language barrier it is paper based on clinical issue and has to back up with nursing theorist

theory_-_salvanesan_v_1.dotpnur2300_leadership_for_practical_nursin_0

language barrier

it is paper based on clinical issue and has to back up with nursing theorist

Pressure Ulcers

Pressure Ulcers and Repositioning

Velupillai Selvanesan

Nursing Theory Assignment- PNUR 2300

Professor Anne Marie Rock

Sunday, July 10, 2011

Pressure Ulcers and Repositioning

Introduction

Pressure ulcers are serious, costly, and unfortunately a more common problem in many health care institutions associated with immobility and inactivity (Kozier, et al., 2010). This article mainly focused on Jean Watson’s theory on patient care utilized in health care settings to prevent pressure ulcers. This essay will discuss briefly about pressure ulcers and its key contributors. Nurses know that for specific actions and decisions, they need some evidence which is clinically proven for the economical and desired outcomes of the client. This assignment will talk about the purpose of this study, how it relates to me as a student nurse, the impact of the study related to the field of nursing and the methods of diminishing pressure ulcers. This study provided me good and informative knowledge and will be very valuable towards my nursing practice.

My Clinical Issue

“Pressure ulcers are significant problems in institutionalized elderly patients and critically ill patients, causing pain, decreasing quality of life, and leading to significant morbidity and prolonged hospital stays. It can also be caused by poorly fitting casts or other health care appliances” (Uptodate, Inc. , 2011)Pressure ulcers can also occur in any age of patients who are unable to move or reposition themselves. RNAO defined pressure ulcers as “any lesions caused by unrelieved pressure that results in damage to underlining tissue. They usually occur over a bony prominence, where it compresses the skin between bone and other objects like mattresses, wheelchair, and other healthcare appliances like casts, splints and safety belts.” (RNAO, 2011) In my clinical placement, different kinds of patients had pressure ulcer by different reasons, different areas/places and I also found different stages of pressure ulcers. The different stages are listed below:


Stage I: skin not damaged but non- balanceable redness over the affected area and colour differs from the surrounding area. (RNAO, 2011).


Stage II: skin dermis damaged and opened with a reddish pink wound and sometimes involves an intact serum filled blister. (RNAO, 2011).


Stage III: loss of skin tissue, subcutaneous tissue may present. . (RNAO, 2011).


Stage IV: skin, subcutaneous tissue fully damaged muscle may damage in this stage. Muscle, bone or tendon may expose also slough or eschar may observe in the wound bed. (RNAO, 2011).

Causative factors in clinical placement

In clinical placement, I am in the restorative care unit. Mostly patients admitted are from the post-surgical care and from emergency care units. I observed different causative factors to develop the pressure ulcers. There are 4 that I will briefly talk about that can cause in developing pressure ulcers. Age is the main causative factor in my placement. For example, a 100 years old woman had pressure ulcer on coccyx area. The aging process is linked with arteriosclerotic change in blood vessels and it will make poor circulation to the skin tissue. Her skin was dry and thin with loss of subcutaneous cushion tissue and it damaged easily. She also had kyphosis, with broken hip and lost muscle strength, reducing her bed mobility. (Maklebust & Sieggreen, 1996). Nutrition malnutrition increases the pressure ulcer formation by iron deficiency. It causes lack of oxygen to the tissues and vitamin deficiency that leads to a breakdown of the skin and also lack of protein intake leads to delayed wound healing (Maklebust & Sieggreen, 1996). Mobility is another major issue of pressure ulcer and immobility creates pressure for long periods of time on the tissue between bony prominence and the outer surface. It can lead to damaged tissue by blocking the blood supply and immobility can also reduce blood circulation in the system. Depending on the illness, the patient’s mobility may reduce. “Critically ill patients admitted to intensive care units are at particularly high risk of developing pressure ulcer” (Berlwitz, 2010). After surgery, most of the clients are unable to reposition themselves due to surgical pain, castes, medication’s side effect and firm position/bed rest. This can take a certain amount of time or many days. For example, in my clinical placement 72 years old patient was admitted with a broken pelvis and she was unable to reposition herself. Excessive moisture leads to softening the skin and this macerated skin is simply scrubbed away by friction when the patient repositions and moves. (Maklebust & Sieggreen, 1996). Sensory deficits are mainly considered around pain and pressure sensations. If the patient doesn’t feels the pain or pressure he or she does not reposition themselves or complain to the heath care providers (Maklebust & Sieggreen, 1996). For example, a knee dislocated patient in my clinical placement had ulcer behind the knee and because she did not feel any pain and pressure on her knee she did not complain.

