Pressure Ulcer Care

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Incorrect or inadequate knowledge of pressure ulcer development and care can prove detrimental or even fatal to our patients as Cherry et al (2006, p. 178) stresses, ‘pressure ulcer incidence remain at a unacceptably high level...this may partly be due to the limited knowledge about the precise mechanisms...our understanding of the basic pathways is less clear, we certainly need a better understanding of the physiological impact’ if we are not fulfilling this need for evidence based practice we are going against the Nursing and Midwifery Councils’ code of conduct stating that ‘You must take part in appropriate learning and practice activities that maintain and develop your competence and performance’. (Nursing and Midwifery council, 2008). One of the biggest consumers of the national health resources both health care related and financially, is pressure ulcer care, with prevalence of hospital acquired pressure ulcers between 2.7% and 29.5%, and figures of those in intensive care being even greater at between 5% and 50%, (Bader et al, 2005). Inevitably this is causing detrimental and even permanent effects on the lives of patients who are put at an increased risk of sepsis and osteomyelitis which have the potential to be life threatening, this leads one to wander if there is fundamental knowledge to be gained in order to reduce the risks of such an injury, the causes and preventions of such pressure ulcers are widely researched and is an ongoing topic of discussion. The aetiology of pressure ulcers is in some parts insubstantial due to the numerous influences that apply to the formation of a pressure ulcer. There are, none the less, a diverse array of contributing factors that have been proven to impair the structure of the skin and disrupt the healing processes, for example heart complications, lack of mobility, nutrition, sensory loss, temperature and age effecting the skins texture and strength. The most significant rationale behind the choice of clinical skill is to assist in the advancement of knowledge base, as Ali & Atkin (2004, p. 103) accurately specify, ‘we need to use our increasing knowledge base to transform service provision and provide better primary care’. As health professionals it needs to be realised that we are a vital link between patients and other specialised health care services, Morison (2001, p. 4) points out the importance of, ‘health care professionals as patient advocates in relation to tissue viability services’, if we do not make it our duty to be knowledgeable of what options our patients have it is impossible to administer care holistically as if our duty as a health care professional. In recent studies it has shown that pressure ulcers are most prominent with surgical patients, research has also shown that the surgical patient develops a pressure ulcer 8 times more than the non surgical patient (Pulskamp, 2007). Interestingly it shows that not only are pressure ulcers observed in older patients but just as often in the younger ago groups, with an increase in occurrence in those who receive neck and head surgeries (Bader et al, 2005), In a study is it is shown that adaptation to the operating table diminished sharply the incidence of pressure ulcer development. Bader et al found that often Pressure ulcers are observed after 2 weeks of being admitted, this then contradicts the theory that ‘pressure ulcers are caused by inadequate nursing care’, this then can only suggest that pressure ulcers develop during an operation, during periods of treatment or during investigations, for example X-ray departments where the mattresses are not adapted to the variety of different patients with a different variety of problems. To reduce occurrence and risk there must be put in place preventative measures in terms of risk assessments but as Pulskamp (2007) points out, ‘There is no validated tool to predict risk of pressure ulcers in the surgical patient’. There are numerous pressure ulcer risk...
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