Introduction
Pressure ulcers are localized skin or underlying tissue damage as a result of long-term pressure on body parts with bony prominence. The most common representations are those that occur on the outer layers of the coccyx, hips, elbows, ankles, and knees. They occur because of the pressure on soft tissues resulting in partial or complete obstruction of blood flow to that area. Moreover, shear can equally play a significant role by pulling on vessels that supply blood to the skin. It is common in individuals who are not regularly moving as those bedridden or in wheelchairs. However, other factors can influence the skin’s tolerance to shear which eventually lead to pressure ulcers. Such factors include microclimate, protein-calorie, and diseases that reduce skin sensitivity or fluid flow to the skin (Atkinson & Cullum, 2018). It is often preventable and treated although it is somewhat difficult for critically ill patients. Cultural and ethical perspectives have shaped the prevention and treatment of pressure sores because of the challenges that they present in the implementation of clinical practices.
This paper will present cultural and ethical perspectives of inquiry on the management of decubitus sores and the challenges surrounding it. The level one cultural question is on the current challenges from people’s way of life and beliefs. On the other hand, the level two ethical question aims to explain the ethical dilemmas involved in prevention or treatment mechanisms. The former concern involves the collective role of all the stakeholders in addressing the problem. The latter focuses on identifying the moral shortcomings that prevent the smooth implementation of policies.
Cultural Perspective of Inquiry: Prevention of Pressure Ulcers
In contemporary society, considerable dogma drawn from cultural standpoints has overrun evidence-based results in preventing this health condition. The therapeutic measures for its treatment are mostly empirically drawn from anecdotal experience. Essentially, the treatment process of pressure ulcers is somewhat problematic due to multiple comorbidities of ill persons and the relatively long duration of chronic pressure ulcers. Moreover, difficulties arise because of a physician’s unfamiliarity with the available approved treatment options (García‐Sánchez et al., 2019). The issues causing dilemmas in the integration of preventive measures in clinical practice are primarily due to risk assessment, treatment, diagnosis procedures, and nutritional support.
In the implementation of some of the precautions such as pressure relief, some health officers faced resistance from the patients. The recommendation to change the position of patients after every two or four hours is problematic for long-term practices. In nursing homes, the caregivers have an easier time identifying the triggers early because they are familiar with the needs of the patients (Lavallée et al., 2018) However, some residents are opposed to the routines, especially at night. They feel that it is a disturbance from the staff constantly repositioning them. Moreover, others also resist adherence to nutritional directives. The patients refuse to take the meals, fluids, or prescribed barrier creams. Some were non-compliant due to incapacitated mental function such as those suffering from brain injury (Lavallée et al., 2018). However, others understood the essence of the procedures but still opted to follow the guidelines.
Other measures that can be used include triggering a cultural change to invoke the required response. One such way is through education, from the nurses to the patients themselves about the diagnosis, prevention, treatment, and fatalities of decubitus ulcers. In conducting the training, there is a need for enforcement and support from the senior management thus boosting professional growth. Despite the idea that increased education does not play a significant role in the development of useful practices, it increases awareness. Consequently, the clinicians can successfully identify risks through the application of such tools as Norton and Braden scale (Stadnyk et al., 2018). The quality care and prevention protocols thus involve clinical informatics to blend with cultural perceptions for better results.
Ethical Perspective of Inquiry: Prevention of Pressure Sores
Pressure ulcer prevention protocols and management require an interdisciplinary technique. Some sections of the available measures are highly routinized although customization is necessary to address the needs of individual patients. For health professionals involved either directly or indirectly, numerous ethical concerns may arise. The issues usually originate from accountability which can be about policies and clinical perspectives (Carlson & Gunningberg, 2017). It is therefore imperative for clinicians to integrate ethical theories and principles to design frameworks that will address ethical dilemmas. Most organizations are currently striving to meet the bare threshold of ethical clinical practices (Carlson & Gunningberg, 2017). However, there are issues with understaffing which lead to poor care of the vulnerable members. As a result, the care is substandard and provides a suitable environment for the development of skin injuries.
However, the theories have been criticized to be rather general and basic, which cannot fully address all the concerns. Alternative approaches include experimental learning and virtue ethics which provide comprehensive guidance inclusive of a pluralistic approach to solving the challenges (García‐Sánchez et al., 2019). There are cases where the patients’ or their family’s beliefs hinder the prevention of decubitus ulcers. One such case is when the family believes that miracles do happen. Thus, in the case of fatalities, they are reluctant to accept clinical advice from healthcare professionals. As such, the caregivers are forced to administer a treatment that does not help in the management of the illness (Lavallée et al., 2018). Others opt for nutraceuticals that are not approved by regulatory bodies or whose effectivity or side effects are unknown. Moreover, some physicians are reluctant to perform surgery for chronic cases such as diverting colostomy. The hesitation is due to the slim chance of success of such kind of procedure after analyzing the risk-to-benefit ratio.
Other controversies are arising from different literature on some preventive mechanisms. One such contentious issue involves nutrition especially on the best mode of nutritional assessment for patients at risk. For instance, there is no agreed-upon specification on the value of serum albumin where some researchers claim that low levels increase risk while others do not (Karpegard & Mordoch, 2019). The AHRQ bedsore prevention directive states that albumin of less than 3.5gm/dl raises risk. However, another study suggests that dietary protein consumption is a somewhat independent predictor of the stated value (Lavallée et al., 2018). The clinicians are thus faced with a dilemma on which side to choose and which will be less detrimental to the patient. Other conflicting texts involve the role that protein-calorie malnutrition plays in the promotion of decubitus ulcers.
Conclusion
The illness possess a threat to the health and life of persons in conditions that trigger its development and thus necessitates a corrective measure to counter its prevalence. The foundations of modern healthcare are based on treating patients with honesty, fairness, dignity, and recognizing their rights. There are various obstacles to addressing the concerns, some of which include non-compliance from the patients and their diverse belief systems. Additionally, the policymakers have difficulties choosing the right protocols to follow due to the controversial literature available. To fully combat the prevalence of pressure injury, it is imperative to consider both the ethical and cultural factors since the solution requires an interdisciplinary approach.
References
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García‐Sánchez, F. J., Martínez‐Vizcaíno, V., & Rodríguez‐Martín, B. (2019). Conceptualisations on home care for pressure ulcers in Spain: Perspectives of patients and their caregivers. Scandinavian journal of caring sciences, 33(3), 592-599.
Karpegård, E., & Svalstedt, J. (2019). Registered nurses’ experiences of preventing pressure ulcers at a person receiving care at a hospital in Peru: A qualitative study.
Lavallée, J. F., Gray, T. A., Dumville, J., & Cullum, N. (2018). Barriers and facilitators to preventing pressure ulcers in nursing home residents: A qualitative analysis informed by the Theoretical Domains Framework. International Journal of Nursing Studies, 82, 79-89.
Stadnyk, B., Mordoch, E., & Martin, D. (2018). Factors in facilitating an organizational culture to prevent pressure ulcers among older adults in health-care facilities. Journal of wound care, 27(Sup7), S4-S10.