Nurses’ perceptions of a pressure ulcer prevention care bundle: a qualitative descriptive study
Critically ill patients are at increased risk for pressure ulcers. Hospital -acquired Pressure ulcers are serious clinical complications and that can lead to increased length of stay, pain, infection and potentially death. Nurses have the primary role in the pressure ulcer prevention. The study assessed nurses’ perceptions of the usefulness and impact of a pressure ulcer prevention care bundle intervention on clinical practice. So it is imperative to understanding nurses’ assessments of interventions when interpreting results and translating evidence into practice.
Background of the study
The efficacy of the pressure ulcer prevention care bundle
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Pressure ulcer prevention has been the nursing worry for many years. Florence Nightingale in 1859 wrote, “If he has a bedsore, it’s generally not the fault of the disease, but of the nursing” (Nightingale, F). People may think pressure ulcers associated with poor nursing care. Prevention of pressure ulcers is a multidisciplinary responsibility; however, nurses have a primary role. Patient participation in prevention of pressure ulcers (pup) care has been shown to result in improved patient safety and satisfaction with care ((Weingart, S.N., Zhu, J., Chiappetta, L., Stuver, S.O., Schneider, E.C., Epstein, A.M. 2011). Purpose of the study includes the nurses and patients partnering together with prevention of pressure ulcers (pup) may be an effective strategy for reducing pressure ulcers (PU) among at-risk individuals. So the research team developed a pressure ulcer prevention care bundle (PUPCB) targeted at both patients and nurses, encouraging patient participation in PUP care with three simple evidence-based messages: 1) Keep moving; 2) Look after your skin; and 3) Eat a healthy diet. Messages were provided to patients with a poster, brochure and DVD. Nurses had training regarding how to be companion with patients in pressure ulcer prevention (Roberts et al. 2016).
The INTACT trial showed a significant reduction in pressure ulcers (PU) incidence in the intervention group at the hospital (cluster) level, but this difference was not significant at the
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,
The research article "What influences the impact of pressure ulcers on health-related quality of life? A qualitative patient-focused exploration of contributory factors" was recently published (2012) in the Journal of Tissue Viability by Gorecki, Nixon, Madill, Firth, and Brown. This is a qualitative study.
Fortunately, according to Chan et al., (2008), 95% of pressure ulcers can be prevented and nursing care is believed to be a primary method of preventing pressure ulcer development. Research was conducted on accredited search databases such as CINAHL, Nursing Resource Center and OvidSP on prevention measures for pressure ulcers. A number of credible evidence based research was found that supported the nursing intervention of
care outcomes, as well as benchmark data to assess current practice,” (Sherwood, 2014). American Nurses Association has a National Database of Nursing Quality Indicators looks for a cause for common healthcare issues, such as “surgical site infections, pain assessment, pressure ulcer development, and falls,” (Sherwood, 2014) to better understand how these things came about to possibly prevent in the future.
A study conducted over seven years by Amir et al (2011) showed a significant decline of pressure ulcer development after three years of the study. This was partly due to strategies being implemented in regards to repositioning along with adequate nutrition, pressure ulcer prevention information leaflets were given to patients and skin assessments (Amir et al., 2011). It must also be considered that different patients will have different comorbidities and the use of a risk assessment tool is vital to assess and implementing a plan for pressure ulcer prevention according to the patient’s score (Tannen et al., 2010).
While nurses encounter patients with pressure ulcers in home care and acute care settings, they are mainly a problem with elderly adults in long term care facilities. This is because of decreased sensory perception, decreased activity and mobility, skin moisture from incontinence, poor nutritional intake, and friction and shear (Stotts and Gunningberg, 2007).
Now, the quality improvement department will need to determine what processes can be modified to improve outcomes. For example, if they see an increase in pressure sores and prevalence of restraints. They could use computerized charting and order entry, along with the evidence-based guidelines, to identify specific groups of patients who are vulnerable to developing pressure ulcers or closely monitoring use of restraints. With early identification, automatic orders for preventive interventions can be implemented quickly. With the assistance of the automated consults and orders, the appropriate equipment, the interdisciplinary task force, continuing education, and monitoring, the hospital system would be able to reduce unnecessary use of restraints and hospital-acquired pressure ulcer prevalence rate (Cherry & Jacob, 2010).
The main priority of the Veterans Affairs system is getting zero pressure ulcers. To achieve this goal, staff must be knowledgeable of the basic principles of skin disease, preventions, and treatments when providing care for the elderly patients. They provide education and training on the current evidenced-base practice on pressure ulcer preventions. The approach that has been effectively used is the care bundle (AHRQ, 2014). We
Despite advancement of technology, pressure ulcer continues to be a primordial in the health care system. Prevention of pressure ulcer remains an important issue in the health care facility. The critically ill ICU patient is the main target of this disease. Prevention remains the key for this problem. Some facility have standard policy for the eradication of pressure ulcer However the question is will the sacrum pressure ulcer formation be reduced in adult critically ill clients
What influences the impact of pressure ulcers on health-related quality of life? A qualitative patient-focused exploration of contributory factors (Gorecki, Nixon, Madill, Firth and Brown, 2012)
Studies have pointed out that nurses possess a significant role and extensive knowledge in pressure ulcer prevention. Instructive programs in the hospitals give great learning to nurses about the preventive and treatment techniques for
Pressure Ulcers affects patients the older patients due to the problem of immobility. A pressure
Qualitative research design might address pressure ulcer rate by giving insight into how pressure ulcers can impact those affected by it. Researchers can gain understanding if the patients’ point of view on how pressure ulcers affect their quality of life in obvious as well as not so obvious ways. Quality of life in a patient with PU incorporates such variable as pain and suffering, serious infections, prolong hospital stays for patients, and lead to increased costs for health care (Langerno, D., 2005).
Improving patient care is a constant, ongoing process of trail and error. As nurses, providing the best of care possible for the patient should always be the number one priority. “The aims of nursing actions (also nursing interventions) are to protect, promote, and optimize health; to prevent illness and injury; to alleviate suffering; and to advocate for individuals, families, communities, and populations” (American Nurses Association, 2010). Standards of practice set in place by governing bodies’ help to serve as guidelines for safe and effective care. But, these too are constantly being critiqued and modified for the betterment of patient care. With these only serving as guidelines, and never concrete, it is critical that nurses
A framework is an abstract, logical structure of meaning, which guides the development of the study and enables the researcher to link the findings to nursing’s body of knowledge. Every study has a framework, and in this study it is explicitly expressed. Drake and colleagues (2012) inductively have studied and surveyed subjects on the matter of pressure ulcer prevention. The concepts in the framework are (a) pediatric nurses’ knowledge of pressure ulcer prevention, (b) beliefs and practices, (c) barriers and facilitators to providing evidence-based pressure ulcer preventive practices. Operational and conceptual definitions are used and are consistently associated with one another. It is implied that enhancing nurses’ knowledge base, disseminating guidelines, and generally improving the practices of nurses working with patients at risk for impaired skin integrity will significantly enhance the quality of life for the patients.