NUR 4169c: Evidence Based Practice

Nurse Intervention to Prevent Pressure Ulcers
Clana Marcellus
University of South Florida
Introduction
This evidence-based project has its basis on the prevention and treatment of bed pressure ulcers by the nursing staff for bed bound patients. Thus, the PICOT question looked into the role of repositioning in preventing pressure ulcers for patients between the ages of 25 to 65 in comparison to independent patients for a period covering ne to three months. The results of the study were also compared for a period spanning one to three months. In the UK between 4% and 10% of all hospitalized patients, at least one of the patients develop a pressure ulcers while 70% of aged people in UK with mobility problems develop pressure ulcer (NHS, 2005).
Infrastructure to support a change in the proposed setting
In order to achieve the set objectives, the hospital envisions changing the shift patterns of the patient, as well as adding new beds in the expanded wings of the hospital. Development of pressure ulcers is a growing problem and it is necessary to turn patients every two hours to make them more comfortable. In addition, the hospital will have to invest in purchase of more med septic skin protection cream, as well as use protective equipment to cut down the possibility of pressure ulcers occurring. The key people to make the project successful will be the nurses, nurse leaders, and nurse specialists. They will collaborate to prevent development of pressure ulcers and assess the risk for bed bound patients.
Summary of synthesized literature review of best evidence
To collect evidence on the effectiveness of nursing interventions in preventing bedsores the research mainly relied on electronic search engines. These search engines included: PubMed, CINAHL, PubMed, omniMedicasearch.com and ClinicalTrials.gov. To narrow down the results of the study the keywords used were pressure ulcers, nurses and bedsores. Furthermore, all the studies focused on bed bound patients, with peer-reviewed articles being mostly considered for this evidence-based project, but textbooks also provided valuable information on evidence based practice.
Synthesis of literature used
A look into literature review provides evidence to give credence to the hypothesis that nursing interventions can help to reduce bedsores. Essentially, pressure ulcers are some kind of skin wounds that come about because of unrelieved pressure, aging, incontinence, medication, humidity, and temperature. According to Talsma et al., (2011), nursing intervention results in a decrease in pressure ulcers in a case study of 6735 patients with the results showing a P value of 0.004, which was statistically significant to illustrate the effectiveness of interventions to prevent PU. This research was carried out using four control units where a daily report of severity of pressure ulcers was effective in identifying patients at risk of getting bedsores. Similarly, Kelly (2010) highlighted on the risk of getting pressure ulcers among different patients, but using a Braden scale. All the patients under study were either hospitalized or home nursing patients standing a high risk of bedsores. Nonetheless, the Braden scale is not completely reliable for identifying patients at risk of pressure ulcers in elderly home care. Ultimately, the study only relied on information about those patients who developed pressure ulcers under the hospital’s care.
According to Jackson et al (2011), patients under surgery stand a high risk of getting pressure ulcers, as they are immobile. The study found out that only 1 patient developed pressure ulcers out of 27 following intervention, but before intervention, 25 patients developed 40 ulcers. Consequently, the authors conducted a study on postoperative cardiovascular patients seeking to find out the prevalence rates of pressure ulcers while under intensive care. Using air fluidized therapy to avert pressure; the authors concluded that this intervention was effective, following a drastic drop in the number of patients who suffered pressure ulcers when compared to the period before intervention. Equally, the Nursing Times (2012) compared results between nursing intervention in an experimental group and control group. However, the study was carried out through sing a 30º tilt in reducing pressure ulcers once for every three hours, with the experimental group showing considerable reduction in pressure ulcers.
Proposed Practice Change
The reviewed literature shows that nursing intervention is clearly helpful in minimizing the incidences of bedsores. Consequently, there is a need to turn patients once for every two hours or as is deemed necessary. Furthermore, all the nurses need to use med septic skin protectant cream anytime there is incontinence. At the same time, all the nursing staff will be sensitized on the need to wear protective equipment to reduce the possibility of pressure ulcers appearing. The proposed changes take into account the need to educate nurses regularly through integrating evidence based projects in nursing practice The evidenced gathered shows that if all the nursing staff have adequate knowledge on the role of nursing intervention, then there is a high likelihood that with compliance then incidences of pressure ulcers would reduce considerably. To ensure that the health facilities are not been overstretched, then the systems and mechanism need to take into account evidence based report (Houser, 2010).
Change Strategy
In order to promote team management and implement change then having open cha...