This essay will focus on a chosen client and how, as a registered nurse, evidenced based practice was implemented to prevent the development of a pressure ulcer, as indicated by National Institute of Clinical Excellence NICE (2005) and European Pressure Ulcer Advisory Panel EPUAP (2009). Important and marked changes have taken place over the last 15years in the development of clinical practice guidance. As Van Zelm et al (2006) noted, the demand for evidence based practice, to determine the effectiveness of healthcare interventions, has seen a move away from consensus of opinion.
The author undertook online literature searches for journals held by Medline, Ovid, Cinahl and the Cochrane databases. Keywords used to facilitate the search were pressure ulcer prevention, pressure ulcer guidelines, pressure sores, wound care, turning, shearing, and assessment, hospital acquired, either independently or in combination. To reduce the literature to workable limits, the author excluded non English language studies, studies over 20 years old and used the literature abstracts to reduce the numbers further and identify relevant articles.
Gebhardt (2002a) identified pressure ulcers as localised, acute ischemic damage to any tissue caused by the application of external force (either shear, compression, or a combination of the two). More recently the European Pressure Ulcer Advisory Panel EPUAP and National Pressure Ulcer Advisory Panel NPUAP (2009) have added their own definitions which have become widely accepted. The EPUAP defines a pressure ulcer as “...an area of localised damage to the skin and underlying tissue caused by pressure, shear, friction, and/or a combination of these.” According to the NPUAP a pressure ulcer is “...localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.” Kottner et al (2009) puts forward the point that “...not all pressure ulcers are pressure ulcers” as shear and friction are not universally accepted as causing pressure ulcer damage. Shear would appear to work alongside compression to cause deep tissue damage whilst friction contributes to superficial skin damage (Kotner et al, 2009).
Several areas have been identified as leading to an increased risk, to a patient, of developing a pressure ulcer; immobility, failure of reactive hyperaemia (tissues ability to recover from ischemic episodes) (Allman et al, 1995), loss of sensation (trauma, congenital or disease process) (Gebhardt, 2002a) and dry sacral skin (Allman et al, 1995; Reddy et al, 2006). Guy (2007) deemed risk factors as being separated into two areas: extrinsic factors - external to the body and can be influenced (continence, mattress type, position); intrinsic factors - within the body and often cannot be influenced (as mentioned above).
Myatt (2004) determined risk to be “the probability or likelihood that harm may occur, coupled with the consequences of that harm.” It can be seen from this single definition, that risk can play a large role in hospital life, and as such risk assessment and management has developed. Potter and Perry (2005) identified risk assessment as the “formal, systematic process in which a range of tools are used to identify an individual’s risk of developing problems.” Holistic assessments take this one stage further, underpinning, effective prevention of pressure sores (European Pressure Ulcer Advisory Panel EPUAP and National Pressure Ulcer Advisory Panel NPUAP, 2009; Guy, 2007; NICE, 2005).
The client chosen was an in-patient on a thoracic surgical ward in a large Manchester teaching hospital. Confidentiality will be maintained throughout in line with The Nursing and Midwifery Council Code of Professional Conduct (NMC, 2004); the client shall be referred to as Zach. A previous biopsy had identified a cancerous tumour in Zach’s right lung, which was to be...