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ethics in patient care
quantitative research in pressure ulcers
Dassen et al., 2010 pressure ulcers
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In the literature review, some of aspects of the topic are covered. Most of the literature has identified that the important part are requires periodic reassessment for pressure ulcers and the nursing care plan of pressure ulcer should be mentioned. The overall goals are that the patient with a pressure ulcer will reduce or eliminate the factors that lead to pressure ulcers; will have healing of the pressure ulcer; and not develop an infection in the pressure area (Guy, 2012).
Kaitani et al. (2010) show clearly details that the majority of patients admitted to a nursing home should be assessed, regardless of their aged, gender or weight, and the results need to be documented. Each patient will then be given a date for regular assessment (Kaitani et al. 2010). Kaitani et al. (2010) also pointed out that nursing assessment is a dynamic and continuous process involving synthesis of information from a variety of sources including underpinning knowledge, previous experience, and specialty based knowledge, recognition of important indicators and knowledge of the patient. Meanwhile, many aspects should be assessed in preventing pressure ulcer, such as nursing assessment of nutrition, wound assessment, risk assessment and assessment of quality of life. Immobility, altered consciousness, greater age and weight (BMI) are important risk factors for pressure ulcers. Factors identified included altered level of consciousness, impaired nutritional intake, faecal incontinence and factures (Kaitani et al. 2010).
Kwong et al. (2009) summarized risk assessment in nursing practice detailedly. Assessment is context-specific, combining knowledge of key risk factors with patient circumstances (Kwong et al. 2009). The literature discussed important as...
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... perform ethically, thus undermining their own authority. Fowler et al (2007) identifies listening skills and the encouragement in the participation of care motivates nurses to actively support changes in patient care. Robison, Curry, & Gruman (2007) remind practitioners that participation requires communication skills that are not universally possessed so nurses must be flexible in their approach to champion the participation of others. Using these concepts Registered nurse should always have built a rapport with carers, praising them for the care they provide, promoting partnership in care whilst emphasising the importance of the care plan. The Partners in Caregiving in a Special Care Environment program is an evidence-based intervention that enables these partnerships to develop and thrive, translating into improved experiences for residents, families, and staff.
The NMBA sets out Statements of Principles which provide guidance to nurses regarding processes that will help to ensure that ‘safety is not compromised’ regarding decision making about nursing practice. According to the NMBA, the fundamental motivation for any decision about a care activity is to meet clients’ health needs or to enhance health outcomes. Decisions regarding activities are made in a planned and careful manner and: ‘only where there is a justifiable, evidence-based reason to perform the activity’ (NMBA: 2012, p.6). Furthermore, the NMBA points out that nursing practice decisions are more effective in a collaborative context of planning, risk management, and evaluation. Thus, organisational employers/managers, other health workers and nurses’ work together in sharing a combined responsibility to design and maintain: environments (including resources, education, policy, evaluation and competence assessment) that support safe decisions and competent, evidence-based practice to the full extent of the scope of nursing practice.
The length of the stay of patients diagnosed with pressure ulcers noticeably increased by about five times. The risk of death is increased about 4.5 times compared to the patients without this condition. This is the main reason this issue is being studied. ICU patients require constant monitoring and invasive procedures performed by the multidisciplinary team. Patients admitted to the ICU are considered critical and hemodynamic unstable. These patients may be sedated, provided with mechanical ventilation, and placed on bed rest for long periods of time. The most difficult challenge regarding pressure ulcers is to maintain skin intact. To ensure optimal pressure ulcer treatment and prevention is used, a multidisciplinary approach, in which nurses play a vital role. Risk assessments, hands-on care, daily skin care, and providing an environment, which will help patients attain optimal health are among these responsibilities. Due to the patients’ inability to turn themselves, critically ill patients have to be repositioned by caregivers frequently. It has to be done by professionals who know about the complications and risk factors because improper repositioning may cause shearing and friction, which will lead to pressure
It is imperative that Health Care Professionals learn to manage risk. There are many factors to think about including environment, assessment, identification and prioritising when managing risk. Being able to strategically implement preventative measures will help in managing risk. Risk management works hand in hand with all enablers set out by chapelhow.
Sayar S.,Turgut, S., Dogan, H., Ekici, A., Yurtsever, S., Dermirkan, F., Doruk, N., Tsdelen, B. (2009) Incidence of pressure ulcers in intensive care unit patients at risk according to the Waterlow scale and factors influencing the development of pressure ulcers. Journal of Clinical Nursing 18, 765-774.
