One of several facets of patient care in which nursing care interacts directly with clinician-provided healthcare is pressure ulcer therapy. Pressure ulcers are small regions of tissue injury or necrosis caused by stress on a bony prominence. After cancer and heart disease, pressure injury is the third most costly ailment. The Centers for Medicare and Medicaid Services (CMS) executed a policy to withhold compensation for the expenses due to acute-care facilities for treating hospital-acquired infections (Fehlberg et al., 2017). As a consequence of this policy change, hospitals now have an incentive to appropriately examine all patients hospitalized for skin disorders and pinpoint all patients in danger of developing pressure ulcers, by using the Plan. Do. Study. Act (PDSA) model, nurses need to endeavor to increase their clinical skills, awareness and viewpoints with regard to pressure ulcers’ evidence-based practices.
Despite current approaches to the treatment of pressure injuries, nurse awareness and education in this area are outdated, and unfavorable attitudes toward preventative initiatives are on the rise. At Baptist Medical Center, for example, a patient who was initially hospitalized with an acute necrotic wound was evaluated, assessed, and diagnosed with a stage IV hospital-acquired pressure ulcer. During repositioning, the patient complained about a lack of advanced care and nursing assistance.
The nurses were tested on the control, avoidance and treatment of pressure ulcers using the Pressure Ulcer Knowledge Tool (PUKT), designed and verified by Beeckman and his colleagues (as cited in Ebi et al., 2019). Although most nurses are aware of the most prevalent risk factors, some nurses reported a lack of appropriate knowledge about contributing factors and preventative strategies, which had a detrimental impact on their performance.
According to the analysis, there was no clear record or documentation of the admissions for any physical examination, suggesting a lack of competence on the part of the admittance nurse. Because the patient was admitted with a wound, the Braden scale had to be utilized to maintain skin integrity. The hospital, on the other hand, reported insufficient usage of the Braden scale for the diagnosis and intervention implementation. The many elements that contribute to pressure ulcers were not noted in the Braden scale. Furthermore, there was a paucity of records on the periodicity of patient repositioning and nutrition diet management since the nurses lacked expertise and knowledge of how to use the Braden scale.
Goal and Quality Indicators
All registered nurses are authorized to conduct assessments using the Braden scale. Braden-scale evaluations should be performed regularly for all confined patients, the frequency of which should be established by individual hospital policy (Han et al., 2018). Patients with movement issues will need to be physically rotated frequently by hospital personnel. The individual’s tissue sensitivity, amount of activity and motility, and overall health condition will decide the rate and repositioning. Hypothetically, because the Braden scale provides a comprehensive approach to risk analysis and gives a blueprint that nurses may utilize to effectively treat pressure ulcers, the patient’s pressure ulcers could have been averted. As a result, the objective is to raise nurses’ awareness and attitudes toward pressure ulcer prophylaxis based on recent scientific information.
There is a need for advanced and latest evidence for pressure ulcer prevention since the traditional methods have become inactive. For instance, Du et al. (2021) conducted a study comparing old didactic techniques that merely offered information about pressure ulcers to a therapeutic case simulation-based strategy for developing competence in evaluating the frequency of occurrence of hospital-acquired pressure ulcers. According to the findings of the study, the nurses in the therapeutic case simulation cluster scored higher points in detecting and evaluating the risks of the disease.
In another research performed by Gaspar et al. (2021) on hospital‐acquired pressure ulcer hindrance, a good percentage of the nurses lacked the necessary skills and competence concerning the use of the Braden scale. In this regard, there is a strong argument that pressure ulcer control is complicated and needs a focused approach along with solid evidence-based knowledge.
The highlighted issue is a lack of pressure ulcer education and training for healthcare workers. Finding a technique to educate healthcare practitioners on the risk, preventive, and skin integrity will lead to a better health experience. The approach entails educating the personnel by ensuring good communication and coordination (PorterArmstrong et al., 2018). To attain the intended results, the educator should implement an open dialogue approach with all team members. Allowing members to freely communicate their problems and challenges while coping with pressure ulcers is critical in developing approaches for improvement. Journal resources on the Braden scale will be made available, as well as courses to educate nurses on the latest developments in managing and avoiding pressure ulcers.
