Minimizing Hospital-Acquired Pressure Ulcers

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Table of Contents

Introduction
Brief Literature Review
Describing the Case from a Theoretical Perspective
Explaining the Synthesized Literature Findings
Summary of the Case
Proposed Solutions
Identifying a Data Collection Instrument
Conclusion
References

Introduction

It is worth mentioning that the medical environment provides healthcare professionals and patients with numerous safety issues. It is so because treating one condition can subject individuals to experiencing harmful effects of other phenomena. That is why sufficient attention should be drawn to identifying potential safety issues and offering specific interventions to improve the situation. Thus, hospital-acquired pressure ulcers (HAPUs) are widespread among numerous patients because a set of prerequisites contributes to this state of affairs. Consequently, this case report will consider safety concepts to comment on pressure injuries within the healthcare setting and recommend a practical intervention to minimize the issue’s harmful impact.

Brief Literature Review

To begin with, one should explain why and whether it is rational to consider HAPUs a safety issue. According to Ismail (2017), patient safety relies on six components, and they are “state policy, diagnosis, medications, surgical operations, infections, and injuries” (p. 592). It means that all the infections, surgical operations complications, and various injuries refer to safety. That is why there is no doubt that pressure injuries should be considered a safety concept.

Furthermore, numerous scholarly and peer-reviewed articles focus on HAPUs, and it is reasonable to locate them to understand the problem. Sharp et al. (2019) mention that pressure injuries are a widespread safety issue among aged individuals. This condition develops when patients spend much time lying or sitting. Furthermore, the scholars even explain that attempts to address the problem can result in drawbacks, threatening patient safety (Sharp et al., 2019). Simultaneously, Lam et al. (2018) stipulate that “1 to 3 million people in the US develop pressure ulcers each year” (p. 1122). These researchers admit that comprehensive interventions are necessary to address the situation and lead to a decreased incidence of the condition. That is why they offer a novel 7-step strategy to impact patients with HAPUs and improve their safety (Lam et al., 2018). This literature indicates that pressure injuries obtain attention in the research field.

Simultaneously, it is a typical case that systematic reviews analyze the issue under consideration and comment on existing preventive measures. For example, Mäki‐Turja‐Rostedt et al. (2019) stipulate that HAPUs are both the cause of suffering for patients and a significant financial burden for the entire medical industry. That is why these scientists have attempted to identify the effectiveness of various interventions. These authors comment on the use of repositioning, specific mattresses, and advanced cushions and conclude that positive outcomes are achieved from using advanced beds or modifying patients’ dietary intake (Mäki‐Turja‐Rostedt et al., 2019). It denotes that healthcare professionals can choose among numerous actions to address the situation.

Other studies also indicate that HAPUs is a severe issue that cannot be mitigated with a single intervention. In particular, Gaspar et al. (2019) admit that prophylactic dressings, system reminders, support surfaces, repositioning, pressure mapping, and others are leading preventive measures that can improve patient safety within the hospital context. The scholars also argue that single interventions are not typically useful, meaning that a comprehensive approach is necessary (Gaspar et al., 2019). This systematic review has demonstrated that pressure injuries significantly impact patient safety, denoting that healthcare professionals should implement multi-faceted interventions to protect individuals from the issue.

Describing the Case from a Theoretical Perspective

In the beginning, one should explain why it is reasonable to rely on a particular theory in addressing the safety issue of HAPUs. The rationale is that a theoretical perspective offers background information regarding what steps are necessary to implement change and achieve positive outcomes. It is so because theories present synthesized data based on previous attempts to investigate a phenomenon and how various actions impact it.

Jean Watson’s Human Caring Theory seems an appropriate option when it comes to addressing the issue under investigation. Wei and Watson (2019) stipulate that “Watson’s Human Caring Theory is widely used to guide nursing education, practice, and research internationally” (p. 17). This quote demonstrates that a healthcare issue can be considered through the lenses of three areas. Each of them is significant, but it is reasonable to admit the importance of education because this domain helps stakeholders obtain the required information to refrain from harmful activities or engage in healthy behaviors. That is why the theory implies that both caregivers and patients should participate in appropriate educational interventions to improve their knowledge regarding the issue.

