How may pressure ulcers be prevented in tertiary health care settings?
How may pressure ulcers be prevented in tertiary health care settings?
A pressure sore is an area of localised damage to the skin and may involve underlying structures. Tissue damage can be restricted to superficial epidermal loss or extend to involve muscle and bone. Banks (1992, cited in Alexander, Fawcett & Runicman, 2001).
The pressure sore problem presents major challenges for nurses as the problem is widespread and persistent, affecting patients from all walks of life and with a range of illnesses. It causes diminished quality of life and distress to patients and carers and it makes major financial demands on the health service. The true cost of pressure sores is not known, the estimated range from £60million to £200 million per year, Department of health (1993), cited in Clay, 2000), pressure sores not only cost money but can cause other problems, they may lengthen a patients stay in hospital, cause extra work for nursing staff, increase the potential for litigation. Research has shown 9% of all patients admitted to hospital develop pressure sores with a further 9% at risk, Dealey (1992, cited in Quinn, 1999), patients aged 65 and over are at greatest risk with 49% in this age range. It is estimated the 95% of sores are preventable. Waterlow, 1988, cited in Quinn, 1999), for nurses, the difficulties arise in trying to identify patients who might develop a pressure sore, and when they are at risk of doing so.
Pressure sores result from areas of previously healthy tissue becoming devitalised, resulting in localised tissue death. Pressure ulcers are prevented through the knowledge and skills of the nurse by correct handling techniques when manoeuvring the patients, positioning of patients in their bed will be (tilted to a 30 degree angle), and also equipment used to relieve pressure. Nutrition should also be considered as an essential part of wound healing. All patients should be screened for malnutrition and should receive an appropriate level of nutritional support. All members of the multidisciplinary team should be on the look out for malnutrition and embrace nutrition as an essential part of wound management. Nutritional assessment is of paramount importance in identifying the appropriate means of nutritional support that can reduce the risk of developing pressure ulcers and should be part of the initial nursing assessment. Older people should be reassessed at regular intervals, within the tertiary health care system patients nutritional needs are looked after by a dietician who is part of the multidisciplinary team. The tissue viability nurses also play a key part in the formulation of a strategy to prevent ulcers, particularly through their staff education role. Nurses need to identify who is at risk and care for patients on the most appropriate surface. A combination of good nursing techniques and preventive aids will definitely be necessary. This includes the mattresses on the bed, and the chairs they may sit on during the day, Dealey, (1992, cited in Quinn, 2000); in tertiary health care settings the majority of the patients are immobile with chronic illnesses, and are elderly. They are dependent on the nurse's care for their day-to-day needs. If a patient has a pressure ulcer on their posterior the nurse would turn the patient on their side alternating two hourly, this process will give the patient relief. If a patient is confined to a chair the patient can be manoeuvred using hoists such as the 'sara' or the 'oxford' hoist again to give the patient relief, this is again done two hourly. If movement is restricted a care plan will be devised by nursing staff to keep the patient off the ulcer as much as possible. There should be a multidisciplinary approach to a selection of equipment and should be installed within four hours of admission. Preventative aids in the tertiary health care setting include special mattresses and beds, chair's are used which must be of the correct height and depth for the patient. Sheepskins are also used which is a mechanical aid to relieve patients who are at low risk. When possible carers and relatives should encourage patients to change position, to sit in chairs as opposed to remaining in bed during the day known as chair-nursing, is widely thought to prevent pressure sores and other complications associated with bed-rest. A study by Gebhardt and Bliss 1994, cited in Clay, 2000), did not support this but suggested that the development of pressure ulcers is strongly correlated with the length of time spent sitting.
A pressure sore is an area of localised damage to the skin and may involve underlying structures. Tissue damage can be restricted to superficial epidermal loss or extend to involve muscle and bone. Banks (1992, cited in Alexander, Fawcett & Runicman, 2001).
The pressure sore problem presents major challenges for nurses as the problem is widespread and persistent, affecting patients from all walks of life and with a range of illnesses. It causes diminished quality of life and distress to patients and carers and it makes major financial demands on the health service. The true cost of pressure sores is not known, the estimated range from £60million to £200 million per year, Department of health (1993), cited in Clay, 2000), pressure sores not only cost money but can cause other problems, they may lengthen a patients stay in hospital, cause extra work for nursing staff, increase the potential for litigation. Research has shown 9% of all patients admitted to hospital develop pressure sores with a further 9% at risk, Dealey (1992, cited in Quinn, 1999), patients aged 65 and over are at greatest risk with 49% in this age range. It is estimated the 95% of sores are preventable. Waterlow, 1988, cited in Quinn, 1999), for nurses, the difficulties arise in trying to identify patients who might develop a pressure sore, and when they are at risk of doing so.
Pressure sores result from areas of previously healthy tissue becoming devitalised, resulting in localised tissue death. Pressure ulcers are prevented through the knowledge and skills of the nurse by correct handling techniques when manoeuvring the patients, positioning of patients in their bed will be (tilted to a 30 degree angle), and also equipment used to relieve pressure. Nutrition should also be considered as an essential part of wound healing. All patients should be screened for malnutrition and should receive an appropriate level of nutritional support. All members of the multidisciplinary team should be on the look out for malnutrition and embrace nutrition as an essential part of wound management. Nutritional assessment is of paramount importance in identifying the appropriate means of nutritional support that can reduce the risk of developing pressure ulcers and should be part of the initial nursing assessment. Older people should be reassessed at regular intervals, within the tertiary health care system patients nutritional needs are looked after by a dietician who is part of the multidisciplinary team. The tissue viability nurses also play a key part in the formulation of a strategy to prevent ulcers, particularly through their staff education role. Nurses need to identify who is at risk and care for patients on the most appropriate surface. A combination of good nursing techniques and preventive aids will definitely be necessary. This includes the mattresses on the bed, and the chairs they may sit on during the day, Dealey, (1992, cited in Quinn, 2000); in tertiary health care settings the majority of the patients are immobile with chronic illnesses, and are elderly. They are dependent on the nurse's care for their day-to-day needs. If a patient has a pressure ulcer on their posterior the nurse would turn the patient on their side alternating two hourly, this process will give the patient relief. If a patient is confined to a chair the patient can be manoeuvred using hoists such as the 'sara' or the 'oxford' hoist again to give the patient relief, this is again done two hourly. If movement is restricted a care plan will be devised by nursing staff to keep the patient off the ulcer as much as possible. There should be a multidisciplinary approach to a selection of equipment and should be installed within four hours of admission. Preventative aids in the tertiary health care setting include special mattresses and beds, chair's are used which must be of the correct height and depth for the patient. Sheepskins are also used which is a mechanical aid to relieve patients who are at low risk. When possible carers and relatives should encourage patients to change position, to sit in chairs as opposed to remaining in bed during the day known as chair-nursing, is widely thought to prevent pressure sores and other complications associated with bed-rest. A study by Gebhardt and Bliss 1994, cited in Clay, 2000), did not support this but suggested that the development of pressure ulcers is strongly correlated with the length of time spent sitting.
