Sunday, September 24, 2023

# Pressure Ulcer Prevention Nurse Teaching

## Sample Size And Sampling Procedure

Arterial Ulcer | Patient Education Series

The sample size was determined by using a single population proportion formula with the assumption of 54.4% Proportion , 95% confidence level and 5% margin of error. Since the source of the population was less than 10,000 , a correction formula was used. Using 10% nonresponse the final sample size obtained was 220. Then, the number of participants in each selected hospital to take a similar proportion of participants were determined using the proportionate population sampling.

## Blood Pressure Teaching 2474

SN instructed patient and caregiver about Blood pressure. According to the American Heart Association, normal blood pressure is anything below 120/80 mm Hg. If these numbers go higher than 120/80 mm Hg, it is often an indication that the heart is working too hard to pump blood through the arteries. High blood pressure, hypertension is when your blood pressure is 140 / 90 mm / Hg or above most of the time Accurate blood pressure readings are important, as high blood pressure may not cause any symptoms until it is dangerously high. Both parties verbalized understanding.

## High Blood Pressure Teaching 2410

SN instructed patient about High blood pressure. Normal blood pressure is when your blood pressure is lower than 120 / 80 mm / Hg most of the time. High blood pressure is when your blood pressure is 140 / 90 mm / Hg or above most of the time. SN explained that the “top number” systolic indicates the pressure in the vessels when the heart beats. The “bottom number” diastolic indicates the pressure in the vessels when the heart is at rest, to between beats. This number is the most concerning number because it tells your medical team the constant pressure on these vessels. Too high can cause damage

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## The Pressure Ulcer Knowledge Assessment Tool

The PUKAT was developed by Beeckman et al. and includes 26 questions and 6 dimensions: etiology and development, classification and observation, nutrition, risk assessment, reduction of the magnitude of pressure and tearing, and reduction of the duration of pressure and shearing. Each question has multiple answers, one of which is correct and the rest are incorrect. The correct answer is given a score of 1 and the incorrect answers are given a score of zero. The overall score and the score of each dimension are reported as a percentage. The final score varies between zero and 26, a higher score indicates more knowledge. Achieving more than 60% of the knowledge score indicates a sufficient level of knowledge .

## Pressure Ulcer Risk Assessment

A person is at risk for pressure ulcers if s/he…

• Is in a bed or chair for eight hours or more excluding sleeping
• Has urine or fecal incontinence
• Has a chronic medical condition
• They already have redness or pain in pressure ulcer areas: such as sacrum, trochanter, scapulae, elbow, heel, inner and outer malleolus, inner and outer knee, back of the head
• Has trouble getting enough calories or fluids every day

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## Relevance To Clinical Practice

• Critical examination of current teaching practice is crucial to address disparity and ensure care for people with darker skin tones is optimised.
• Nurse educators have a responsibility to educate for the care needs of all, as the quality of nurse education has a direct impact on care delivery and health disparity.
• This paper highlights the importance of addressing skin tone diversity and offers the opportunity for reflective practice, not just in formal education, but in clinical settings by preceptors and senior staff.

## Courses Related To Pressure Ulcers

WEB338: Its Just a Stage 1 Pressure Injury. Or is it?Under pressure: just a blanchable event or an underlying injury? It can be much more difficult to distinguish a deeper tissue injury from a stage 1 injury when assessing darker skin tones versus very light skin tones. The National Pressure Ulcer Advisory Panel modified descriptive language from pressure ulcer to pressure injury in 2016. Since skin can look very different based on an individuals skin tone, its important to fortify assessment skills with tips you can use to help prevent missed deeper injuries.

CE743: Diabetic Foot Ulcers Remain a Primary Healthcare ConcernDespite recent improvements in patient access to medical care in the U.S., diabetic foot ulcers continue to be a prevalent health problem. Interprofessional approaches used to manage other diseases have also been shown to help prevent the occurrence of diabetic ulcers. In addition, understanding the pathophysiology of diabetic ulcers to enhance screening and prevention skills, appreciation of the principles of offloading, optimal wound care and adjunct therapies may all contribute to prevention and healing of the vast majority of diabetic foot ulcers. Thus, education of both primary care providers and patients remains of paramount importance.

