Nursing Essay On Development Of Pressure Sore

Question

Task:
Identify a clinical issue in nursing practice that aligns with one of the three stipulated National Quality and Safety Health Service Standards (2nd Edition):

• Preventing and controlling healthcare associated infection standard
• Medication safety
• Comprehensive care standard

Your nursing essay should include details on one clinical issue you identify from the literature. This clinical issue must involve an infection control issue, medication errors, falls risk, development of pressure sores, cognitive impairment etc.

You will describe the circumstances that may have contributed to the clinical issue and explain how the chosen issue impacts at either a patient level, nursing level, ward/unit level or at an organisational level.

Answer

Introduction
It is evident in this nursing essay that registered Nurses have been witnessing a major issue of injuries among the patient of geriatric or palliative care wards which has been making their role complex and critical to some extent. Elderly patients living in their health care setting or wards sustain an increased risk of development of bedsores which is commonly known as the tern pressure sore. Pressure sores are known as injuries that are caused due to the continuation of immobilized state due to disability or paralysis. Thus, the Registered Nurses tend to possess a major role in supporting and assisting these elderly patients with care in order to avoid the development of pressure sore (Savonnet, Wang & Duprey, 2018). There are policies and standards that work within the premises of health care organizations in order to manage the condition of pressure sore. One of these national standards includes the National Quality and Safety Health Service Standards- Preventing and controlling healthcare associated infection standard that accounts for the prevention and management of the condition of pressure injuries such as pressure sore in susceptible patients (Kirman & Geibel, 2018). Thus, the aim of the research is to assess the development of a pressure sore among elderly patients with disabilities.

Review of the Literature:
Search strategy:
In order to carry out the literature review, it will be necessary to carry our search of relevant literature supports using search strategy (Eriksen & Frandsen, 2018). It is initially necessary to attain search terms using PICO which is carried out as follows:

The search term will thus include words such as "Pressure sore", "development" "elderly", and "nursing care" that will be arranged with Boolean's operators such as "AND", "OR" and "NOT". The search term with Boolean's operators will be further used to search for literature in electronic databases such as Medline, PubMed, Embase, Google Scholar, or EBSCO. It has a significant role in providing précised literature articles that have their significant relation to the topic "development of pressure sore". From the search strategy, 4 literature articles have been selected.

Data extraction table for details of the selected studies:

Problem identification:
From the research studies, it has been found that pressure sore and other injuries related to pressure have an epidemiological result which varies entirely in the clinical setting. It is known to range from 1 to 40 percent in the acute care wards while it has been found that in the long-term care wards the percentage is around 2 to 20 percent. It has been found that the socioeconomic burden of the condition of pressure sore is around third among the condition of cancer as other cardiovascular diseases (Komici et al., 2017). Another study provided information about the problem that around one hundred and eight-four participants out of 380 accounting for 4. 7 percent were found to sustain pressure sore due to disability is movement.

Causative factors:
It has been found from the selected 4 literature articles that prolonged bedridden conditions either due to a disability, or preoperative and postoperative duration often tend to develop the condition of pressure sore among elderly patients. It has been observed that limited or no mobilization of the patient often develops a state of constant pressure among précised localities of the body which tends to cause inflammation and lead to infection due to pressure sore (Chen et al., 2018). It has been found in 4 of the studies that mobilization is necessary for a patient with a disability or bedridden states in order to minimize the condition of pressure sore and related complications.

Approaches/Interventions for preventing or minimizing the problem
From the research studies, it has been found that there are certain treatment measures and interventions that can be used in order to treat or minimize the development of a pressure sore in patients. There are treatment and management interventions such as intensive multidisciplinary optimization, enhanced patient education, short surgery time, minimized bleeding, meticulous wound care (Chiang, Wang & Tzeng, 2018). These interventions has their benefits in making the treatment and care with less complicated and thus ensures no severity of the condition of pressure sore is observed.

Discussion:
The research study carried out by Chen et al., (2018) provided the fact that patients with disability and lack of mobility due to any acute or chronic health complication sustain the increased rate of development of pressure sore. It tends to develop a major health complication and suffering from elderly patients which thus explains the need for proper nursing care and attempt to sustain better recovery (Chen et al., 2018). It explains the end of assisting patients with proper mobility as well as wound management care to sustain better health care service and nursing practice.

