The Impact Of Pressure Ulcers Nursing Essay

CHAPTER ONE

INTRODUCTION

The impact of pressure ulcers on the quality of life of the patient cannot be overemphasised, as it can be devastating (Spilsbury et al. 2007; MEP Ltd, 2009; NHS for Scotland, 2009).

A pressure ulcer (PU) otherwise known as pressure sore, pressure damage, pressure injuries or bed sore ( Spilsbury et al. 2007); is an area of the skin that has become damaged over time when the blood supply to a particular part of the body is reduced or cut off. It is mainly caused by sitting or lying in the same position for too long (RCN, 2005). It can also be described as a localised abrasion on the skin or the underlying tissue, in most cases over a bony prominence, due to the pressure or pressure in combination with deformation of the site; this can also be caused by friction. Based on the degree of damage, it can further be defined as partial-thickness skin loss involving epidermis or dermis; mainly superficial and presents clinically as an abrasion, blister or swollen crater (Lyder 2010 & Guy 2012). Furthermore, Pressure ulcer in some other cases can present as an erythematic or abnormal redness of the skin due to dilation of the blood vessels in the skin (http://www.merckmanuals.com/home/heart_and_blood_vessel_disorders.html)

The reddened area remains as such for longer than 30 minutes after pressure is relieved (Barbanel, and Hagisawa, 2001)

In view of the fact that Pressure ulcer has been widely noted to reduce the quality of life of the sufferers (Dorner et al, 2009), this topic is very important and relevant to a very large extent for Nurses and other caregivers involved with the treatment and management of PUs in individuals having learning disability.

Among the many reasons for studying this particular topic are as follows: Having established that pressure ulcers are a major cause of morbidity, mortality and healthcare burden globally and that many of the cases are avoidable (Whittington et al 2004); it follows that solutions need to be sought aimed at reducing if at all, its prevalence.

Looking at PUs from the perspectives of treatment and management, it has been observed that both treatment and management are capital intensive, but it is also preventable (Soban et al 2011). It is very important to concentrate more efforts at minimising the occurrence of PUs, rather than wasting resources on treatment, which might be counterproductive, especially in diabetic patients (European Pressure Ulcer Advisory Panel [EPUAP], 2005).

Pressure ulcers pose grave consequences on the wellbeing of the patient, be that as it may, its treatment, prevention and management is a major priority within the clinical and policy agenda. It is very important that patients are educated on the impact of PUs on health and quality of life, at the same time; it is their right to make informed decision about their care and treatment in conjunction with the healthcare provider (Spilsbury et al, 2007; NICE clinical guideline (2005).

Furthermore, data generated could be used to estimate the total number cases with PUs within a particular population (i.e. prevalence) and the rate at which new Pressure Ulcers are occurring. (Clark 2007).

Plaum et al (2006), in their questionnaire research on Pressure ulcer discovered that it was possible for patients to have a combination of sensory deficit, memory problems, and Arnold Chiari malformation. The above combination of health conditions tended to increase the risk of developing pressure ulcers (Plaum et al 2006 ).

This study will therefore discuss common risk factors for developing pressure ulcers, its prevention and management (Guy H 2012, Vanderwee et al 2007).

This study intends to find out effect on age,and nutrition on the persistence and spread of pressure ulcer. The findings will summarise the finding the various ways to curtail the emergence as well as the ways to improve the wellbeing of the patients with pressure sores. According to the International guidelines on Pressure ulcer prevention, prevalence and Incidence (MEP Ltd, 2009: page 8), "The results of PUs prevalence and incidence studies could be used to raise awareness, to reduce PUs Occurrence, and to improve clinical practice. It is very important to understand the consequences and pitfalls of the prevalence and incidence of PU.

Lastly it is essential for all healthcare practitioners, managers, payers and funders involved in the development, implementation and assessment of PU prevention protocols (Fletcher et al. 2011).

