Introduction Pressure ulcers are a significant problem in those with complex illnesses or injuries which require admission into the Intensive Care Unit (ICU). Many ICU patients suffer from pressure ulcers. According to Shahin, Dassen and Halfrens (2009) “patients in the ICU have a 50% higher chance of developing a pressure ulcer as compared to patients on any other unit in a facility” (p. 370). ICU registered nurses (R.N.s) blame the frequency of pressure ulcers on not having enough time to provide adequate care and the presence of machines and monitoring devices attached to patients, which restricts movement. Pressure ulcer development in patients admitted to the ICU is classified under the Quality and Safety Education for Nurses (QSEN) topic of safety. Safety by definition reduces the risk of harm to patients and providers through system effectiveness and individual performance (Cronenwett et al., 2007). Patient outcomes significantly improve if pressure ulcers in the ICU are prevented; patient pain related to pressure ulcers is eliminated and the risk of infection associated with pressure ulcers is greatly reduced (Cooper, 2011). Using the transformational leadership theory requires the nurse manager to motivate staff to change procedure. First, nurse managers must educate staff nurses about the prevalence of pressure ulcers within their unit. Second, nurse managers must use the democratic management theory to obtain the opinions of the other nurses about the problem and the possible resolutions. In addition, managers need to discuss the cost associated with a nosocomial acquired pressure ulcer and pose suggestions about implementing a protocol to reduce the number of pressure ulcers in ICU patients. Implementing a P... ... middle of paper ... ...374. doi: 10.1111/j.1365-2753.2009.01018.x Strand, T., & Lindgren, M. (2010). Knowledge, attitudes and barriers towards prevention of pressure ulcers in intensive care units: A descriptive cross-sectional study. Intensive and Critical Care Nursing, 26(46), 335-342. doi: 10.1016/j.iccn.2010.08.006 U.S. Department of Health and Human Services. (2011). How do we measure our pressure ulcer rates and practices? Retrieved from http://www.ahrq.gov/professionals/systems/long-term-care/resources/pressure-ulcers/pressureulcertoolkit/putool5.html Welch, R. (2011). Making decisions and solving problems. In P. Yoder-Wise, Leading and managing in nursing (5th ed., pp. 98-115). St. Louis, MO: Elsevier. Wilcox, J. (2012). Challenges of nursing management and leadership. In J. Zerwekh, & A. Garneau, Nursing today transition and trends (7th ed., pp. 191-217). St. Louis, MO: Elsevier.
Whitehead, D. K., Weiss, S. A., & Tappen, R. M. (2010). Essentials of nursing leadership and
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).
As an ICU nurse I constantly watch how patients develop pressure ulcers, a pressure ulcer is an area of skin that breaks down due to having constant friction and pressure, also from having limited movement and being in the same position over a prolonged period of time. Pressure Ulcers commonly occur in the buttocks, elbows, knees, back, shoulders, hips, heels, back of head, ankles and any other area with bony prominences. According to Cox, J. (2011) “Pressure ulcers are one of the most underrated conditions in critically ill patients. Despite the introduction of clinical practice guidelines and advances in medical technology, the prevalence of pressure ulcers in hospitalized patients continues to escalate” (p. 364). Patients with critical conditions have many factors that affect their mobility and therefore predispose them to developing pressure ulcers. This issue is significant to the nursing practice because nurses are the main care givers of these patients and are the ones responsible for the prevention of pressure ulcers in patients. Nurses should be aware of the tools and resources available and know the different techniques in providing care for the prevention of such. The purpose of this paper is to identify possible research questions that relate to the development of pressure ulcers in ICU patients and in the end generate a research question using the PICO model. “The PICO framework and its variations were developed to answer health related questions” (Davies, K., 2011).
Roussel, L., & Swansburg, R.C. (2009). Management and leadership for nurse administrators. Sudbury, MA: Jones & Bartlett Publishers.
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...