It was found from the research study carried out by Luo et al., (2019), that patent prolonging the duration of preoperative as well as a postoperative condition due to spinal surgery or any other treatment often sustains the risk of pressure soreness. Thus, focusing on the research findings, it was suggested that it is necessary to promote the extension of preventive interventions for patients with pressure sore and minimize the duration of preoperative and postoperative condition in patients following surgery (Luo et al., 2019).

from the research carried out by Komici et al., (2017), it was found that patients with growing age sustained a major risk of development of pressure sore and related issues. The study results ensure that around 16.3 percent of participants accounting for 27 patients sustained the condition of pressure sore. It was found that the risk increases with increasing age among patients with complex health conditions (Komici et al., 2017). The limitation of the research study was that the study was carried out in a single setting with the involvement of a small sample group for the assessment of research findings.

From the research article conducted by Chiang, Wang and Tzeng, (2018) it was found that treatment and care measures such as intensive multidisciplinary optimization, enhanced patient education, and meticulous wound care have their beneficial outcome in promoting better pressure sore treatment and care. It though contained one limitation that the research study included a very small sample size which minimized the efficacy of the outcome (Chiang, Wang & Tzeng, 2018).

The findings from the selected 4 research articles help in assessing and evaluating the measure as well as factors that need to be addressed while caring for elderly patients with delivered mobility as well as a complex health condition. It guides the Registered Nurses to sustain proper nursing care which ensures no infection or injury is caused that may cause pressure sore. It helps them with proper knowledge about the treatment measures they need to use in case of patient with pressure sore, interventions to avoid development of the health condition as well as fast recovery from the infection.

Conclusion
In order to conclude, it can be stated that the literature review provided a brief idea about the development of a pressure sore among elderly patients with acute health complications. It has been found that pressure sore has been a major issue for nursing facilities as patients with disability or complex health issues such as myocardial infarction, spine surgery and many more have the greater risk of attaining the issues. It is due to lack of mobility to develop a constant amount of pressure at a common location for a longer duration leading to the development of the condition. It is thus necessary for the Registered Nurses to develop their nursing practice and ensure proper treatment and care is provided which ensures pressure is not exerted at a précised location and infection is caused. Thus, it is recommended to promote better nursing skills for Registered Nurses to assist patients with a lack of mobility to minimize the threat of the condition.

References:
Chen, J. H., Wu, S. C., Chen, H. J., Kao, C. H., Tseng, C. H., & Tsai, C. H. (2018). Risk of developing pressure sore in amyotrophic lateral sclerosis patients–a nationwide cohort study. Journal of the European Academy of Dermatology and Venereology, 32(9), 1589-1596. https://doi.org/10.1111/jdv.14911

Chiang, I. H., Wang, C. H., & Tzeng, Y. S. (2018). Surgical treatment and strategy in patients with multiple pressure sores. International wound journal, 15(6), 900-908. https://doi.org/10.1111/iwj.12942

Eriksen, M. B., & Frandsen, T. F. (2018). The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. Journal of the Medical Library Association: JMLA, 106(4), 420. 10.5195/jmla.2018.345

Kirman, C. N., & Geibel, J. (2018). Pressure injuries (Pressure Ulcers) and wound care. Medscape J Med. Retrieved from: Pressure-Injuries-Pressure-Ulcers-and-Wound-Care_-Practice-Essentials-Background-Anatomy.pdf (alijansazazdravlje.com)

Komici, K., Vitale, D. F., Leosco, D., Mancini, A., Corbi, G., Bencivenga, L., ... & Rengo, G. (2017). Pressure injuries in elderly with acute myocardial infarction. Clinical interventions in aging, 12, 1495. 10.2147/CIA.S135676

Luo, M., Long, X. H., Wu, J. L., Huang, S. Z., & Zeng, Y. (2019). Incidence and risk factors of pressure injuries in surgical spinal patients: a retrospective study. Journal of Wound Ostomy & Continence Nursing, 46(5), 397-400. doi: 10.1097/WON.0000000000000570

Savonnet, L., Wang, X., & Duprey, S. (2018). Finite element models of the thigh-buttock complex for assessing static sitting discomfort and pressure sore risk: a literature review. Computer methods in biomechanics and biomedical engineering, 21(4), 379-388. https://doi.org/10.1080/10255842.2018.1466117