With noticeable increase in chronic diseases, trauma, and increasing number of aging population, nurses are required to be in the position of providing pressure ulcer care and prevention. Immobility, advanced age, incontinence, prolonged pressure or friction, inadequate nutrition, dehydration, anemia, hypoxemia, multiple comorbidities, sensory deficiency, thin skin, prominent bony prominences, circulatory abnormalities, pain, and smoking are important risk factors. The barriers in the implementation of preventive measures are staff shortage, shortage of pressure relieving devices (e.g., foam or air mattresses), excessive workload, and uncooperative patients. The Centers for Medicare and Medicaid Services has classified the pressure ulcers as a preventable Hospital Acquired Conditions and stopped reimbursing for such hospital acquired conditions. In the United States, the cost of an individual patient care per pressure ulcer includes skin cleanser, moisturizer, dressings, wound debridgement, antibiotics, analgesics, turning sheet and support surfaces, nursing time for risk assessment, monitoring, and repositioning. It is the second most common claim after wrongful death and greater than falls or emotional distress. No matter what causes the pressure ulcers, the presence or absence of pressure ulcers is generally regarded as a performance measure of quality nursing care and overall patient health. Pressure ulcers can be avoided by applying simple interventions like factor assessment scales and regular turning of the patient. Proper hydration, a balanced diet, activity, wound care, and keeping patient’s skin and body dry are treatment, as well as, preventive measures of this problem. A thorough physical assessment, risk assessment (using a risk assessment tool like Barden scale), repositioning, patient and caretaker education, effective communication, and
In this event, the matter that is unusual can be the fact that I have experienced and witnessed the process for interprofessional collaboration between the community nurse and other professionals that I have never knew about before. This event made me realize that there are many aspects of community nursing that I have knew about before where in this situation it is the importance and accountability of interprofessional collaboration. From my nursing theory course I have learned that interprofessional collaboration is when the nurse forms relationships with other professionals that enable them to achieve a common goal to deliver care and strengthen the health system and clients involved in it. (Betker & Bewich, 2012, p.30) In this event, our mutual goal is to provide the appropriate care for the patients/residents so they can restore their health after their hip or knee surgery. In the nursing leadership and management textbook it stated “interprofessional practice removes the gatekeeper and allows client access to all caregivers based on expertise needed.” (Kelly & Crawford, 2013, p.35) In this event, my preceptor and I gained knowledge about Revera and will pass on this information to patients who are interested in staying at a retirement home after they discharge from the hospital. One literature talked about how according to the Institute of Medicine, it is critical to have the capacity to work together as part of the interdisciplinary team to assist in delivering high quality, patient-centered care. In addition, effective collaboration among health care professionals results in improved patient care and outcomes. (Wellmon, Gilin, Knauss & Linn, 2012) This indicates the importance of interprofessional collaboration to provide...
Two potential barriers to the Patient-Family Centered Care model are time and patient/family expectations. Nursing is a demanding job that is known for it's fast paced and often hectic environment. While caring for several patients at a time, it might be difficult to make time to discuss and involve patients and their family in all aspects of their care. This could lead to the patient/family feeling left out or even lead to fear about why information if being kept from them. To address this barrier I will set aside time to spend with each of my patients solely dedicated to discussion about the care they are receiving as well as provide an opportunity to voice questions and concerns.
The reduction of pressure ulcer prevalence rates is a national healthcare goal (Lahmann, Halfens, & Dassen, 2010). Pressure ulcer development causes increased costs to the medical facility and delayed healing in the affected patients (Thomas, 2001). Standards and guidelines developed for pressure ulcer prevention are not always followed by nursing staff. For example, nurses are expected to complete a full assessment on new patients within 24 hours at most acute-care hospitals and nursing homes (Lahmann et al., 2010). A recent study on the causes of pressure ulcer de...
Patients Safety is the most crucial about healthcare sector around the world. It is defined as ‘the prevention of patients harm’ (Kohn et al. 2000). Even thou patient safety is shared among organization members, Nurses play a key role, as they are liable for direct and continuous patients care. Nurses should be capable of recognizing the risk of patients and address it to the other multi disciplinary on time.
According to JAMA (The Journal of the American Medical Association) bed sores, also known as pressure ulcers, happen to those who have continued exposer to moisture, like urine or feces and are confined to a bed or wheelchair (Gill, 2003). What happens most of the time is that a nurse has so many patients to take care of that they just do not have the time or they do not care about individual patients. When elderly people complains or gripe about his or her position or the situation they may not have a voice in the matter because the facility is following doctors’ orders. For the most part, patients spend most of the day in their room by themselves, often only checked on during rounds. The elderly are often left to succumb to boredom and depression due to the fact of no companionship. The people who were once active in their community now have to be confined to a small room, and unfamiliar surrounding which can have devastating
Westhead, C. (2007). Perioperative Nursing Management of the Elderly Patient. Canadian Operating Room Nursing Journal, 25(3), 34-41. Retrieved from http://gateway.library.qut.edu.au/login?url=http://search.proquest.com.ezp01.library.qut.edu.au/docview/274594603?accountid=13380.
In an interview with a staff nurse (S.N), the main problem within patient communication included lack of patient’s (and family) involvement/willingness in planning cares. The staff nurse emphasized how “Patients often feel overwhelmed and do not want to participate. But, it is important for patients to be involved in their care for better outcomes” (S.N., personal communication, February 5, 2014). The staff nurse’s statement is supported by Evans (2013) whom remarked “better-informed patients avoid unnecessary care and frustration”.
Mrs S. is an 88 years old female patient who lives on her own, and was admitted into a rehabilitation ward following a hip operation due to a fall at home. She has a past medical history of Congestive Cardiac Failure (CCF), diverticulitis, and asthma. Also, Mrs S presented with rapid weight loss, palpitation, feeling tired, peripheral oedema, fatigue, difficulty breathing when lying flat in the bed, waking up at night with shortness of breath and anxiety. In addition to all that she had a pressure sore in her bottom that was not broken. In order to have good holistic care of Mrs S, the nursing process was used as identified by Sibson. Sibson (2010) identifies four key steps to the nursing process, which are assessment, planning, implementation and evaluation; which are important for ensuring a quality standard of nursing care.
This new era of year it is necessary for most nurses to undertake a literature review at one point in their study time. It is a complex process of skills, such as learning how to find the research topics and gaining skills of literature searching and developing ability to study and blending the data. The first step in literature search is to find a review topic. I found my topic, as I was interested in studying pain management of patient with pressure ulcers. I refined my search in to more specific so that the final information will be manageable. Selecting key terms is critical for achieving successful results when searching for evidence. A good place to begin identifying key terms is the PICOT question (smidt-114). In electronic data base
Brunner, L.S. & Suddarth, D. S Textbook of Medical- Surgical Nursing, 1988 6th ed. J. B. Lippincott Company, Philadelphia