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Introduction
In the 1990’s, professional organizations and government agencies made it possible to publish guidelines for clinical practices in regards to the prevention of PU Pressure Ulcers. However, the means of translating the guidelines on the bedside has continued to be a problem. Incontinence care has made it clear that it has become a significant task for clinicians. For patients who suffer from pressure ulcers and incontinence, to use RCT will be required using support surfaces and repositioning the patient in order to avoid exposure to urine or stool respectively and improve these conditions. In regards to the condition of pressure ulcers, proceedings and the policy state that every resident requires to have an assessment of the skin together with a treatment plan in line with maintaining the skin integrity and wounds in which management is needed. “Having the evidence that is current or at hand, repositioning of the patient, the use of support surfaces, watching for the nutritional status, and moisturizing sacral skin are all strategies that can be applicable in preventing pressure ulcers.” This new evidence occurred in a journal by studying a case of 39 RCT’s which had to be selected and categorized into three groups.
This article is a review that was conducted by the authors for the description of evidence which is at hand in regards to treatment and prevention. This is used to formulate the recommendations for research and clinical practice. Patients who have incontinence are fond to have issues to deal with dermatitis. This kind of challenges becomes a hindrance to practitioners and professionals. They find it difficult to maintain a healthy skin to victimized patients. “The data sources were retrieved from Cochrane, PubMed, PubMed, the, Embase, Allied Health Literature and Cumulative Index to Nursing, conference proceedings and reference lists in September 2008,” (Beeckman, Schoonhoven, Verhaeghe, Heyneman, & Defloor, 2009). There is a possibility of development which includes these terms. There is no requirement for a study design for a section in line with the characters which are explosive and with a scarce literature. The authors were able to place 36 publications which deal with 25 studies. The authors suggested the use of moisturizers for skin cleansing. This is an implementation of perineal skin. “Patients who are considered to have a high risk of incontinence that is associated with dermatitis are recommended to have a skin protectant.” (Beeckman et al., 2009). It is preferable to use ointments rather than water for the skin. “After every episode and stage of incontinence the care of the skin is usually suggested in particular when faeces are present.” (Beeckman et al., 2009). Thus, it is stated that incontinence can be avoided if the skin is protected and cleaned in time (Beeckman et al., 2009).
Discussion
The above article is a review on the quality improvements and interventions concerning pressure ulcers. This is a systematic review concerning nurse focus-intervention that is conducted in a hospital setting. This informs evidence that is based on implementations concerning the prevention programs of pressure ulcers. This article has little evidence concerning intervention and successful integration despite of the published guidelines that are available. “The two previous literature syntheses on PU prevention have included articles from multiple settings but have not focused specifically on QI (quality improvement).” (Lynn, et al., 2011, p. 245). The article is containing six electronic database searches for publications which were conducted between the years 1990 January to 2009 September (Lynn, Hempel, Munjas, Miles, & Rubenstein, 2011). The authors found that 39 studies were able to meet the criteria. A majority of them used a study guide known before and after through a single site. Some of the intervention strategies included the combination of quality improvement strategies and specific changes in pressure ulcers. By going through every study, the authors were able to come to a conclusion that there was a positive effect with those interventions. It will be possible to build a future research on the basis of implementation through increased emphasis on understanding the mechanisms. This proved that the outcome could be able to describe and achieve the appropriate conditions under specific intervention strategies which were likely to fail or succeed.
