Prevention Strategies for the Development of Pressure Ulcers

Prevention Strategies for the Development of Pressure UlcersThis assignment leave behind examine the mental surgical operation and methods substance abused when gathering empirical shew, for a chosen found supervise issue, using different seem strategies and medical databases. An appraisal and discussion of the chosen evidence leave also be do, posting how the evidence was self-contained and its relevance to the chosen based feel for issue. The process of collecting such evidence and the grandeur of its use will be reflectedupon using a proper(postnominal) reflective model.The practice based care issue which has been chosen is measure of insisting ulcerationations. A instancy ulcer is an area of localised hurt to the skin and underlying tissue (EPUAP, 2009) which develops when there is persisting pull on a bony site, obstructing wellnessycapillary flow , leading to tissue necrosis (Lyder, 2003).The rule for selecting this type of look into is due to the high prevalence rate of printing press ulcer among patients and the current wish of experience concerning guidelines of jam ulcer stripe (Moore Price, 2004). I am very interested in this topic and olfactory perception a deeper knowledge of imperativeness ulcer development and take chances legal opinion tools will enable me to provide better clinical practice. According to Davies (2008) health care professionals are striving constantly to improve and develop standards of care which evolves from the integration of re appear evidence, clinical expertise and patient needs and set (Institute of Medicine, 2001),this is also kn birth as evidence-based practice.The reflective model that I will be using is Rolfe et al (2001) what model which composes of tercet main areas, what? So what? Now what? This model tugs to identify the following what was I trying to extend to? What is my invigorated knowledge of collar? What information is needed to face a similar situation again? Ichose this particular model compared to Johns model of reflection (1994) as I institute it the easiest model for outline and meaning to the process of reflection..Reflection involves accessing previous experience to help in ontogenesis tacit and intuitive knowledge (Johnsand Fresh weewee, 2005) and the main principles of reflection include get mindful, spirit and learnedness from experience. Reflection facilitates an evaluation of ones own practice, both as individuals and with their teams (Sines, Saunders Burford, 2013). It is vital that Nurses reflect and practice reflectively as it allows them to learn from experience and make better hereafter judgement, becoming circumstantial practitioners and facilitating excellent patient care.The critique model I will be using for the critical appraisal and discussion is the Critical Appraisal Skills curriculum (CASP) as it is a lighten tool which identifies the worth of the articles I sop up engraft (CASP, 2013).Critical AppraisalAft er researching for applicable articles, I mulish to choose three of the most relevant articles to critically appraise. Each of these three articles involves a have evaluating the effectiveness of prevention strategies for the development of atmospheric printing press ulcers.The counterbalance single blind randomised control acquire by Webster et al (2011) aimed to approximate the effectiveness of two mash-ulcer screening tools against clinical judgement in preventing pressure ulcers. This story had a very clear and focused intention which stimulated the reader to continue reading due to the direct avoiding the use of jargon or buzz words (Carr, 2001). This was an experimental and correlation field of study showing the link surrounded by two factors with the aim of producing quantative results. 1231 patients were randomly allocated to either a water low or ramstadius screeningtool or to a clinical judgement root word. Randomised Control Trials (RCT) are comparative stu dies with an intervention group and a control group the assignment of the subject is assigned with randomization(Melnick Everitt, 2008). The advantages of using RCT are that it removes potential of twist in the allocation of participants and that randomisation tends to produce comparable groups that is, measured as well as unfathomable or unmeasured prognostics factors and characteristics at the time of random allocation will be balanced (Friedman, Furberg Demets, 2010).The investigators ensured that patients allocated were excluded if their hospital stay was expected to be slight than 3 days or if they had been in hospital 24 hours prior to the baseline assessment occurring. This is to allow thorough and regular direct ceremonial occasion of the incidence of hospital acquired pressure ulcers, allowing the researcher to attempt to control the studies hardship and reliability (Marshall, 2004).In a research study it is vital that the researcher ensures that the subjects a re aware of the process of the study and have given trusted consent. In the case of this study, for pressure ulcer screening and observation, consent was not required. However, signed consent was sought from any