Prevention by Using of Nursing Theory

Prevention of pressure ulcers are one of the nursing diagnosis with each patients care plan. Prevention is routine mission; daily follow-up is needed to identify the changes of skin. This daily inspection and care prevents pressure ulcer formation and also lead to a rapid healing process. “Watson maintains that caring is central to the professional discipline” (Alligood, 2010). According to Watson’s caring theory, the good quality patient caring will prevent the pressure ulcer and promote rapid healing. This process can occur in my clinical placement. All pressure ulcers can be prevented by good quality nursing care. For the quality care, nurses need to add pressure ulcer as a nursing diagnosis with other medical problems. This care plan for pressure ulcer management will help to prevent and aid in the healing process.

Identifications

Some basic assessment strategies will give you the warning signs of the risk of pressure ulcers. You need to do a highly detailed and thorough skin assessment with each and every client at admission. A daily assessment will need to be performed for those identified at risk for skin breakdown. Special emphases should be placed on sensitive areas. A reliable tool which should be utilized is the Braden Scale of Predicting Pressure Sore Risk. The National Pressure Ulcer Advisory Panel, with the acronym NPUAP, is used to identify pressure ulcers. It is important to use the RNAO best practice guide in the event pressure ulcers are identified. Documentation of the data at the time of assessment and reassessment is also important.

Once pressure ulcers have been identified, there should be a planning strategy, which should be based on assessment data, risk factors and the client’s goals. Such a plan should be developed with the participation of the client, their trusted ones and working members of health care. The risk can be interpreted in terms of the client’s profile and goals using clinical judgment. Suitable positioning, transferring, and turning techniques should be incorporated. Information on transfer and positioning techniques can be provided by occupational therapy and physiotherapy. Pain can reduce mobility and affect activity. Measures for pain control can include proper medication, therapeutic positioning, and support surfaces. The level of pain should be gauged on a regular basis with use of a reliable pain-measuring tool.

Preventing methods

There are many preventive methods and it all involves how we take care of the patient and how we identify risk factors and control them. Treat bony areas as sensitive and avoid massaging over the area. A client should not stay on a standard mattress if he or she is at risk of developing a pressure ulcer. Instead, for such clients, they should use a replacement mattress with low interface pressure. The use of pressure-relieving surfaces should be reserved for high risk clients experiencing surgical intervention. Individuals restricted to bed should use devices to permit independent positioning, lifting and transfers, and reposition at least every 2 hours (or sooner if at high risk). Use sponge-like materials to avoid contact between bony prominences. Avoid dragging clients during position shifts and transfers by using a lifting device. Make sure the patient is given enough liquids and encourage proper skin conditions. Do not apply much pressure during the skin cleansing process. Nutritional examinations should be mandatory when a client’s condition changes. Nurses have a number of options to help patients reduce their risks. While the above mentioned suggestions are aimed for nurses, the client themselves can work on their repositioning and develop a sense of trust with the nurse to be able to state what the issues are so the nurse is able to do his or her best to help. An institution can also provide education to nurses so that they follow the prevention method. They can also supply nurses with the necessary equipment, such as proper mattresses.

Conclusion

This study provided me good and informative knowledge and will be very valuable towards my nursing practice. We explored pressure ulcers and their main causes. The Registered Nurses’ Association of Ontario (RNAO) is focused on risk assessment and the avoidance of pressure ulcers. The profession of nursing has a major effect on pressure ulcer development and the avoidance of it. Special care is required to address the most frequently reported risk factors. There is a common, unified goal of healing with the development of a pressure ulcer. This is why nursing is at the top of ensuring patients are well protected from pressure ulcers.

References

Berlwitz, D. (2010, May 04). Ulcers: Epidemiology; pathogenesis; clinical manifestations; and

Staging. Retrieved June 03, 2011, from uptodate.com: http://www.uptodate.com

Kozier, B., Erb, G., Berman, A., Snyder, S. J., Bouchal, D. S., Hirst, S., et al. (2010).

Fundamentals of Canadian Nursing (2nd Canadian Ed.). Toronto: Pearson Education

Canada.

Maklebust, J., & Sieggreen, M. (1996). Pressure Ulcers Guidlines for Prevention and Nursing Management. Springhouse: Springhouse Corporation.

Alligood, M. R. (2010). Nursing theory Utilization & Application. Maryland Heights: MOSBY

ELSEVIER.

Uptodate, Inc. . (2011). Pressure Ulcers: Epidemology, pathogens; clinical manifestations; and

staging. Retrieved July 8, 2011, from Uptodate: www.uptodate.com

Leadership for Practical Nursing Assignment Rubric: Utilization of a Nursing Theory (4

5

% of PNUR2300 grade)