The overall aim of this study a strategy geared towards the reduction of PUs as well as reducing the number of patients who have it.

The need for identification and production of new antimicrobial agents that are selectively toxic and broadly effective with a low propensity to induce resistance is very crucial (Bowler et al. 2001).

According to Bowler et al (2001), while it is true that microorganisms are known to be responsible for wound infections, there are widespread controversies regarding the exact mechanisms by which the microbes cause infection and also their significance in non-healing wounds that fail to exhibit clinical manifestation. Robson (1999); observed that the mass per unit volume of microorganisms is a critical factor in determining the probability of the wound healing. However, (Pallua, et al 1999) argued that the presence of specific pathogens is of primary importance in delayed healing but others have reported that microorganisms are of minimal importance in delayed healing.

There is yet another debate about microbiological examination of wound samples. The value of wound sampling in determining the cause of infection and subsequent treatment, as well as the sampling technique required to provide the most reliable data is encouraged. (EWMA MEP Ltd, 2005), opined that; not all wounds become infected because; the susceptibility or resistivity of the host determines if such a wound will eventually become infected by bacterial pathogen.

Although the role of Microbiology laboratory is incontrovertible, careful consideration must be given to the relevance of culturing multi-microbial wound samples in order to save in cost, labour, and time to both the wound management team and the patient, (Bowler et al 2001).

1.3 Furthermore, since pressure ulcer pressure ulcer (PU) is a debilitating, chronic wound that affects mostly individuals who are incapacitated as a result of age or an underlying illness, its treatment typically involves multiple treatment modalities simultaneously (e.g. support surface plus dressings plus nutritional supplementation), and often different treatments are applied at different stages of treatment, (Lyder, 2003).

CHAPTER TWO

METHODS

The methods adopted in this dissertation involved various strategies: Selecting a review topic and searching the literatures to be used. Gathering, reading and analysing the literature followed by the review of references.

Having selected the topic the next step was identification of the appropriate and related information. This method was in agreement with (Hek and Langton 2000), who observed that a systematic approach is considered most likely to generate a review that will be beneficial in informing practice, while a narrative or traditional review is not.

All the literature searches were undertaken online with the aid of computer and electronic databases. The reason for using computer databases is that they offer access to varieties of information, which cannot be obtained manually. Keyword searches were the most common method of identifying literature (Ely and Scott, 2007). However, keywords which have to do with the review/assessment and management of pressure ulcers, were used.

Databases of relevance to the selected topic, which are very useful for Nurses (Parahoo, 2006), aided the search for related journals included British Nursing Index Nursing journals in the English language. CINAHL (Cumulative Index of Nursing and Allied Health Literature) related publications. Cochrane Library Systematic reviews of the literature on medicine, nursing and professions that are allied to health. Pubmed / MEDLINE A service of the National Library of Medicine and additional life science journals MeSH, Medical Subject Headings or subject headings, Journals of wound care.

Generally, journals are much more up-to-date than books as sources of information; therefore, maximum period of 10 years was placed on the age of the works and journals that were used in this work. Since the objectives are to identify the impact of pressure ulcers (PUs) and PU interventions on health-related quality of life (HRQL), therefore the search strategy sought to identify all published and unpublished research investigating patient reports about the impact of PUs and PU interventions on HRQL. Data extraction involved the reading through each of the published articles and identifying their findings in the form of statements by the author supported by patient reported data. The extracted patient reported data produced (Gorecki et al 2009). In addition, specialist Journals and relevant conference proceedings were hand searched, the Internet was searched for PU self-help Web sites, and a citation search was performed on all included studies and systematic reviews were identified in the search.

Eligibility: Inclusion Criteria: primary research; reporting the impact of PUs and PU interventions on Health related quality of life(HRQL), including symptoms and patient evaluation of interventions. Eligibility: Exclusion Criteria for final selection were used (Gorecki et al 2009).