patient who developed a pressure injury in order to validate the assigned pressure ulcer through clinical photography. The researchers also obtained institutional ethics cheers which included the right to access the patients medical infix for audit purposes. The incidences of hospital acquired pressure ulcers were similar between all groups.The authors found no evidence to show that two common pressure ulcers pretend assessment tools were superior to clinical judgement to prevent pressure injury. The authors matte that resources associated with the use of these tools might be better spent on thorough daily skin inspection and improving management targeted at particularised risks. This is supported by the work of Sarabahiand Tiwari (2012) who suggests a regular and ri gid enumeration of inspection must be followed as part of the patients daily routine. Nurses task the trial were more familiar with the Water low scoring system which could have led to contamination in the clinical judgementgroup. The limitation of this study is that they did not use patients from acute settings who could be at risk and wherefore cannot use these results as a representation of all hospital settings.The morsel randomised controlled study by Nixon et al (2006) aimed to compare whether differences exist between jump pressure overlays and alternating pressure mattresses in the development of new pressure ulcers. This criterion for this study come to participants aged at to the lowest full point 55 years who had been admitted to vascular, orthopaedic, medical, or care of elderly wards, and had limited mobility.The methodology used for this study was pragmatic, open, multicentre and randomised controlled trial. An open label study is where the investigator and e xperimental units knows which treatment the experimental unit is to receive. Although this type ofstudy is simple and behind to design, it could cause the individual to favour the type of treatment, leading to possible bias (Ambrosisus, 2007). A multicentre method involves the study world placeed by several institutions. An advantage to conducting a multicenter is that it increases the number of patients available to participate (Bhandari Joensson, 2011), which in the this trial is a large 1972, leading to the findings beinghighly likely to be representative of what would happen in usual clinical practice.The design of this study involved patients beingallocated to either an alternating pressure overlay or an alternating pressure mattress, within 24 hours of hospital admission, with the expected length of stay of at least vii days. Clinical research nurses assessed skin status twice weekly for 30 days and then once a week up to 60 days for the development of pressure ulcers. A limitation of this study is the privation of blinded outcome assessment due to difficulty in disguising or masking the mattresses, however, according to Khan, Kunz, Kleijen Antes (2011) only few observational studies manage to instrument appropriate measures to achieve blinding. The researcher tried to combat this through self-supporting skin assessments which were taken by the Nurses to avoid any bias.Ethical approval for this study was approved by theNorth West multicentre research ethics committee and local ethics committees in order to undertake this research. This study had a clear aim to evaluate the effects on pressure ulcer risk and was able to undertake the study with fairly low rates of ulcer incidence, meaning the patients were subjected to minimal harm.The most important issue arising in the honourable review of scientific research involves preventing human participants, is risk of harm (Smith Waddington, 2013) therefrom it was highly important that the researchers were able to conduct this study with low incidence rates.The results of this study were that the patients allocated to either an alternating pressure overlay or alternating pressure mattress that developed a new pressure ulcer of grade 2 or worse did not differ, highlighting the need for other term of enlistment measures.The final study by Moore et al (2011) aimed to compare the incidence of pressure ulcers among older persons nursed using two different move regimens. The researchers aim is very clear, evaluating the effectiveness of positioning patients 3 hourly and 6hourly at darkness time. The methodology used was a pragmatic, multi-centre, open label, prospective and pack-randomised controlled trial, similar to the study above, the findings are highly likely to be representative of what would happen in usual clinical practice due to a multicentre approach being commonly accepted as providing a more representative creation (Luchetti Amadio, 2008). Cluster randomised control trial involves randomizing professionals so it is much easier to move on the intervention separate from the control groups but methodological, statistical and ethical issues must be taken into account in making sense of cluster trials(Gilbody Bower, 2010). This study did indeed ensure that ethical approval was received by participants before the study commenced.The results obtained through the research were that repositioning patients