It is necessary to draw sufficient attention to the role of education in this theoretical perspective. For healthcare professionals, it is impossible to overestimate the significance of life-long improvement in their skills, experience, and knowledge. It is so because participating in a continuous improvement process allows these workers to sophisticate their practice and research approaches, which, in turn, leads to a better medical industry. Simultaneously, educational activities are also equally essential for patients and their family members. This claim relies on the idea that better knowledge results in the fact that individuals are more willing to engage in the right behaviors. For example, when people are sufficiently educated, they tend to abide by doctors’ recommendations regarding taking medicine. On the contrary, poorly educated patients typically fail to follow the prescribed treatment guidelines, which harmfully affects their health. This idea is relevant to HAPUs because patients’ involvement and participation are of significance to protect them from this safety issue.

It is also worth mentioning that Watson’s Human Caring Theory relies on two essential aspects. Firstly, loving-kindness for self and others is of importance in the healthcare setting (Wei et al., 2021). This phenomenon focuses on establishing a trustworthy and productive relationship between a medical professional and a patient. Secondly, Wei et al. (2021) clarify that a moment of caring is essential because it allows healthcare workers to understand patients and their subjective attitudes. The combination of these two aspects results in the fact that the given theoretical perspective leads to positive outcomes regarding patient safety.

Explaining the Synthesized Literature Findings

A detailed discussion of the synthesized literature findings is necessary to identify what themes are found in the research field concerning the issue under analysis. This activity will reveal whether sufficient attention is drawn to pressure injuries in the modern medical industry. That is why the following paragraphs of this section will present the leading themes that have been located from gathered literature findings on the topic.

The first theme refers to the place of HAPUs in healthcare. The study by Lam et al. (2018) represents this topic because the authors clarify that one-third of the US population suffers from this problem. It denotes that a significant portion of US patients deals with reduced safety. Simultaneously, Sharp et al. (2019) explain that the problem affects specific population groups more severely. It relates to the claim that the elderly are more subject to experiencing HAPUs compared to young individuals (Sharp et al., 2019). Even though there are some preferences, one should admit that representatives of all age groups and clinical settings can suffer from the safety issue under review.

Numerous approaches to addressing HAPUs represent the second essential theme. Today, healthcare professionals can choose among multiple interventions and Mäki‐Turja‐Rostedt et al. (2019) comment on a few of them. The researchers consider the effectiveness of repositioning, mattresses, cushions, and a healthy diet (Mäki‐Turja‐Rostedt et al., 2019). Gaspar et al. (2019) also draw attention to these measures and focus on additional interventions. It refers to reminder systems and educational interventions that should improve healthcare professionals’ awareness of the problem and the necessity to address it (Gaspar et al., 2019). It is worth mentioning that the two studies indicate that widely-accepted repositioning techniques lack effectiveness when used in isolation.

The third theme does not have a direct relation to HAPUs and their prevention measures. However, it offers theoretical concepts that are necessary to identify whether and how it is possible to influence the problem under investigation. Thus, the given theme focuses on Jean Watson’s Human Caring Theory. Wei and Watson (2019) present general information regarding this theoretical perspective. This evidence is required to understand whether there is a connection between pressure injuries and the given theory. In turn, Wei et al. (2021) comment on what components are included in the perspective, and this information demonstrates why it applies to the given case.

Summary of the Case

The information above allows for creating a transitional summary of the case. Firstly, sufficient evidence reveals that the entire healthcare industry suffers from HAPUs. Patients of various ages and representatives of different clinical settings are subject to pressure injuries if they are forced to spend much time sitting or lying in the same position. This fact explains why numerous scholarly and peer-reviewed studies are devoted to this problem.

Secondly, one should admit that the research field understands the importance of this issue, which explains why many articles consider HAPUs prevention measures. The case under analysis has demonstrated that the existing solutions are compared, and medical professionals’ task is to choose the most optimal variants. The most significant finding relates to the fact that traditional repositioning interventions are not sufficiently effective, while Sharp et al. (2019) even admit that this strategy decreases patient safety. That is why the given summary should articulate that it is a significant challenge to find an efficient preventive action course.

Finally, the identified theoretical perspective has provided useful information to cope with the task above. It refers to the fact that Jean Watson’s Human Caring Theory stipulates that education, practice, and research are mutually related phenomena that can affect safety. Furthermore, the given theoretical concept focuses on loving-kindness and establishing trustworthy relationships between patients and their caregivers. This summary allows concluding that it is reasonable to invest in promoting education among both patients and healthcare professionals. The reasoning behind this suggestion is that sophisticated education will enable the stakeholders to improve mutual understanding. If this occurs, there is an opportunity that the relationships will become better, contributing to loving-kindness in the clinical setting. That is why the following section will comment on the proposed solutions to address the identified inefficiency.

