Pressure Ulcer Prevention For Long Team Care ( Ltc )

Quality improvement issues in healthcare focus on the care that patients receive and the outcomes that patients experience. Nurses play a major advocacy role for ensuring safe and quality care to all patients. Also, nurses share the responsibility in leading the efforts in improving patient care in all settings (Berwick, 2002). One of the ongoing problems plaguing hospitals and nursing homes is the development of new pressure ulcers in patients after admission. A pressure ulcer can be defined as a localized area of necrotic tissue that is likely to occur after soft tissue is compressed between a bony prominence and a surface for prolonged periods of time (Andrychuk, 1998). According to the Centers for Medicare and Medicaid,

The research article "What influences the impact of pressure ulcers on health-related quality of life? A qualitative patient-focused exploration of contributory factors" was recently published (2012) in the Journal of Tissue Viability by Gorecki, Nixon, Madill, Firth, and Brown. This is a qualitative study.

According to, the European Pressure Ulcer Advisory Panel (EPUAP), National Pressure Ulcer Advisory Panel (NPUAP) and Pan Pacific Pressure Injury Alliance (PPPIA) classification system (2014) pressure ulcers are categorised into four stages depending on their severity. Stage one: skin still intact with non-blanching, redness with swelling present. Stage two: the skin breaks open or forms a blister without slough and is usually tender or painful. Stage three: pressure sore becomes worse, slough may be present and extends into the tissue beneath the skin where subcutaneous fat may be visible but bone, tendon or muscles are not exposed. Stage four: pressure sore becomes very deep reaching into the muscle or tendon causing extensive damage with necrosis. However, pressure ulcer staging is dependent on visible skin characteristics therefore misclassifying pressure-related injury can remain undetected for days or weeks before a purple discolouration of the skin appears (Mallah, Nassar and Badr, 2014).

A common health concern seen in the elderly, especially those within institutions, are pressure ulcers. A pressure ulcer is defined as a localized injury to the skin or underlying tissue that occurs when something keeps rubbing or pressing against the skin. Pressure on the skin causes a decrease of blood flow to that area and as a result, an ulcer may form because of the skin dying due to the lack of blood in that region. They generally occur over bony prominences such as, the buttock, elbow, hip, heel, back of the head and ankles. An ulcer has a greater chance of forming if the person uses a wheelchair or stays in bed for a long period of

1. Pressure ulcers, also known as bed sores or pressure sores are injuries of the skin and underlying tissue. They appear when the affected area of skin is under too much pressure. Due to the pressure the blood flow is disrupted, the area does not irrigate, therefore nutrients and oxygen do not reach the skin cells. The skin then breaks and pressure ulcers form

Pressure ulcers continue to be a prevalent issue in the health care system and causes “pain, slow recovery from morbid conditions, infection and death” (Kwong, Pang, Aboo, & Law, 2009, p. 2609). In the field of nursing turning and repositioning patients is a well-known nursing intervention to prevent development of pressure ulcers. However, many hospitals and facilities still neglect to apply this as a standard policy. This gives room for nurses and nursing aides to overlook the importance of this intervention resulting in increased pressure ulcer development. The purpose of turning and repositioning patients is to prevent oxygen

Pressure ulcers are one of the most common problems health care facilities often face which causes pain and discomfort for the patient, cost effective to manage and impacts negatively on the hospital (Pieper, Langemo, & Cuddigan, 2009; Padula et al., 2011). The development of pressure ulcers occur when there is injury to the skin or tissue usually over bony prominences such as the coccyx, sacrum or heels from the increase of pressure and shear. This injury will compromise blood flow and result in ischemia due to lack of oxygen being delivered (Gyawali et al., 2011). Patients such as those who are critically ill or bed bounded are at high risk of developing pressure ulcers (O'Brien et

While nurses encounter patients with pressure ulcers in home care and acute care settings, they are mainly a problem with elderly adults in long term care facilities. This is because of decreased sensory perception, decreased activity and mobility, skin moisture from incontinence, poor nutritional intake, and friction and shear (Stotts and Gunningberg, 2007).

As cited by Jarvis (2012, p.203), “the skin is the sentry that guards the body from environmental stresses and adapt it to other environmental influences.” Maintaining the elderly patient’s skin integrity requires a holistic care approach. As a nurse, one of our best practices is performing a thorough skin assessment of the whole body of our patients. A detailed head-to-toe skin assessment and clear documentation can help the interdisciplinary team in generating individualize plan of care. I perform a thorough assessment by inspecting the patient’s skin color, temperature, texture, moisture, and for presence of wounds. I ensure that the information I obtained from the skin inspection is clearly documented in the patient’s chart and plan of care, and any skin changes are communicated to the physician or nurse practitioner.

Pressure Ulcer is a breakdown of skin appears on the skin over a very thin or bony prominence

Critically ill patients are at increased risk for pressure ulcers. Hospital -acquired Pressure ulcers are serious clinical complications and that can lead to increased length of stay, pain, infection and potentially death. Nurses have the primary role in the pressure ulcer prevention. The study assessed nurses’ perceptions of the usefulness and impact of a pressure ulcer prevention care bundle intervention on clinical practice. So it is imperative to understanding nurses’ assessments of interventions when interpreting results and translating evidence into practice.

Pressure ulcer is an adverse outcome in the clinical care setting that also linked to poor quality of nursing care. Though pressure should never happen in a professional care setting, it is still prevalent throughout the world’s medical settings. This article looks at many other previous studies from 1992 to present to compare and find the underlying issues that may contribute to pressure ulcer. A closer look at the nurse’s knowledge versus actual decision will be observe, because it is the key factor in pressure ulcer prevention.

Pressure ulcers are painful and can be difficult to treat. Pressure ulcer prevention should be a part of everyday nursing practice. Pressure ulcer prevention is a nursing practice priority across all care settings. With the new Centers for Medicare and Medicaid regulations regarding pressure ulcers now in effect, prevention is more critical than ever. However, nurses cannot expect to make significant progress in preventing pressure ulcers if pressure ulcer risk assessment, prevention planning, prevention intervention, and outcomes evaluation function as distinct and unrelated activities.

Pressure Ulcer/ Deep tissue injury is the damage to the skin under or the underlying tissue which cushion the prominent and heavy parts of the body while sitting and lying. Pressure Ulcer develops when the blood supply throughout the layers of the skin diminished by the weight of the body imposed on the skin while the patient is lying or sitting for long period of time. The c blood pressure in capillaries under the skin is about 20 to 40 mm Hg. Consequently, when the body exert weight or pressure on the skin, it leads to hypo perfusion. Once the pressure ulcer developed, then the pressure ulcer is described and treated according to the stages of damage has occurred. Stage 1 sign and symptom is non-blanchable erythema on skin upon pressure,

Pressure Injuries—often referred to as pressure sores, bed sores, pressure ulcers or decubitus ulcers—are the injuries, sores, inflammation or ulcers in the skin over a bony prominence due to constant pressure or friction. The common sites for pressure injuries are sacrum, heels, elbows, ankles, hip, knees, occipital bones and shoulder blades (Harris, Nagy &Vardaxis, 2010, p.1404). A shearing force or a frequent pressure on a bony prominence tends to block the blood supply which leads to ischemia or cell death. Elderly, incontinent, wheelchair or bed-bound individuals are prone to pressure sores. However, it also depends on the individual’s skin integrity and weight (Brown & Edwards, 2012, p. 239). The pressure injury can affect any person of any age. Therefore, every patient requires an assessment for risks regardless of gender, age or weight. A pressure injury can develop with both the high pressure for short duration and low