with a pressure ulcer every three hours at night, using the 30 degree tilt, reduces the risk of pressure ulcers compared with usual care which issupported by the recommendations of the International pressure ulcer prevention guidelines (2009). Arguably, the research is well written with a right-hand(a) cadence of supporting literature, stating clearly the incidence of pressure ulcers with a effectual rationale for the studies aim. This study included results of other similar researchers who have found similar results of repositioning, giving scop e for further research such asDefloor et al (2005). The limitation of this study is that the target of 398 participants was hard to find which caused the variance in the size of the clusters to be different, which could have had a major effect on the research gathered. Another limitation is that most participants were 80 years or older which means it cannot be a representative of most patients, as expected.Reflection use the Rolfe et al (2001) reflective model, I will evaluate the actions in undertaking my searches and what I found. As mentioned above, the stages of the reflective model includes what? So what? Now What?The first stage (what?) involved the process of searching for my articles in relation to the subject issuepressure ulcer prevention. Using the databases,Pubmed, Scopus and JSTOR I searched for articles using key words such as, prevention, pressure ulcer, pressure sore and risk assessment. In order to limit the amount of results gathered I used the Boolean operators an d and or as well as advanced searches such a UK based and No older than 2005 ensuring a realistic amount of hits were gathered, relevant to the subject issue. In order to identify relevant articles, I read through the titles and abstracts, as this gave me an idea of how relevant the articles were. Once I read through a few studies, I was able to choose 3 studies to critically evaluate.The second stage (So what?) involved identifying the difficulties which I encountered when conducting the search. I found the searching quite challenging as many a(prenominal) of the results either came back as a large amount of hits or a small number of hits based around remote research to my subject. Using keywords and re wording phrases such as pressure sores instead of pressure ulcers enabled me to widen my search.The final stage (Now what?) involved reflecting on the search which I had undertaken as well as the results obtained. I had to conduct many different searches and keywords to find effec tive results. The problem I encountered was that many results obtained were regarding scandalise care and not prevention if I was to repeat this search again I would ensure I put NOT wound care. I feel further exploration of medical databases would be beneficial for future research to give me a better understanding of search terms and criterion available.Prior to carrying out this assignment, I was certain that risk assessment tools played a major part in the role of pressure sore prevention. However, risk assessments such as water low, have been criticised due to its poor validity, particularly for the tool to underestimate the poetry at risk (Pancorbo Fernandez, 2006). Thestudies which I have critically evaluated have made it clear that observation and repositioning is key to pressure sore prevention. As identified by Guyatt et al, (2000) Nurses do not feel sufficiently fit to be able to appraise research findings because they lack the necessary understanding of information re trieval techniques, research design and data analysis and therefore it is important that Nurses are educated in pressure sore management, for clinical practice to be effective.This assignment has expressed the importance of evidence based practice for effective clinical practice,although contradictory findings from different sources and a lack of critical appraisal skills can make interpretation of evidence difficult.It has taught me the note value of observation when caring for patients and made me become mindful of reading and evaluating research to learn and improve my clinical practice. I am aware that repositioning and skin integrity checks are a major pressure ulcer prevention and that risk factors such an nutrition also need to be monitored closely, I feel I will confidently use the knowledge I have obtained when in practice.This assignment has put into perspective the importance of identifying all factors when caring for a patient and aiming to prevent pressure sores. For f uture development I would like to do further research on methodology as I believe this will help me to evaluatethe studies in much more depth, especially seeing ascertain study methodological designs are likely to be more reliable compared to others.ConclusionIn conclusion, this essay demonstrates an effective search strategy for research studies on preventing pressure ulcers which have each been critically appraised.A reflection on the process of the research was carried out using Rolfe model of reflection (2001) highlighting learning outcomes as well as encouraging me to exploreimprovements for my future practice and search strategies.