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## Pressure Ulcer Or Injury Prevention Remains One Of The Most Common And Significant Tasks In Healthcare For Decreasing Harm

Ethically, we want to do no harm. We not only dont want to cause harm, but we also want to avoid harm by preventing conditions like pressure ulcers in the first place. Benjamin Franklins adage, An ounce of prevention is worth a pound of cure, resonates in the healthcare community where we see the outcomes of preventable and unpreventable injuries.

We would much rather prevent injury than watch a patient live through preventable pain, wounds or diagnoses. A paradigm shift is in progress toward education efforts in communities to help people maintain or achieve healthy lifestyles so preventable conditions are avoided.

However, in acute, subacute and chronic environments, we care for patients/clients who have one or many healthcare conditions that put them at risk for injury skin injury in particular.

## Blood Pressure Teaching 2476

Pressure Ulcer Prevention Learning Session

SN instructed patient and caregiver about Blood pressure. When checking blood pressure at home, Use the cuff’s right size for the most accurate reading. Take a few deep breaths and relax for up to 5 minutes before measuring blood pressure do not talk or cross your feet or legs during the test. Measure the blood pressure at a few different times during the day. Patient and caregiver shown correct placement for blood pressure cuff, and is able to return demonstrate home blood pressure monitoring with 100% understanding.

Instructed patient to report to nurse or MD at the first sign or symptom of pressure ulcer formation, for example: redness that remains half an hour after pressure has been removed from area.

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## Strengths And Limitations Of This Study

• Strength of this study was that the study tried to assess the magnitude and factors associated with pressure injury prevention practices among nurses and it can be an input for prevention of pressure injury together with other pocket studies from different corners of the country .

• The study might have faced some limitations such as, nature of the study design, which cannot establish a temporal relationship between the predictors and the outcome variable.

• The study does not assessed nurses knowledge with respect to pressure injury treatment interventions, it only assessed the preventive aspect.

• Socially desirability bias since the study assessed self-reported practice there might be over reported behaviour.

## Skin Tone Variance And Diversity

In all five cases, both in the observation and in the documentary analysis, identification of skin tone diversity in relation to pressure injuries was made. However, the terminology varied, and no specific categorisation of skin tone was made.

All nurse educators presented information regarding people with darker skin tones during the observed classroom teaching either as a question or as the content of a slide in a PowerPoint presentation. In one case, in relation to early skin damage, the phrase âwhatever the colour of the skinâ was used. In another case, cultural variance was loosely associated with diversity after a student asked a question surrounding language barriers and self-reporting. In this instance, the nurse educator referred the student to a television programme regarding culture however, the details provided were not clear. Four out of the five Higher Education Institutions included information on people with darker skin tones within the teaching material and used the terms âdarkly pigmented skinâ and âdark pigmented skin.â

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## Pressure Ulcer Nursing Care Plans

A pressure ulcer is a localized skin injury where tissues are compressed between bony prominences and hard surfaces such as a mattress. They are caused by pressure in combination with friction, shearing forces, and moisture. The pressure compresses small blood vessels and leads to impaired tissue perfusion. The reduction of blood flow causes tissue hypoxia leading to cellular death.

## Student Demographic And Pu Influencing Factors Form

The mean age of the intervention group was 20.69 ± 1.94 years. Of 42 students in the intervention group, 66.7% were female, 97.6% were single, 92.9% were graduates of high schools other than a nursing high school, 100% were not working as a nurse, 92.9% did not have work experience in hospitals, 88.1% did not perform PU care during practicums and 97.6% did not receive education about PUs except for the courses Nursing Principles and Foundations and Surgical Diseases Nursing .

The mean

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## Bone Marrow Teaching 1381

The patient was instructed in bone marrow suppression that will be more susceptible to infection, bleeding, and anemia. The patient was encouraged in the prevention of the infection by eating healthy meals, keep mouth, teeth and gums clean, avoid people who are sick. The patient was encouraged in the prevention of the bleeding avoiding physical activities that could cause injuries. The patient was encouraged in the prevention in the anemia by eating a high-protein diet, and multivitamin supplement with minerals.