Pressure ulcer occurrences are reduced when healthcare practitioners are taught the hazards and preventive strategies for the ulcers. For example, healthcare professionals received refresher training on minimizing and avoiding pressure ulcers. In addition, multidisciplinary coaching, education, and workshops for the clinicians were held regularly to give information and assure compliance. The objective was to accomplish the desired results by open communication, vulnerability assessments, repositioning, and nourishment. The stages for reaching the goals are as follows:
- identify the target population,
- welcome and educate the relevant parties,
- treat and evaluate the target groups.
The study’s target population and sampling size should be limited. Case in point, the research should be limited to all the nurses that participate in discharging pressure ulcers and those located in acute care where chances of developing pressure ulcers are high. In this case, administrators can monitor the results of the study using the profile of the nurses participating in the research. The period set for the study is approximately one year, allowing enough time to monitor the readmission of patients who develop pressure ulcers after discharge. Therefore, with low readmission of pressure ulcers and low counts of the new development of hospital-acquired pressure ulcers, the study will be regarded as a success.
Educating nurses on pressure sore risk, prevention, and skin quality would greatly reduce pressure sores. The analysis results show that there were good accomplishments, implying that the current report’s goal is feasible and attainable. Nurses cannot effectively treat pressure ulcers unless they engage in ongoing medical and evidence-based practice and education. As a result, it is critical to design a complete educational program for personnel on pressure sore care. With such a favorable outcome, institutions can create long-term plans or include pressure ulcer education into their policies and practices for pressure sore patients.
In conclusion, the PSDA model helps in evaluating pressure ulcers. Through the model, insufficient knowledge by the nurses was identified as a problem. Consequently, educating the healthcare providers regarding the risk, prevention, and skin quality care of patients using evidence-based practices was recognized as a much-needed strategy. Moreover, refresher education for healthcare personnel regarding pressure ulcers, distribution of brochures, frequent multidisciplinary training, awareness, and workshop for healthcare workers was also successful. Therefore, the PSDA model is practical and defensible and should be implored for use in pressure ulcers’ long-term initiatives and policy changes.
Du, Y. L., Ma, C. H., Liao, Y. F., Wang, L., Zhang, Y., & Niu, G. (2021). Is clinical scenario simulation teaching effectively in cultivating the competency of nursing students to recognize and assess the risk of pressure ulcers? Risk Management and Healthcare Policy, 14(1), 2887-2896. Web.
Ebi, W. E., Hirko, G. F., & Mijena, D. A. (2019). Nurses’ knowledge to pressure ulcer prevention in public hospitals in Wollega: A cross-sectional study design. BMC Nursing, 18(1), 1-12. Web.
Fehlberg, E. A., Lucero, R. J., Weaver, M. T., McDaniel, A. M., Chandler, M., Richey, P. A., Mion, L., & Shorr, R. I. (2017). Impact of the CMS no-pay policy on hospital-acquired fall prevention-related practice patterns. Innovation in Aging, 1(3), 1-7. Web.
Gaspar, S., Botelho Guedes, F., Vitoriano Budri, A. M., Ferreira, C., & Gaspar de Matos, M. (2021). Hospital‐acquired pressure ulcer prevention: What is needed for patient safety? The perceptions of nurse stakeholders. Scandinavian Journal of Caring Sciences, 1(1), 1-10. Web.
Han, Y., Choi, J. E., Jin, Y. J., Jin, T. X., & Lee, S. M. (2018). The usefulness of the Braden scale in intensive care units: A study based on electronic health record data. Journal of Nursing Care Quality, 33(3), 238-246. Web.
Porter‐Armstrong, A. P., Moore, Z. E., Bradbury, I., & McDonough, S. (2018). Education of healthcare professionals for preventing pressure ulcers. Cochrane Database of Systematic Reviews, 5(5), 1-50. Web.