The article contains the methods of preventing pressure ulcers. It begins by defining a pressure ulcer which is a common problem for patient settings. The article involves the outcomes of adverse health and the costs of high treatments. The objective of the authors is to analyse and review the kinds of evidence that examine interventions for the prevention of pressure ulcers (Reddy, Rochon, & Gill, 2006). The sources for the research carried in the article are retrieved from Embase, Medline, and Cinahl. These were incepted from the Cochrane databases in the year 2006. They were searched, identified, made relevant and random through (RCTs) randomized controlled trials. There was a search for UMI, which is Proquest Digital Dissertations, and Cambridge Scientific Abstracts and includes ISI Web for Science. Almost all the researchers used the same terminology like pressure sore, pressure ulcer, bedsore, prophylactic, prevention, randomized, reduction, decubitus, and clinical trials. There was more review on references of articles that were identified. There was a selection of fifty-nine RCTs. The analysis of the cure was done on the particular subjects, thus, the authors were able to compile them into three categories, which include the ones that address impairments towards movement, skin health, or nutrition (Reddy, Rochon, & Gill, 2006). The quality of method and means which were used for RCTS were general suboptimal variables. “Effective strategies that addressed impaired mobility included the use of support surfaces, mattress overlays on operating tables, and specialized foam and specialized sheepskin overlays.” (Reddy, Rochon, & Gill, 2006, p. 974). Through this, there are few evidences for the specific recommendation and turning regimens when it comes to patients who have impaired mobility. Supplements become a benefit to patients with poor nutritional and dietary supplements. “The incremental benefit of specific topical agents over simple moisturizers for patients with impaired skin health is unclear.” (Reddy, Rochon, & Gill, 2006, p. 974). According to the results of the article (Reddy, Rochon, & Gill, 2006), repositioning the patient, usage of support surfaces, moisturizing sacral skin and optimizing nutritional status are the strategies that are appropriate for the prevention on pressure ulcers (Reddy, Rochon, & Gill, 2006). “Although a number of RCTs have evaluated preventive strategies for pressure ulcers, many of them had important methodological limitations.” (Reddy, Rochon, & Gill, 2006, p. 974). In the article, there is a requirement for well-designed RCTs which follow a standard criterion for the report of non-pharmacological interventions. This created the formation of data provision towards cost effectiveness along with the interventions.
The following article written by Spark deals with the incontinence and its association with skin disease. The author begins defining the types of urinary that are involved in incontinence. They include functional, overflow, urge and stress. She also describes the skin types that may be involved in altering the life of an elderly person. The article majors on management and prevention of skin issues and functional incontinence, pressure ulcer and dermatitis (Sparks, 2011). Spark defines incontinence and provides the means of management and prevention. Incontinence is a frustrating, potentially disabling common condition that affects the elderly (Sparks, 2011). As aging is not the main reason for incontinence, urinary incontinence prevalence is the highest in terms of care facilities and reasons for institutionalization. All four urinary types of incontinence have their own symptoms. Stress incontinence results in loss of urine and an increase in abdominal pressure. Overflow incontinence is caused as a result of urinary retention in the function of the bladder. “Urge incontinence produces inability to delay voiding after sensation of fullness.” (Sparks, 2011, p. 22). Finally, functional incontinence is compared to cognitive function or impaired physical, environmental barriers or unwillingness. The author explains that there are various types of interventions that may assist in the prevention of urinary incontinence. These interventions include faecal impaction, prevention of urinary tract infection, heart failure and diabetes mellitus, reduction of diuretic fluids, correction of hypercalemia, avoidance of chemical or physical restraints and medication management that may cause urinary incontinence.
The above mentioned authors of the article were involved in a multinational group which should have had to evaluate and review a research that examined IAD incontinence associated with dermatitis. The study implements the knowledge into the best practical recommendation on the existing evidence. In this article, the authors reveal information which consists of evidences that may provide insight into pathophysiology, etiology and epidemiology of IAD. In the article, they were able to identify a research which supports the use of skin care that is defined based on principles which are application of skin protectants, miniaturization, and gentle perineal cleansing. The article also indicates that clinical experience supports applications with faecal incontinence, a high use of anti-inflammatory products in special cases, urinary aggressive containment, and crème having cutaneous candidiasis, and ointment. Due to the study conducted, the researchers were able to come up with a conclusion that research would remain limited and there was an urgent requirement of additional studies that would enhance the understanding of IAD (Gray, Beeckman, Bliss, Fader, Logan, Junkin, Selekof, Doughty, D & Kurz, 2012). This would create an establishment of evidence which was based on protocol for its treatment and prevention.