Proposed Solutions

The information above has already clarified that a single intervention is not typically sufficient to address the safety issue of HAPUs. This finding means that it is necessary to implement a comprehensive approach to solve the problem and achieve positive outcomes. That is why the following paragraphs will present a detailed overview of the proposed solution by focusing on separate interventions that are necessary to achieve the desired goal. The recommendations will be given based on Jean Watson’s Human Caring Theory.

Firstly, the theoretical perspective under consideration admits the significance of education. It means that any safety issue can only be addressed if an intervention relies on educational measures. As for pressure injury prevention, both healthcare professionals and patients should involve in improving their knowledge and experience. Thus, Suva et al. (2018) admit that inter-professional teams can only deal with optimal HAPU management if they participate in specifically tailored education. The scholars stipulate that positive outcomes are achieved when medical staff is involved in e-learning “with technical support and the use of high-quality wound pictures” (Suva et al., 2018, p. 580). It indicates that promoting additional resources is useful in improving education effectiveness. Simultaneously, patients’ knowledge should also be improved to deal with pressure injury prevention. Robineau et al. (2019) focus on this issue and investigate whether regular discussion concerning HAPU prevention and workshops to transfer this knowledge to real-life situations lead to positive outcomes. The authors’ evidence demonstrates that such an educational program has a positive impact (Robineau et al., 2019). These data indicate that it is reasonable to rely on education when it comes to pressure injury prevention.

Secondly, one should admit that improving knowledge is not sufficient to prevent HAPUs. That is why specific practice actions and steps are necessary to increase patient safety and protect them from pressure injuries. Numerous scientific studies offer empirical evidence regarding the effectiveness of different interventions. Lam et al. (2018) stipulate that a decrease in HAPU incidence rates is possible when healthcare professionals rely on multiple steps. They include mandatory 2-hourly repositioning, improved diets, pressure-reducing beds, and others (Lam et al., 2018). Simultaneously, Gaspar et al. (2019) also admit the effectiveness of numerous interventions, including “prophylactic dressing, support surfaces, repositioning,” and others (p. 1087). These interventions represent a comprehensive approach since they address both internal and external safety issues.

Finally, since the theoretical perspective highlights the importance of research, it is reasonable to comment on this issue regarding the proposed solutions. It is worth mentioning that the research field is the source of information that is necessary for identifying effective interventions. Consequently, empirical evidence from credible articles has been located and analyzed to offer the most useful interventions, including repositioning, support surfaces, and modified nutrition. Thus, this information demonstrates that the proposed solutions conform with Jean Watson’s Human Caring Theory because they address education, practice, and research. That is why it is possible to suppose that the interventions under review can result in positive outcomes regarding patient safety. However, a more detailed explanation of how to evaluate the solutions is required.

Identifying a Data Collection Instrument

When it comes to evaluating the proposed solutions, it is necessary to find a useful data collection instrument. Vonnes and Wolf (2017) clarify that any HAPU prevention activities focus on several falls and consecutive injuries. That is why it is reasonable that the evaluation process should involve calculating such occurrences within a specific medical setting. It seems that the data collection instrument of observation can be an optimal choice in this case. It is so because this approach is ideal for having “an in-depth and extensive understanding of a complex reality” (Queirós et al., 2017, p. 372). This non-experimental method implies watching individuals in their environment to identify how it influences their behavior, decisions, and health outcomes. Furthermore, the evidence by Queirós et al. (2017) reveals that this research instrument is a flexible approach to accumulating required knowledge. That is why it is possible to rely on observations to identify whether the proposed solutions will reach the expected improvements.

In addition to that, one should comment on the recommended instrument’s evaluation to identify whether it is reasonable to rely on it. Its essential benefits have already been presented in the previous paragraph. That is why it is necessary to admit that the instrument also implies some challenges. For example, Queirós et al. (2017) claim that this method is time-consuming and requires significant preparation to generate valuable results. Moreover, the instrument’s reliability essentially depends on observers’ impartiality (Queirós et al., 2017). These data indicate that evaluating the tool implies focusing on both advantages and disadvantages. It is necessary to identify and compare them to find whether the given approach is suitable for the case under analysis.

