One of the most basic principles of nursing is bringing the patient back to optimal functioning. Assisting in healing a wound is one of the most elementary tasks, but can be complicated by many factors. The patient must be assessed for all factors that could affect wound healing. Giving the best care must begin with the knowledge of wounds, wound healing, and available equipment. Synopsis Wound healing is very prevalent for a variety of wounds, many of those being pressure ulcers in geriatric patients. The baby boomer generation is very large and within the next 30 years, the aging population will grow enormously, increasing the need for wound care. All nurses must be educated on the most up to date and best practice for healing wounds. According to Casey in Kai Tiaki Nursing journal (2012), within the last twenty years available dressings for wound healing have increased exponentially now including fifty-eight categories. The nurse has the responsibility to select the best dressing, for a specific wound to promote optimal healing. The idea behind dressings has also changed. Dressings previously were designed to keep a wound dry, absorbing secretion, and preventing infection (Casey, 2012). Dressings today are designed to facilitate healing, provide a moist environment, debridement, infection control, thermal insulations, and possible suction to remove drainage and pull oxygen and nutrients to the wound bed (Casey, 2012). Relevance Proper effective wound care is expensive, according to Kaufman and Pahl’s article in Dermatology Nursing (2003), the care of one pressure ulcer can easily cost $23,465 and take an average 247 days to heal. Kaufman and Pahl’s (2003) research showed great success when treating a pressure ulcer with a vacuum assisted closure device, showing closure in 97 days and costing only $14,564. The cost of treatment correlates significantly with the healing time. According to van Anholt, Sobotka,Meijer, Heyman, Groen, Topinkova, van Leen, and Schols (2010), if you decrease wound size, you use fewer dressings, spend less time, and ultimately less money on the wound care. Beyond the need for knowledge of dressings, the nurse must have the knowledge of types of wounds, and factors affecting healing. Wounds needing to be addressed may be acute, or chronic (existing for more than twelve weeks) (Casey, 2012). The wounds will need to advance through all four stages of healing: inflammation, proliferation, re-epithelialization, and maturation (Casey, 2012). In order for a wound to heal, it must be kept open, healing from the inside out.
The skin of the elderly tends to be thinner and more delicate, which means an older person has an increased possibility of developing a pressure sore
Pressure ulcers development occurs in every hospital and it remains a major worldwide health problem for many years. However, pressure ulcers have received minimal attention when we talk about it as a patient safety issue. It is a patient safety issue as it can lead to serious damage such as life-threatening infections and pain (Richardson & Barrow, 2015). On a med/surg unit, individuals may experience long or short hospital stays depending on the situation. For the short stays, the focus of care is often on regaining activities of daily living (Registered Nurses’ Association of Ontario, 2011). Therefore, assessment and education regarding pressure ulcers is often minimal or non-existent (RNAO, 2011). Every client who is at risk needs to be assessed and educated regarding pressure ulcers and the subsequent skin breakdown (Cooper, 2013). During the hospital stay, clients may have limited movement and pressure ulcers can extend into the muscle, tendon, and bone (RNAO, 2011). In many cases, clients do not notice the formation of an ulcer and as it may be in areas that are out of sight such as the coccyx. Often,
Currently health care facilities use individual, multi-component interventions, or series of interventions to prevent pressure ulcers. Either health care staff is not implementing these strategies into their patient’s care or some changes obviously need to be made. Interventions to prevent pressure ulcers consist of using the Braden Scale for initial and repeated skin assessments to determine the patient’s risks for pressure ulcers, specialized support mattresses, heel supports, and frequent repositioning for bed bound patients, encouraging mobility, moisture management, nutrition, hydration, and reducing friction or shear forces on parts of the body at increased risk for pressure ulcers (Sullivan & Schoelles, 2013).
Utilizing this tool will allow The Restorative Nurse and Wound Nurse to generate a graph based off of the data retrieved from the Center of Medicare and Medicaid Services (CMS) quarterly Quality Measures Report (APPENDIX B). The Wound Nurse and Restorative Nurse will start with the last data reported before the start of the On-Time Project and then graph the data every three months during the On-Time Project for the following areas: falls, weight loss, in- house acquired pressure injuries and nosocomial infection. For that purpose, to monitor the effectiveness of the On- Time Project the Wound Nurse and Restorative Nurse will provide a designated share drive to present to the Director of Nursing and other stakeholders on a quarterly schedule at the quarterly Quality Assurance Improvement Program(QAIP)
Pressure ulcers are one of the most common problems health care facilities often face which causes pain and discomfort for the patient, cost effective to manage and impacts negatively on the hospital (Pieper, Langemo, & Cuddigan, 2009; Padula et al., 2011). The development of pressure ulcers occur when there is injury to the skin or tissue usually over bony prominences such as the coccyx, sacrum or heels from the increase of pressure and shear. This injury will compromise blood flow and result in ischemia due to lack of oxygen being delivered (Gyawali et al., 2011). Patients such as those who are critically ill or bed bounded are at high risk of developing pressure ulcers (O'Brien et al., 2014).