10

5

Category	Mark	Above Standard	Expected Standard	Approaching Standard	F- Below Standard	Score
Organization		5	 Engaging introduction and thoughtful conclusion.  Purpose of paper clearly identified  Logical focused presentation of well developed ideas  Smooth flow of ideas  Significant details evident A+ 4.5-5/5 A 4-4.5/5	 Effective introduction and conclusion.  Purpose of paper included  Main ideas are straightforward  Transition of ideas between paragraphs is evident.  Relevant details B+ 3.75-3.9/5 B 3.5-3.75/5	 Introduction and conclusion are lacking in clarity  Discernible purpose statement, but inadequate development  Ideas and purposes are recognizable but simple  Transitions not always smooth  Adequate detail C+ 3.25-3.4/5	 Introduction and conclusion weak, vague or cursory  No purpose statement included  Main points are not clear or not logically developed.  Transitions are lacking in clarity  Some appropriate details, some inadequate information present < 3.25/5 Below 65%
Content 1. Identification of Issue	10	 Parameters of content clearly identified.  Perceptive, sure grasp of the issue  A sense of completeness about the handling of the issue  Assignment criteria are met with depth and/or creativity demonstrated. A+ 9.0-10/10 A 8.0-9.0/10	 Parameters of content are evident.  Good grasp of issue  Careful presentation of evidence, accurately documented  Assignment criteria are met. B+ 7.5-7.9/10 B 7.0-7.4/10	 Parameters of the content are identified but reflect a lack of understanding of issue  Adequate grasp of issue  Documentation or evidence is present, but awkwardly or routinely handled  Not all assignment criteria are met; minor gaps are evident C+ 6.5-6.9/10	 Some attempt to supply evidence or to document content  Weak grasp of issue  No clear development of issue, issue superficially covered.  Not all assignment criteria are met; many gaps are evident < 6.4/10 Below 65%
2. Utilization & Application of Theorist		10	 Parameters of content clearly identified.  Perceptive, sure grasp of theory utilization  A sense of completeness about the theory application  Identification of metaparadigm is met with depth A+ 9.0-10/10 A 8.0-9.0/10	 Parameters of content are evident.  Good grasp of theory utilization  Careful presentation of theory application is evident and accurately documented  Identification of metaparadigm is met. B+ 7.5-7.9/10 B 7.0-7.4/10	 Parameters of the content are identified but reflect a lack of understanding  Adequate grasp of theory utilization  Documentation or evidence of theory application is present, but awkwardly or routinely handled  Identification of metaparadigm is met; minor gaps evident C+ 6.5-6.9/10	 Some attempt to supply evidence or to document content  Weak grasp of theory utilization  No clear development of theory application, superficially covered.  Identification of metaparadigm is not met; many gaps evident < 6.4/10 Below 65%
3. Issue Resolution	 Parameters of issue resolution clearly identified  Perceptive, sure grasp of issue resolution targeted to clinical setting  A sense of completeness about the resolution strategies  Evidence-informed resolution applicable to clinical setting A+ 9.0-10/10 A 8.0-9.0/10	 Parameters of issue resolution are evident  Good grasp of issue resolution targeted to clinical setting  Careful presentation of the resolution strategies is evident and accurately documented  Resolution applicable to clinical setting B+ 7.5-7.9/10 B 7.0-7.4/10	 Parameters of issue resolution identified but reflect a lack of understanding of issue  Adequate grasp of issue resolution  Documentation or evidence of resolution strategies is present, but awkwardly or routinely handled  Resolution applicable to clinical setting, with minor gaps evident C+ 6.5-6.9/10	 Some attempt to supply evidence or to document content on issue resolution  Weak grasp of issue resolution targeted to clinical setting  No clear development of issue resolution, superficially covered  Resolution applicable to clinical setting, with many gaps evident < 6.4/10 Below 65%
4. Scholarly Resources	 Number and quality of resources reflects a thorough exploration of the topic A+ 4.5-5/5 A 4-4.5/5	 Effective use of resources in type, number and quality B+ 3.75-3.9/5 B 3.5-3.75/5	 Adequate use of resources in type, number and quality C+ 3.25-3.4/5	 Inadequate use of resources in type, quantity and quality < 3.25/5 Below 65%
Style & Mechanics	5	 Evidence of excellent writing skills throughout paper using extensive and accurate vocabulary  Work reflects precision and thoughtful use of words  Sentences vary in type and length which ensures logical flow when read  APA style is strictly adhered to in text and reference list (no errors).  Habitually and consistently correct spelling, punctuation and grammar A+ 4.5-5/5 A 4-4.5/5	 Evidence of good writing skills using effective and appropriate vocabulary  Minimal misuse of words  Graceful, varied sentences  APA style is utilized in text and reference list (minor errors)  Minimal spelling, grammatical or punctuation errors B+ 3.75-3.9/5 B 3.5-3.75/5	 Fair writing skills with limited vocabulary  Basic use of English language  Some variation in sentences but style does not engage the reader  APA style is attempted, but not always adhered to in text and reference list (numerous errors)  Repeated spelling, grammatical and punctuation errors C+ 3.25-3.4/5	 Weak writing skills with limited vocabulary  Misuse of words  Simple sentences, without variety  APA style is incorrectly used in text and reference list (many errors)  Significant spelling, grammatical and punctuation errors < 3.25/5 Below 65%

Your theory essay will be graded using the following rubric.

The paper may meet different grade levels in the various categories, so the assigned mark will be determined by an overall assessment.