Conclusion

The case report has presented valuable commentaries regarding the presence of hospital-acquired pressure ulcers in the healthcare environment. According to the evidence from scholarly and peer-reviewed articles, these health conditions are widespread in the medical industry, affecting numerous patients of different ages and from various settings. Since pressure injuries endanger patient safety, it is evident that appropriate measures are necessary to address the situation and protect individuals. In the beginning, a proper theoretical perspective has been located. Jean Watson’s Human Caring Theory mentions that it is possible to address patient safety issues by relying on education, practice, and research. That is why it was decided to propose specific solutions that will lead to pressure injury prevention through these three domains.

The empirical evidence provides sufficient information to propose possible solutions and predict their effectiveness. Thus, research data have been accumulated and synthesized to conclude that suitable interventions include education programs, repositioning, improved nutrition, and pressure-reducing beds. All these steps introduce a comprehensive approach to the problem. It is so because educational measures promote increased pressure ulcer prevention skills and knowledge among the involved stakeholders. Simultaneously, practice interventions minimize this safety issue’s impact by affecting internal and external threats. Since the proposed solutions rely on the theoretical perspective, there is an increased probability that positive outcomes will be achieved.

Finally, the case report has justified the use of observation as a data collection instrument to assess the proposed interventions. This method is appropriate because it allows for identifying how many pressure injuries occur, which is the leading indicator of any prevention measures. Empirical evidence has also revealed that this method implies advantages and drawbacks, meaning that observers should consider them while deciding whether to rely on observations. Thus, the given instrument could be evaluated by focusing on its strengths and limitations.

References

Gaspar, S., Peralta, M., Marques, A., Budri, A., & de Matos, M. G. (2019). Effectiveness on hospital-acquired pressure ulcers prevention: A systematic review.International Wound Journal, 16(5), 1087-1102. Web.

Ismail, M. N. b. I. (2017). Patient safety and its components. Patient Safety & Quality Improvement Journal, 5(4), 592-593.

Lam, C., Elkbuli, A., Benson, B., Young, E., Morejon, O., Boneva, D., Hai, S., & McKenney, M. (2018). Implementing a novel guideline to prevent hospital-acquired pressure ulcers in a trauma population: A patient-safety approach. Journal of the American College of Surgeons, 226(6), 1122-1127. Web.

Mäki‐Turja‐Rostedt, S., Stolt, M., Leino-Kilpi, H., & Haavisto, E. (2019). Preventive interventions for pressure ulcers in long-term older people care facilities: A systematic review.Journal of Clinical Nursing, 28(13-14), 2420-2442. Web.

Queirós, A., Faria, D., & Almeida, F. (2017). Strengths and limitations of qualitative and quantitative research methods.European Journal of Education Studies, 3(9), 369-397. Web.

Robineau, S., Nicolas, B., Mathieu, L., Duruflé, A., Leblong, E., Fraudet, B., Gélis, A., & Gallien, P. (2019). Assessing the impact of a patient education program on pressure ulcer prevention in patients with spinal cord injuries. Journal of Tissue Viability, 28(4), 167-172. Web.

Sharp, C. A., Schulz Moore, J. S., & McLaws, M. L. (2019). Two-hourly repositioning for prevention of pressure ulcers in the elderly: Patient safety or elder abuse?Bioethical Inquiry, 16(1), 17-34. Web.

Suva, G., Sharma, T., Campbell, K. E., Sibbald, R. G., An, D., & Woo, K. (2018). Strategies to support pressure injury best practices by the inter-professional team: A systematic review.International Wound Journal, 15(4), 580-589. Web.

Vonnes, C., & Wolf, D. (2017). Fall risk and prevention agreement: Engaging patients and families with a partnership for patient safety.BMJ Open Quality, 6(2), 1-4. Web.

Wei, H., Hardin, S. R., & Watson, J. (2021). A unitary caring science resilience-building model: Unifying the human caring theory and research-informed psychology and neuroscience evidence.International Journal of Nursing Sciences, 8(1), 130-135. Web.

Wei, H., & Watson, J. (2019). Healthcare interprofessional team members’ perspectives on human caring: A directed content analysis study.International Journal of Nursing Sciences, 6(1), 17-23. Web.

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