This article contains a definition of perineal skin breakdown, problems that are encountered in the community concerning IAD, a case study of Mrs Smith, as well as treatment and prevention of IAD. The authors start with defining what IAD is stating that it is referred to as a clinical manifestation of moisture that is associated with skin damage. They continue to explain that it is a known problem which is common to patients who are dwelling in the community. Nurses in the society have had a very significant challenge with the management of IAD, urinary incontinence, and patients with faecal (Beeckman, Woodward, & Gray, 2012). This calls for a need to empower nurses to be able to handle such conditions. The purpose for writing the article is focused on the provision of brief updates concerning the treatment and prevention of IAD. It also examines the difference between pressure ulcers and IAD, as well as pathophysiology of IAD (Beeckman, Woodward, & Gray, 2012).
Conclusion
The elderly people are tend to get infected with IAD and IU. These conditions can be treated due to some interventions that are effective to the patient. The kind of intervention that requires to be implemented is repositioning the patient and moisturizing the skin using cleansers. The case study of Mrs Smith and the damage of her skin are also disappointing because it turns out that the community nurses are unable to handle cases of pressure ulcers and incontinence. There is a need for improvement of level of the courses the nurses take. The health practitioners should be able to handle such conditions considering the frequency they affect the elderly. The gap in this research reveals more evidences that ought to be applied to support the policy and procedures. Are there other possible cases where someone who is young has experienced symptoms of pressure ulcers and incontinence? In relation to the PICO question, the two conditions of incontinence and pressure ulcers are treatable and can be detected soon enough to avoid permanent damage. The findings and the evidences that are retrieved from the nursing profession are based on facts and real life research. Nurses are the people who spend a lot of time with the patients, so they are able to monitor any changes that may occur. It is also easy for them to follow up on any proceedings because of their capability to translate and interpret the guidelines that are on the bedside. The nursing field requires a lot of accuracy in writing. Perfection on writing the correct format ensures that no mistakes are done and guarantees that one understands the importance of writing. This is not only significant in formatting but also reporting. This is applicable in chart and reports, which have to be done in the correct way. The interactions that are made with the patients and doctors have to be done fairly. Professional writing is important in nursing because as a situation occurs, one has to be able to manage the recorded information.
References
Beeckman, D., Schoonhoven, L., Verhaeghe, S., Heyneman, A., & Defloor, T. (2009). Prevention and Treatment of Incontinence-Associated Dermatitis: Literature Review. Journal of Advanced Nursing 65(6), 1141–1154.
Beeckman, D., Woodward, S., & Gray, M. (2012). Incontinence-Associated Dermatitis: Step-by-step Prevention and Treatment. British Journal of Community Nursing 16(8), 382-389.
Gray, M., Beeckman, D., Bliss, D.Z., Fader, M., Logan, S., Junkin, J., Selekof, J., Doughty, D., & Kurz, P. (2012). Incontinence-Associated Dermatitis: A Comprehensive Review and Update. The Wound, Ostomy and Continence Nurses Society 39(1), 61-74.
Lynn, M., Hempel, S., Munjas, B.A., Miles, J., & Rubenstein, L.V. (2011). Preventing Pressure Ulcers in Hospitals: A Systematic Review of Nurse-Focused Quality Improvement Interventions. The Joint Commission Journal on Quality and Patient Safety 37(6), 245-252.
Reddy, M., Rochon, P. A., & Gill, S.S. (2006). Preventing Pressure Ulcers: A Systematic Review. Clinician’s Corner 296(8), 974-984.
Sparks, M. (2011). Incontinence and Associated Skin Care. Long Term Living Magazine, 22-25.
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