To be part of a WOCN team, it is imperative to have excellent wound assessment skills, wound care techniques and knowledge of wounds, healing process, and appliances (Fitzpatrick, 2012 p. 200). The goal will follow the SMART format of being, specific, measurable, attainable, realistic, and time bound.
The field of nursing is one that requires much passion, hard work and critical thinking. It is a nurses job to promote the well being of their patients and help the return to normal function. However unfortunate events occur, resulting in patients receiving adverse health conditions as a result of being in a medical facility One of the most prevalent of these nosocomial conditions are pressure ulcers. Not only do the patients suffer from the pain of pressure ulcers but the hospitals and medical facilities are effected as well. A randomized controlled trial conducted by Pickham et al. reported that “ Pressure ulcers are insidious complications that affect approximately 2.5 million patients and account for approximately US$$ 11 billion in annual health care spending each year” (2016). Pressure ulcers not only cause the patient pain but “even contribute to disability and
Registered Nurses Association of Ontario (RNAO). (2005). Best practice guideline (BPG): Risk assessment and prevention of ulcers. Retrieved from http:// www.rnao.org
Quality improvement issues in healthcare focus on the care that patients receive and the outcomes that patients experience. Nurses play a major advocacy role for ensuring safe and quality care to all patients. Also, nurses share the responsibility in leading the efforts in improving patient care in all settings (Berwick, 2002). One of the ongoing problems plaguing hospitals and nursing homes is the development of new pressure ulcers in patients after admission. A pressure ulcer can be defined as a localized area of necrotic tissue that is likely to occur after soft tissue is compressed between a bony prominence and a surface for prolonged periods of time (Andrychuk, 1998). According to the Centers for Medicare and Medicaid, patients should never develop pressure ulcers while under the supervision of any medical institution because they are totally preventable (Berwick, 2002). The purpose of this paper is to discuss the problems associated with pressure ulcers, examine the progress on improving this specific issue, and explain the Plan, Do, Study, Act cycle that I would use to improve patient care in this area.
Nursing theory is, “the principles that underpin practice and help to generate further nursing knowledge” (Colley, 2003, p. 33). Nursing theory is important in nursing practice. The two theorists that are relevant to my nursing practice are Florence Nightingale and Hildegard Peplau. Florence Nightingale theory was about the patient having a clean and healing environment (Smith & Park, 2015, p. 51). The theory that Hildegard Peplau created was the importance of nurse-patient relationships (Smith & Park, 2015, p. 68). Both of these theories put the patient’s safety and care first. When I am at work I try to form a healthy and healing relationship with all my patients. I also make sure the environment that they are in is conducive to healing,
Today I was able to watch a vac dressing being placed on a patients wound. I had little knowledge about the vac dressing before going into this situation, it was interesting to see the situation in a real life situation first before doing research on it. There were two doctors in the patients room who were setting up the vac, one of the doctors was very good at explaining what they were doing and explaining how the vacuum dressing works. When they began to remove the old dressing I was surprised at how much packing the wound had. It wasn’t until all of it was removed that I noticed how large the wound actually was. We were able to get a nice view of the wound while the doctors were examining it. As they began to repack the dressing they
Due to the high risk that pressure ulcers impose on the health of patients, nurses play a vital role in the prevention and treatment. “A pressure ulcer is a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure or pressure in combination with shear and/or friction”, (Gulanick & Myers, 2014). All patients, no matter what age, ...
Our approach in managing wounds was far from being optimal in our own setting. After having read the article of Sibbald et al (1) and assisting to presentations during the first residential week-end, our approach at St. Mary 's Hospital Center 's Family Medicine Clinic must change. We were not classifying wounds as healable, maintenance or non-healable. We were always considering the wounds in our practice as healable despite considering the system 's restraints or the patients ' preferences. In the following lines, I will define and summarize the methods one should use in order to initial management of wounds and how to integrate it better to our site. The first goal we need to set is to determine its ability to heal. In order to ascertain if a wound is healable, maintenance or a non-healable wound.
The normal wound healing process mainly consists of four main stages being haemostasis, inflammation, proliferation or new tissue formation, and tissue remodeling or resolution. For a wound to heal well the above mentioned stages should occur in a sequential and orderly manner. Disturbances, abnormalities and delays in any of the above stages may lead to impaired healing or even chronic wounds. In adults, this process of normal healing takes place in the following steps (1)rapid haemostasis (2)appropriate inflammation (3)mesenchymal cell differentiation, proliferation, and migration to the wound site (4)suitable angiogenesis (5)prompt re-epithelialization and (6) proper synthesis, cross-linking, and alignment of collagen to provide strength to the healing tissue.
Separating the nursing theory from other healthcare professions seems to be a daunting task. One of the main goals in nursing is to promote the healing of patients and the ultimate goals of any healthcare profession would be to ensure that the patients are receiving adequate and substantial healthcare.