Safety is focused on reducing the chance of harm to staff and patients. The 2016 National Patient Safety Goals for Hospitals includes criteria such as using two forms of identification when caring for a patient to ensure the right patient is being treated, proper hand washing techniques to prevent nosocomial infections and reporting critical information promptly (Joint Commission, 2015). It is important that nurses follow standards and protocols intending to patients to decrease adverse
Kerfoot, K. (2008). Bossing or serving?: how leaders execute effectively. MEDSURG nursing, 17(2), 133-134. Retrieved from EBSCO host
Sarah Dobinson is a patient at increased risk of infection she is an older patient in a hyper metabolic state secondary to trauma. To ensure Sarah’s safety a set of CVC guidelines have been developed using the most recent primary sources. These guidelines will focus on nursing interventions post insertion in an adult ICU setting they have been developed under four sections addressing the importance of hand hygiene and aseptic technique, changing of administra...
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
Some nursing care protocols I have witnessed, while working in the ER are nurses using pillows to prop their patient to a upright position, while elevating the feet with a hospital wedge in between bony prone areas of the body. In addition, I have witnessed nurses manage the moisture build up on their patients body, due to perspiration and clean all soiled areas of the body immediately. It states, in our course textbook that , "nutrition recommendations for the treatment of pressure ulcers are as follows (Doley, 2010; Thomas, 2009): •Optimize protein intake with a goal of 1.25 to 2 g/kg/day. •Meet calorie requirements at 30-40 kcal/kg/day. •Assess the effect of medications on wound healing and supplement if indicated. •Replace micronutrients if depleted—routine supplementation is not warranted" (Mahan, L., Escott-Stump, S., Raymond, J., & Krause,
...elly, P., & Crawford, H. (2013). Nursing leadership & management. In Nursing leadership & management(2nd ed., pp. 168-177). Canada: Nelson Education.
In the Intensive Care Unit (ICU), patients are being monitored very closely while their vital signs, their neurological status, and their physical status are being managed with strong medications, lifesaving machines, and the clinical knowledge and skills of trained ICU nurses. Outside of the ICU, it is essential for staff nurses to identify the patient that is clinically deteriorating and in need of urgent intervention.
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.
Hospital acquired pressure ulcers is a major nurse sensitive indicator and nurses greatly impact the development and prevention. Prevention of hospital acquired pressure ulcers often involves minimal use of equipment, but requires attentive caution to treat the continually increasing risks associated with the development of pressure ulcers. Not all pressure ulcers can be prevented, but the use of comprehensive pressure ulcer programs can prevent the majority of its development, (Gulanick & Myers, 2014). When a pressure ulcer develops, the goals of healing or preventing deterioration and infection are paramount. As leaders, nurses must take initiative in constantly educating themselves about new successful interventions and implementing evidenced-based practice and take action in the prevention before risk factors are detected.
In today’s society, leadership is a common yet useful trait used in every aspect of life and how we use this trait depends on our role. What defines leadership is when someone has the capability to lead an organization or a group of people. There are many examples that display a great sense of leadership such being an educator in health, a parent to their child, or even a nurse. In the medical field, leadership is highly used among nurses, doctors, nurse managers, director of nursing, and even the vice president of patient care services. Among the many positions in the nursing field, one who is a nurse manager shows great leadership. The reason why nurse manager plays an important role in patient care is because it is known to be the most difficult position. As a nurse manager, one must deal with many patient care issues, relationships with medical staff, staff concerns, supplies, as well as maintaining work-life balance. Also, a nurse manager represents leadership by being accountable for the many responsibilities he or she holds. Furthermore, this position is a collaborative yet vital role because they provide the connection between nursing staff and higher level superiors, as well as giving direction and organization to accomplish tasks and goals. In addition, nurse managers provide nurse-patient ratios and the amount of workload nursing staff has. It is their responsibility to make sure that nursing staff is productive and well balanced between their work and personal lives.