Practice problem: Pressure ulcers in an Assisted Living Facility workshop
In nursing practice, there are several practice problems that nurses encountered in the line of their duty that requires interventions to address. One of these practice problems that I would like to explore in my organization and in healthcare as a whole is pressure ulcers which remain a major health problem and affect approximately 3 million adults across the world (Guzman, McClanahan & Vaughn, 2018).
By description, pressure ulcers (also known as pressure sores or bedsores) refer to injuries to the skin and underlying tissue and are mainly a result of prolonged pressure on the skin (Al et al., 2020). Pressure ulcers can affect anyone, but usually affect people confined to bed or who sit in a chair and those in wheelchairs for long periods of time such as those living in assisted facility workshops (Guzman, McClanahan & Vaughn, 2018). Pressure ulcers are most common on the bony parts of the body like the base of the spine, the heels, elbows, and hips. They usually develop gradually, but can sometimes form in a few hours. People who are affected by pressure ulcers are likely to experience pain and negatively affect health-related quality of life (Al et al., 2020)
Is the issue a common issue in healthcare or nursing practice, or is this issue specific to your organization or facility?
A pressure ulcer is a common issue in healthcare and nursing practice, especially among people who are confined to bed or who sit in a chair and those in wheelchairs for long periods of time such as those living in assisted facility workshops. According to Lavallee et al. (2019), most people who are living in nursing homes are at greater risk of developing a pressure ulcer. Lavallee et al. (2019) also explain that pressure ulcers (PUs) are classified as some of the iatrogenic sources of additional morbidity for hospitalized patients with a prevalence rate of 4% to 49% across the world. As a major issue of concern to the organization, nursing practice, and healthcare as a whole, pressure ulcers increase the cost of treatment and may result in a longer length of time spent in the hospital (Al et al., 2020)
Is this issue addressed in the literature?
Several kinds of literature have recommended the best practice to prevent pressure ulcers including the guidelines provided by National Institute for Health and Care Excellence. According to Al et al. (2020), pressure ulcers are considered preventable through the application of evidence-based prevention programs. These programs include evidence-based practices, evidence-based product selection, and training and education healthcare providers in prevention techniques. Lavallee et al. (2019) point out the practice that can be implemented to address pressure ulcers using three prevention practices which include skin inspection, support surfaces, and repositioning. Other practices suggested in the literature to reduce pressure ulcers include proper nutrition and hydration and keeping moving regularly while changing the position. It is also recommended to apply dressings that speed up the healing process, use specially designed static foam mattresses or cushions, and always clean wound and remove damaged tissue (Guzman, McClanahan & Vaughn, 2018).
Has this issue been addressed by management to date? If so, how?
Even though there are several practices and guidelines recommended to manage pressure ulcers, the implementation of pressure ulcer prevention activities at the organization level is still a challenge. This is particularly in a nursing home and assisted living facility where there is a lack of monitoring, high levels of understaffing, and high staff turnover. The lack of pressure ulcers prevention programs in the organization has resulted in increased complications, mortality, and high cost of treatment (Guzman, McClanahan & Vaughn, 2018).
References
Al, M. A., Ambani, Z., Al, O. F., Al, S. K., Alhassan, H., & Al, M. A. (2020). The effectiveness of pressure ulcer prevention program: A comparative study. International Wound Journal, 17, 1, 214-219.
Guzman, J. L., McClanahan, R., & Vaughn, S. (2018). Development of guidelines for pressure ulcer prevention. Wounds International, 9, 4, 34-38.
Lavallee, J. F., Gray, T. A., Dumville, J., Cullum, N., Lavallee, J. F., Gray, T. A., Dumville, J., … Cullum, N. (2019). Preventing pressure ulcers in nursing homes using a care bundle: A feasibility study. Health and Social Care in the Community, 27, 4.
Stannard, D. (2021). Problem identification: The first step in evidence‐based practice. AORN Journal, 113(4), 377–378. https://doi.org/10.1002/aorn.13359
