Nursing 499: Capstone Project Pressure Injuries.

Abstract

Pressure injuries are a common concern among patients hospitalized for long and affect especially the elderly. The resulting bed sores are a quality issue for hospitals that needs to be addressed for better patient outcomes. Sustained pressure on bony prominences restricts blood flow to affected areas when a bed-ridden patient is not regularly turned. This can be a source of extreme discomfort and pain to the patient. Pressure injuries are a nursing quality benchmark and nurses must identify patients at risk and promptly prevent the same to avoid complications. Evidence-based interventions for this problem were gathered through clinical inquiry by the PICOT model.Nursing 499: Capstone Project Pressure Injuries.

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The databases used to gather evidence included CINAHL, PubMed, Cochrane, and Embase. Some of the search results were not useful since they were not experimental and were discarded. The major answers from the evidence indicated that pressure injury prevention is achievable through a nurse-driven bundle of using the Braden Scale risk assessment tool, better nutrition, 2-hourly turning with pressure area care, and management of comorbidities. This collection of evidence means a need for change to evidence-based practice (EBP). Expected constraints in this plan include ineffective dissemination and resistance to change. Nursing 499: Capstone Project Pressure Injuries.

Keywords: pressure injuries, prevention, Braden Scale.

Pressure Injuries

Pressure injuries are a quality improvement issue that is common in intensive care settings where most of the patients are either on life support or are unconscious and therefore bed ridden. The problem is also rampant in settings in which older and infirm patients are cared for. Prolonged pressure on bony prominences when lying down results in reduced blood supply with subsequent necrosis of tissue and ulceration. The problem reviewed within the framework of the current paper are therefore pressure injuries that create obstacles for care provision within organizations and have a huge impact on the patient outcomes for bed-ridden patients.Nursing 499: Capstone Project Pressure Injuries. One of the most prominent problems associated with pressure ulcers is the inevitable increase in the cost of treatment and hospitalization caused by the pressure ulcers that do not heal quickly. The problem tests the ability of providers to adjust their practices to the ever-changing care environment and to administer adequate care to patients who are both at risk of developing pressure injuries and have already been exposed to respective ulcers (Gaspar et al., 2019). In other words, the providers must change from common practice to evidence-based practice or EBP. Therefore, the process of preventing pressure injuries and their severer derivatives is what poses one of the biggest questions for the health care industry and the nursing profession.Nursing 499: Capstone Project Pressure Injuries. Different clinical settings generate a variety of epidemiology options related to pressure injuries, making it harder to generalize the existing findings and find the best treatments able to prevent ulcer-related complications. The purpose of this proposal is therefore to present ways in which EBP can be adopted to deal with the quality problem of pressure injuries. This paper is about an in-depth analysis of the potential improvements that could be introduced to the clinical setting with the intention of limiting the percentage of patients with pressure injuries and disseminating the required knowledge among care providers. The search for and implementation of the EBP interventions uses the Iowa EBP implementation model that emphasizes piloting before full scale adoption. The Iowa model was chosen because (1) it takes a problem-solving approach (2) it considers EBP as a practice and process and not as an event, and (3) it suits the facility in question in as far as the need for assembling an EBP team is concerned, since the facility has an organizational culture of innovation and technology use.Nursing 499: Capstone Project Pressure Injuries.

Problem and/or Knowledge Focused Triggers

The external trigger to the search for evidence-based interventions aimed at tackling the problem of pressure ulcers came from regulatory bodies such as the state board of nursing and accreditation bodies, notably the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Knowing that successful functional recovery of patients could be slowed down due to pressure injuries, it is crucial to reduce the length of hospital stays in at-risk patients in order to prevent development of pressure ulcers. Poor prevention measures and prognosis contribute to numerous cases of premature mortality and make it harder for care providers to deal with the effects of pressure ulcers. Different stages of pressure ulcer complexity also pose a threat for both patients and providers because inappropriate care could negatively affect patient outcomes and invalidate the existing care strategies (Kottner et al., 2019).Nursing 499: Capstone Project Pressure Injuries.

