Pressure ulcers are injuries occurring on the skin surface, due to prolonged exertion of pressure on the skins surface. Mostly, pressure ulcers occur on a bodys bony areas, heels, hips, ankles as well as tailbone. Pressure ulcers occur mostly in a hospitals intensive care department. They are also prevalent among patients admitted in the USA acute care hospital systems. This is a doctoral reflection that aims at providing a comprehensive information pertaining the development and interventions of pressure ulcers in the USA acute care hospital systems. This reflection addresses the AACN Essentials (2006) that are relevant to advanced nursing practice proficiencies for the DNP-prepared nurses.
The Hospital Acquired Pressure Ulcers (HAPU) is the most common form of pressure ulcers that affects patients admitted in a hospital ICU department. Although patients of all ages can develop HAPU, aging patients are most susceptible to the condition (Worsley, Smith, Schoonhoven, & Bader, 2016). Such patients with HAPU have sore skins with painful blisters and abrasion. In most cases, such injuries are evidenced on a patients body surface that is in most contact with the operating table or bed. So as to treat the HAPU, there are various diverse and culturally sensitive approaches that are effective remedies for the condition. Such include the use of antibiotics, creams and ointments, debridement, surgery, and maggot therapy among others. Nevertheless, the most effective approach that is employed by patients from diverse backgrounds is the use of special mattresses in the ICU departments.
In a science publication authored by Pagnamenta (2017), provisioning of therapy mattresses and repositioning of the mattresses among hospitalized patients is among the most effective strategies for preventing HAPU (Pagnamenta, 2017). The use and changing of the positioning of special mattresses in the ICU department are also among the most effective therapeutic intervention that can be employed in treating and preventing pressure ulcers. This intervention can also be employed to relieve pressure exerted on the grade one and two pressure ulcers among HAPU patients. This intervention can be supported by a scientific review conducted by Zuo and Meng (2015) that supported the repositioning of patients and special mattresses as an effective pressure ulcers intervention strategy (Zuo & Meng, 2015).
Developing sustaining therapeutic relationships with patients suffering from HAPU is among the best ways that medical practitioners can employ to attain optimal care and improved patient outcome. This phenomenon can be supported by a publication authored by Cano, et al. (2015) that illustrated how a multidisciplinary process improvement program was employed to enhance care delivery among HAPU patients. The program also improved the level of the patient outcomes tremendously. Through the process improvement program, the nursing staff replaced the inpatient's beds of HAPU patients with therapeutic relationship strategies (Cano, et al., 2015). Such strategies included the nursing supported turning schedules and self-remedying wound bandaging strategies for the patients (Cano, et al., 2015).
Although there are different strategies that can be employed as interventions for HAPU treatment, the repositioning of bedridden patients is arguably the most effective. Medical practitioners can implement this intervention by fostering a good relationship with the affected HAPU patients. Some of the effective repositioning tips that such medical practitioners can employ include adjusting the level of admitted patients beds, selecting and using special mattress and cushions for HAPU patients and advising the HAPU patients to shift their weight regularly. This intervention can be supported by an intervention authored by Gillespie, et al. (2014), which was a summary of a study conducted to determine the effect of repositioning on pressure ulcers prevention among adults.
The findings of the study supported the repositioning intervention to be among the most effective HAPU prevention intervention used in most medical facilities (Gillespie, et al., 2014). Additionally, according to a publication authored by Kallman (2015), repositioning of immobile elderly patients is a recognized and important nursing practice (Kallman, 2015). The publication was a summary of a quantitative research conducted that focused on determining the level of usage of the repositioning intervention strategy among elderly patients. Additionally, using this intervention is cost-effective in comparison to other HAPU intervention strategies like using antibiotics. Moreover, some of HAPU patients can administer the procedure themselves without relying on the assistance of the nursing practitioners at the medical facilities.
Additionally, the effectiveness of the usage of patient repositioning strategy can be supported by research conducted by Peterson, Gravenstein, Schwab, and Caruso (2013). The findings of the research portrayed that the repositioning of patients helps in preventing the development of pressure ulcers among patients (Peterson, Gravenstein, Schwab & Caruso, 2013). However, the researchers stated that the repositioning intervention strategy should be accompanied by a practice aimed at relieving the at-risk tissues among patients at risk of attaining HAPU (Peterson, Gravenstein, Schwab & Caruso, 2013). As such, from these research studies, it is evident that the repositioning intervention for hospitalized patients can be immensely effective in treating and preventing the development of the HAPU.
Moreover, there is need to guide, mentor and support other nurses in the medical profession. Additionally, to attain excellence in implementing the proposed intervention strategies for managing HAPU among hospitalized patients, it is essential for the nurses responsible for the intervention to fulfill the AACN essentials. According to the AACN Essential-I provide a framework for scientific underpinnings for the nursing practice (AACN, 2016). In this essential, the practice of doctorate in the nursing profession will offer the DNP students the terminal academic preparation useful to implement various healthcare interventions in the nursing practice. According to AACN Essential II, DNP graduates must be able to uphold the organizational as well as systems leadership to improve quality and systems thinking (AACN, 2006). This is primarily because both the organizational as well as systems leadership are imperative in improving the level of patients as well as healthcare outcomes.
