Introduction.
This report will discuss the risk of impaired wound healing, amongst patients in the community. Patients may be at risk due to increased age, malnutrition and underlying medical conditions (Timmons, 2003, White, 2008). However, this report concerns with patients’ knowledge deficit about the importance of nutrition, which may be the risk factor (Casey, 1998, Dealey, 2005, Timmons, 2003). In this respect, a management package in the form of a leaflet aimed at these patients has been prepared, (see appendix), which may improve patients’ knowledge. The report will evaluate how the risk could be minimised by using this leaflet.
The rationale for selecting the identified risk comes from observations, during community placement, where many patients had chronic wounds, which would not heal, despite nursing interventions, which is supported by Moffat (2001). Personal observations highlighted that some patients may have a knowledge deficit about the importance of balanced diet, to achieve wounds healing. However, despite nurse’s involvement in verbal health promotion, some patients were reluctant to follow nurses’ advice, which may increase their risk (Wientjes, 2008).
Methodology.
As the result of this observation a literature review was undertaken, which included RCN Journals, Library and on-line resources using key words, such as ‘delayed wound healing’. In addition, the observation on availability of health promotion tools on wound healing was carried out, within my placement. Personal observations highlighted some gaps within existing packages, aimed at patients. In addition, a literature review and observations identified that most packages are designed for nurses, rather then patients, for example, the Woun...
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.... It, also, requires patients’ cooperation and effective pain management (Gould, 1999).
Nurses may evaluate this package by undertaking observational audits, which may include accurate recording of wound presentation, measurements and photographs (Sterling, 1996). This may involve nurses using the Wound Care chart to reassess patients, within six weeks. In addition, nurses may ask questions about patients’ diet and enquire if patients have food in their fridge. In addition, nurses may check patients’ blood test results for glucose level and insufficient nutrients (Walkland, 2002). The success may be measured by the reduction of weekly visits to patients, as the result of patient cooperation.
This report highlighted that wound healing may be improved by patients education and cooperation in improving their diet (Casey, 1998, Dealey, 2005, Timmons, 2003).
...ssure ulcers can be preventable if there is a systemic and multi-professional approach to their prevention and continuing assessment of skin integrity. Mary was determined and worked well with the physiotherapist; she was up and on her feet within a week of returning. Staff had to prompt her to move around the ward, which at times was hard for her due to her anxiety. Mary was deemed high risk for falls, so was put on a prevention of falls chart in conjunction with the pressure area chart and repositioning chart.
Often in practice, we as nurses deal with a variety of diseases and treatments and often have to react to the illness that the patient presents with upon our interaction. While this is an essential piece of our practice, we also have a duty to our patients to be proactive in preventing specific health-related consequences based on their risk factors and to promote their health and well being. Health promotion as it relates to nursing is about us empowering our patients to increase their control over their lives and well beings and includes: focusing on their health not just illness, empowering our patients, recognizing that health involves many dimensions and is also effected by factors outside of their control (Whitehead et al. 2008)..
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
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)
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
(patient) and the Clinical Nurse Manager both parties agreed that the author could proceed. All information will be kept confidential and no names will appear on this assignment that could be traced back to the client or hospital. As a student nurse this will comply with the guidelines set out by An Bord Altranais (2009). All nurses should be able to account for the care they give, why they give the care and also an evaluation of the care they have given. Barett et al (2009) maintain that this is a core part of care planning.The Department of Health and Children (2001) has shown its commitment to organising care plans and the importance of them as was evident in the 'Primary Care A new Direction' health strategy.This identified the importance of discharge planning and and the development of individualised care plans following discharge. This assignment will cover a full assessment of a person whose care the author has managed in the clinical setting. Based on this assessment the author will compile a care plan focusing on two key nursing diagnoses derived from the nursing assessment. The author will list all nursing diagnosis related to this patient and give a rationale for each.
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...
... Even after finding evidence-based practice that would prompt a change in the patients care plan, you may still have problems convincing professional colleagues and the management of your findings and putting them into place. Journal of Wound Care p. 11. Practitioners have a responsibility to ensure their practice is based on sound clinical evidence and that the care delivered is of a high quality.
Every person’s needs must be recognized, respected, and filled if he or she must attain wholeness. The environment must attuned to that wholeness for healing to occur. Healing must be total or holistic if health must be restored or maintained. And a nurse-patient relationship is the very foundation of nursing (Conway et al 2011; Johnson, 2011). The Theory recognizes a person’s needs above all. It sets up the conducive environment to healing. It addresses and works on the restoration and maintenance of total health rather than only specific parts or aspect of the patient’s body or personality. And these are possible only through a positive healing relationship between the patient and the nurse (Conway et al, Johnson).
Davenport, Joan M., Stacy Estridge, and Dolores M. Zygmont. Medical-surgical nursing. 2nd ed. Upper Saddle River, N.J.: Pearson Prentice Hall, 2008, 66-88.
middle of paper ... ... The priority for this patient was to establish that she was fully aware of what the procedure involved and the possible risks and complications. I feel that the pre-assessment form used within the unit is far too fundamental, if elements of the roper et al activities of daily living were to be incorporated this would help in achieving a much more in-depth holistic nursing assessment enabling for the best quality and level of care to be given to all patients arriving in the unit. Whilst I feel a full nursing assessment is not fully necessary for a day case unit, as previously stated I feel that the communication element is an excellent way of ensuring a better holistic approach is achieved, it will also help to achieve better documentation and communication between all staff members.
A wound is an injury to living tissue caused by a cut, blow, or other impact, typically one in which the skin is cut or broken. The skin is the body’s largest organ, making up 15% of the human body. It is responsible for temperature and protection of the body from various external influences. Wound healing is the normal body response to injury, either surgical or traumatic, causing disruption of the integrity of tissues. Surgical wounds are classified according to their degree of microbiology (2014 Advanced Tissues).
According to Healthy People 2012 there are more then 800,000 new cases of diabetes each year, with the numbers on the rise. With this in mind, Healthy People 2012 has identified diabetes as their number five focus area. In order to reach their goal of improving the quality of life for people with diabetes they have identified diabetes teaching as their number one objective. Furthermore, in order to reduce the number of complications of diabetes, Healthy People 2012 has identified foot ulcers as their ninth objective. Through patient education Healthy People 2012 hopes to reduce the number of foot ulcers in people with diabetes, as diabetes is the number one cause of nontraumatic amputations in the United States. In order to successfully reduce the number of amputations and diabetic foot ulcers, patient teaching is essential. Patient teaching, as with the nursing process, begins with assessment in order to identify the patients learning needs (Wilkinson & Van Leuven, 2007).
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.