Literature Review/Synthesize Research into Practice

Existing literature on the subject mostly focuses on the patient preferences and their interference with the treatment plans proposed by the interprofessional teams. Nixon et al. (2019), for example, discuss the impact of targeting the process of decision-making and making easier to evaluate the rate of pressure ulcer trial effectiveness. The ability to address modifiable risk factors is what other researchers have also touched upon in their articles, pointing out the potential of applying multi-faceted strategies (a comprehensive approach). Baron et al. (2016) consider that educational interventions aimed at care providers could be the most effective because they increase the significance of provider activities and improve the whole team’s knowledge about pressure injuries. Even though knowledge is an important concept, evaluation and prevention of pressure ulcers would not be possible without specific tools. One of these tools is the Braden Scale risk assessment tool.Nursing 499: Capstone Project Pressure Injuries.

Pressure injuries present a major problem especially with regard to cost of hospitalization and treatment, aside from the risk of mortality especially among the geriatric population. As it is stated by Angmorterh et al. (2019), application of mattresses to the x-ray tables could protect respective patients from ulcer development. Nevertheless, it may also be crucial to address the value of unconventional treatment options prior to deploying any care strategy. Hekmatpou et al. (2018) describe aloe vera gel use as one of the non-pharmacologic treatments that actually help battle pressure ulcers. A comprehensive bundled approach including all the above, 2-hourly turning with pressure area care, as well as the use of nonconventional remedies such as aloe vera presents the best strategy.Nursing 499: Capstone Project Pressure Injuries.

Team Formation and Resolution Strategy

There are several essential elements that are going to be included in the resolution: the use of specialized tools, information dissemination, and patient-provider communication to discuss the potential value of non-pharmacological interventions as part of the overall intervention bundle. First, the team should see if foam cushions or mattress pads could be utilized to reduce the pressure on patients’ bodies during the hospital stay. Depending on whether the patient stays in a wheelchair or in bed, staff members would pick an appropriate risk assessment tool like the Braden Scale and inform the patient about the benefits of changing the positions more often or utilizing different additional devices to reduce the occurrence of sores.Nursing 499: Capstone Project Pressure Injuries. After that, the implementation team would have to disseminate valuable information about pressure injuries among providers and patients in order to bridge the knowledge gap and create an environment where pressure ulcers are successfully prevented instead of reacting to their development. Ultimately, the resolution would include patient-provider information exchange sessions where the team would share the benefits of a bundled approach including non-pharmacological treatments with the patients, motivating them not to be afraid of trying an unconventional approach to pressure injury prevention.Nursing 499: Capstone Project Pressure Injuries.

Piloting Plan/ Implementation Plan

Piloting before full scale implementation is a major pillar of the Iowa Model of EBP implementation. The implementation plan for the current proposal is fairly simple, as it would only include three essential stages. During the first one, the team would be responsible for choosing several pilot units and ensuring that the staff realizes the need to introduce organization-wide changes related to how pressure injuries are prevented, addressed, and treated. Nursing 499: Capstone Project Pressure Injuries.This is the training stage for staff. The second stage would becollaboration with the patients by the piloting teamto refine its evidence-based interventions to the best alternatives that are most effective. Every intermediate result will be discussed within the team, and staff members will be important conveyors of information and feedback from the patients in the pilot program. At the end of the second stage, the team would be able to determine the best practices and involve the concerned hospital units and departments in improving the change proposal further. In a nutshell, it will engage every actor responsible for patient outcomes as represented in the pilot program.Nursing 499: Capstone Project Pressure Injuries.

The third stage of the pilot program implementation is going to be an ongoing communication with both patients and care providers. This step is required because the team members and the management require honest and comprehensive feedback for success. Although the facility might not have allthe required resources at first, the ongoing improvement process might make it easier for the team to build relationships with outside experts and patients alike. Their interest in evaluating the program outcomes together with the pilot team might yield lasting partnerships. The piloted evidence-based prevention practices will be continuously reviewed to collect and analyze specific data related to pressure injury care.Nursing 499: Capstone Project Pressure Injuries.