Moreover, the DNP graduates must uphold Essential III that advocates for the usage of the clinical scholarship as well as the analytical strategies for implementing evidence-based practice (AACN, 2006). By honoring the AACN Essential III, the DNP nurses can be in a position to translate the medical research on the best intervention strategies for HAPU into practice (AACN, 2006). Moreover, they will be in a position to disseminate as well as integrate the newly acquired knowledge on HAPU treatment into practice. Additionally, in guiding, mentoring as well as supporting other nurses, the AACN Essential IV should also be employed. This essential advocate for the usage of patient care technology for the improvement as well as the transformation of the healthcare services in the medical sector (AACN, 2006).
Additionally, the AACN essential VIII offers the DNP nurses the knowledge as well as ability to improve both the health and wellness to their team and public members (Ahmed & Davis, 2012). This is through the provision of an advanced level of care as well as knowledge. As such, the DNP nurses will be able to employ conceptual as well as analytical skills in evaluating the varying links that exist in populations, fiscal, policy and organization issues in the nursing practice (Barker, 2012). Consequently, the DNP nurses can then use the acquired skills to mentor other nurses in the nursing practice so as to achieve an overall nursing excellence. As such, from the acquired knowledge and skills derived from the DNP training and practice, it is evident that there subsists a link between various research on the best treatment interventions for HAPU. Most research supports the effectiveness of repositioning of patients and use of special mattresses as effective pressure ulcers intervention strategy. Additionally, different research also portrays that the adult population - particularly the aging are the mostly affected persons by the HAPU.
In conclusion, the AACN Essentials (2006) are relevant to advanced nursing practice proficiencies for the DNP-prepared nurses. The nursing educators can use the AACN Essentials as effective guidelines for guiding, mentoring and supporting the DNP graduates. Additionally, pressure ulcers are injuries that occur on the skins surface as a result of a prolonged exertion of pressure on the affected section. Moreover, there are numerous intervention strategies that can be employed to treat and prevent the occurrence of HAPU among patients. Nevertheless, the use of repositioning and special mattress strategies are the most effective strategies for managing the occurrence of HAPU.
AACN. (2006, October). The Essentials of Doctoral Education for Advanced Nursing Practice. American Association of Colleges of Nursing: Advancing Higher Education In Nursing, 1-27.
Ahmed, S., & Davis, S. (2012). DNP Education, Practice, and Policy: Redesigning Advanced Practice Roles for the 21st Century. New York: Springer Publishing Company.
Barker, A. M. (2012). Advanced Nursing Practice. Burlington: Jones & Bartlett Publishers.
Cano, A., Anglade, D., Stamp, H., Joaquin, F., Lopez, J. A., Lupe, L., . . . Young, D. L. (2015, September). Improving Outcomes by Implementing a Pressure Ulcer Prevention Program (PUPP): Going Beyond the Basics. Healthcare (Basel), 3(3), 574-585. doi:10.3390/healthcare3030574
Gillespie, B. M., Chaboyer, W. P., Mclnnes, E., Kent, B., Whitty, J. A., & Thalib, L. (2014, April 3). Repositioning for pressure ulcer prevention in adults. The Cochrane Database of Systematic Reviews(4). doi:10.1002/14651858.CD009958.pub2.
Kallman, U. (2015). Evaluation of Repositioning in Pressure Ulcer Prevention. Linkoping University Medical Dissertations: Division of Nursing Science Department of Medical and Health Sciences Linkoping University, Sweden(1455), 3-81.
Pagnamenta, F. (2017, March 23). The Provision of Therapy Mattress For Pressure Ulcers Intervention. British Journal of Nursing, 26(6), 28-33. doi:10.12968/bjon.2017.26.6.S28
Peterson, M. J., Gravenstein, N., Schwab, W. K., & Caruso, L. J. (2013). Patient repositioning and pressure ulcer riskMonitoring interface pressures of at-risk patients. Journal of Rehabilitation Research and Development, 50(4), 477-488. doi:10.1682/JRRD.2012.03.0040
Worsley, P. R., Smith, G., Schoonhoven, L., & Bader, D. L. (2016, March 16). Characteristics of patients who are admitted with or acquire Pressure Ulcers in a District General Hospital; a 3 year retrospective analysis. Nursing Open, 3(3), 152-158. doi:10.1002/nop2.50
Zuo, X.-L., & Meng, F.-J. (2015, December). A Care Bundle for Pressure Ulcer Treatment in Intensive Care Units. International Journal of Nursing Sciences, 2(4), 340-347. doi:10.1016/j.ijnss.2015.10.008
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