in Clinical Practice, 26(6), 1669-1676. Web.