Monitor & Analyze Outcome Data

In order to analyze the data collected throughout the pilot study, the implementation team would have to evaluate the magnitude of the changes across the organization and see how the routines and structures were altered among both providers and patients. Another benchmark could be utilized to evaluate staff performance and ensure that there is a quarterly analysis of team activities that can be utilized as evidence for the promotion of the initiative.Nursing 499: Capstone Project Pressure Injuries. This is basedon the pilot study proving successful. The executive unit should organize its activities in a way that would leave every actor participating in the implementation responsible for their particular duties in order not to cause any overlap in the reports and interventions (Etafa et al., 2018). The structure of the reports will be in a unified format to make analysis of the effectiveness of organizational operations easier. For instance, the team could introduce an organizational scorecard to gain access to quantitative measures of staff performance such as patients’ length of stay in hospital, pressure ulcer percentage, number of severe and light cases of pressure injuries, and Braden Scale scores.Nursing 499: Capstone Project Pressure Injuries.

Evaluation & Dissemination

The evaluation process relates to the sustaining of the advantages discovered throughout the deployment by piloting. It also involves getting rid of the drawbacks that divert the team from effectively preventing pressure injuries. At the end of the day, this would assist the team in identifying the most common causes of pressure injuries and respond to them in the most appropriate manner, taking into consideration the multifaceted nature of the proposed prevention strategy.Nursing 499: Capstone Project Pressure Injuries. With extended access to quantitative and qualitative data sets, the team would get a chance to measure the outcomes of their prevention practices and decide on whether it would be efficient to continue deploying the programfully after the piloting phase (Mitchell, 2018). Regular meetings might help the team engage in evidence-based decision-making and only deploy targeted practices instead of involving the whole facility simultaneously. Over time, the team will get a chance to integrate their practices across the whole organization and validate the need for proposed changes with the help of relevant practical evidence.Nursing 499: Capstone Project Pressure Injuries.

The main objective of the current program would be to change patient and provider attitudes toward the improvement process and popularize the need to transform pressure ulcer prevention practices. The success of the pilot program would be measured against the leadership support and prevention initiatives that allowed the team to reduce the number of patients exposed to pressure injuries. A sustainable environment created with the help of joint efforts would be a chance for the team to reassess their approach to other issues and redefine some of the prevention measures that were not related to pressure ulcers initially.Nursing 499: Capstone Project Pressure Injuries. For instance, the process of communication would become much easier between different units, as their unique contributions to the process of preventing pressure injuries would unite staff members and allow them to attain common organizational objectives. This way, the process of risk assessment would also become much easier, protecting the team from unexpected expenditures and patient reluctance. With success confirmed through piloting, full-scale dissemination will then take place through measures such as policy briefs, podium presentations, and publications. In particular, policy briefs to the top management of the organization will ensure that the change proposals are infused in the organization’s policies and procedures making them organizational culture. Nursing 499: Capstone Project Pressure Injuries.

Summary/Conclusion

The problem of pressure injuries is a major quality issue in healthcare and nursing practice. It is the starting point or trigger for the team in the Iowa Model of EBP implementation to implement a comprehensive improvement programfor preventing and managing pressure ulcers. The proposed program is going to feature multiple elements such as provider-patient communication, 2-hourly turning with pressure area care, non-pharmacological treatments, and the use of risk assessment tools like the Braden Scale.Nursing 499: Capstone Project Pressure Injuries. Each of the elements in the pilot program is evidence-based, as informed by clinical inquiry. Leadership will be a crucial element in the success of adopting the recommendations, as well as in the process of identifying and referring at-risk patients.  In the end, both patients and providersmust cooperate to achieve the best possible organizational and patient outcomes. The impact and significance of the findings will be seen in the reduction of hospital days, reduced mortality among the aged but critically ill, better facility ratings, and higher patient satisfaction indices.Nursing 499: Capstone Project Pressure Injuries.