Research Paper on Predicting Pressure Sore Risk: The Braden Scale

Introduction

Patients with hospital-acquired pressure ulcers (HAPU) possess higher mortality. They are more likely to be readmitted for treatment within 30 days after discharge from the hospital where they were initially admitted. The Braden Scale, created in 1987, was used for Predicting Pressure Sore Risk (Mallah, Nassar, & Badr, 2015). The technology has spread over thirty countries, where it assists with the prevention of the condition. The machine used as an assessment tool helps in measuring various factors and calculates the patient's risk associated with pressure ulcer development. Besides, the device is used in conjunction with medical care and other implemented interventions to decrease the development of HAPU. Therefore, coming up with relevant responses will ensure maximum control of pressure ulcers.

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Interventions describe various measures set in place to help prevent and control pressure ulcers. The responses to curb this condition are diverse, including multiple strategies put in place, such as reducing the pressure of the affected with the surface by introducing support surfaces, surgical repair, cleansing, and wound dressing. Introducing intervention agents ensure the victim receives proper healthcare to control more complications that might appear in advanced stages of pressure ulcers (Wilborn & Whitney, 2015). The research focused on the repositioning control method for pressure ulcer prevention. A review question was set to guide through the research process, which stated, "How and at what frequency is repositioning beneficial in preventing pressure ulcers?"

Repositioning of the Patients

Physical inactivity and immobility for long durations, especially for patients in intensive care units, are considered among the significant factors accelerating the development of skin sores. Repositioning is, therefore, viewed as a manual strategy used in the prevention of PU conditions in hospitals. The method involves a process by which regular positioning of the patient in different positions to modify the pressure point. Adjusting the area frequently ensures uniform transportation of oxygen in all the body tissues, thus limiting the development of pressure ulcers. The recommended repositioning frequency traditionally of every 2 to 4 hours has worked effectively as a preventive measure in reducing incidences of pressure ulcers in hospitals. The rate can be traced back to the nursing unit that was used in the Second World War victims. During this period, two soldiers were left the mandate of turning and repositioning their injured colleagues.

The research on the various database, including the Cochrane Wounds Group Specialized Register of 2013, significantly contributed to assessing the effects of turning and repositioning of the patients' schedule. The randomized control trials (RCTs) were also conducted to come up with a comprehensive report on the subject matter. The RCTs included 502 random participants from the acute care setting and exposed to various trails. The trails compared tilt positions of 30 and 90 degrees applying similar repositioning sequence. Later, an alternative repositioning frequency was conducted to compare the effectiveness. It can be applied in trans-theoretical model of behavior change where the patient adopts repositioning to prevent pressure ulcer by sticking to one position for longer durations.

Rationale Background for Repositioning

The research applied a pre and post-test method in collecting data required for the report. Descriptive information about the study history of the various participant was gathered. The process involved inviting the individuals to a repositioning volunteer and review the guidance of different side-lying techniques where a comprehensive report was developed (Gillespie et al., 2014). The present specialized measured turn angles and formulated an assessment on offloading of the hard reputation of the participants.

The repositioning method formed considerable variations in the samples represented. In each case, turn angles decreased as guided by the nurses, but the offloading of the body remained sporadic due to vulnerability to pressure damage. The significance of repositioning for critical conditioned patients is to allow a steady and uniform flow of blood to all parts of the body.

According to the research, the participants with less mobility were subjected to a frequent repositioning pattern reducing to 1.7 hours each (Gillespie et al., 2014). Besides applying this method in most of the medical facilities, and patients receiving the scheduled service, patients with limited movement due to their health condition remains at high risk of developing pressure ulcers. The reason could be, however, not adequately supported. The pressure felt under the skin is not sufficiently relieved hence developing unusual sore, which may eventually lead to ulcers. Therefore, close observation should be introduced to diagnose any sore developing on the skin.

Implementation in a Clinical Settings

Despite the availability of a wide range of guidelines on the patient's repositioning, there remains a challenging factor to apply the intervention method in hospitals. The 2-hourly frequency being a common theme over decades, there is very little proof on the effectiveness (Lyder, 2003). According to a particular trail, the cost of a 2-4-hour spectrum provided a small clinical benefit with a higher cost hence arguing on the method not being most appropriate to apply.

In some cases, the frequency of repositioning is favorable, while in other cases, the patient may require a shorter interval depending on the degree of pressure on the body tissues. Therefore, the clinical setting should provide a frequent checkup on the facility conditions to come up with a relevant frequency favorable to their patients. Besides, some of the victims may feel the pressure before the set interval elapse; hence require special attention; in such cases, nurses should consider individuals' risk factors and attend to him or her immediately. For instance, various clinical guidelines no longer advocate for the 2-hour interval for repositioning e.g., European Pressure Ulcer Advisory Panel 2009 and National Pressure Ulcer Advisory Panel (Lyder, 2003). The two panels base their argument on the condition of the facilities provided to patients and the degree of illness. Hence, they recommend a well-revised interval to avoid complications.

Conclusion

In conclusion, pressure ulcer prevention requires a revised set of interventions to help control the condition. Repositioning, as among those control measures, is an integral component of the prevention process. The method necessitates clear guidance on the turning frequency to ensure positive outcomes. High quality and adequate trails are required to assess the effects of position and the overall frequency of repositioning.

References

Gillespie, B. M., Chaboyer, W. P., McInnes, E., Kent, B., Whitty, J. A., & Thalib, L. (2014). Repositioning for pressure ulcer prevention in adults. Cochrane Database of Systematic Reviews, (4).

Lyder, C. H. (2003). Pressure ulcer prevention and management. Jama, 289(2), 223-226.

Mallah, Z., Nassar, N., & Badr, L. K. (2015). The effectiveness of a pressure ulcer intervention program on the prevalence of hospital acquired pressure ulcers: controlled before and after study. Applied Nursing Research, 28(2), 106-113.

Wilborn, and Whitney (2015). Pressure ulcer prevention strategies. [online] Nursingcenter.com. Available at: https://www.nursingcenter.com/journalarticle?Article_ID=3218713&Journal_ID=417221&Issue_ID=3218692 [Accessed 10 Feb. 2020].