## Sociodemographic Characteristics Of Nurses

The total number of eligible nurses was 220 of these, 212 were volunteered to participate in the study, a response rate of 96.3%. Most of them were males . The mean age among the study participants was 28.2±5.2 years. Majority of study participants were a diploma holder in nursing, 71.2% had 510years of clinical experience in the nursing profession. One hundred sixty of the participants attended education on PU almost half of them got PU education at University/ college education. One hundred fifty-six did not read articles about pressure ulcer, while, 138 of the participants had no exposure to PU training as illustrated in .

Table 1 Demographic characteristics of the nurses

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## Practicing Prevention Also Can Reduce Costs

Being prevention-minded can help save money too. Medicare has penalized hospitals with regard to preventable injuries or complications such as pressure injuries as reported in the article 769 hospitals face Medicare penalties due to patient injuries in Healthcare IT News. Penalties for hospitals for preventable complications may be upward of \$400 million.

In addition, pressure ulcers are a frequent topic for litigation, more so than even falls, according to the Agency for Healthcare Research and Quality. A past estimate states that a pressure ulcer can add tens of thousands of dollars in costs to a hospital admission.

There are things we can do to help decrease healthcare injuries. A number of innovations have been published offering practicing nurses and managers ideas for raising awareness of skin care and preventing pressure ulcers, states a research article published by the National Institutes of Health. The majority of these have focused on patients in hospital settings with very little in the literature related to care-home and community initiatives.

Despite available literature, pressure injuries are still a significant issue, and risk for pressure injury increases in persons with compromised mobility and/or nutrition, according to the NIH article Pressure ulcer prevention is everyones business: the PUPS project.

## General Information Teaching 2113

Pressure Ulcer Prevention: Patient Education

SN instructed patient / caregiver on service authorization, advance directives, rights and responsibilities, rights of the elderly and obtained necessary signatures. Instructed patient / caregiver on 24 hour nurse availability and provided / posted the agency telephone number. Also instructed that after hours, weekends and holidays an answering service will reach the nurse and he / she will return the patient / caregiver call and answer any questions or make a visit if needed. Patient and caregiver stated understanding. Patient and caregiver educated on diabetic diet, diabetic foot care, symptoms / signs of depression, managing pain with medications, healthy skin, and pressure ulcer prevention. Leaflets left in home.

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## Selection Of Studies And Data Extraction

Initially, the two researchers independently screened articles based on title and abstract, eliminating irrelevant studies. Then the full text of the remaining articles was read, and studies that did not report the required information were excluded from the analysis based on inclusion and exclusion criteria. The inclusion criteria were: conducting a study on nurses or nursing students, using PUKAT to measure the knowledge of pressure ulcer prevention, reporting the overall score or the score of different dimensions of knowledge, and publishing in English. Eligible articles were reviewed by two independent researchers and the necessary information such as the first author, year of publication, sample size, target group, total score of knowledge, and score of different dimensions of knowledge were extracted and recorded in the pre-prepared form. Studies that did not report essential information, whose full text was not available, or measured knowledge based on other tools were excluded from the analysis. In all stages of reviewing and evaluating the articles, any disagreements were resolved through consultation.

## How You Can Help Prevent Pressure Ulcers

Is there a way we can involve healthcare teams through interprofessional education and discipline-specific prevention interventions to combat skin and pressure injuries? Yes!

In 2016, the National Pressure Ulcer Advisory Panel described a change in terminology. The NPUAP staging system now refers to pressure ulcers as pressure injuries.

The change should help healthcare professionals think of injuries and potential for injury in terms of harm to tissue from pressure regardless of whether the harm has resulted in open injury or nonintact skin. There can be underlying serious tissue injury before the injury progresses to the point of an ulcer or nonintact skin.

Have you ever heard a colleague say, Its just a stage 1 pressure injury. or If it blanches, its OK. Well, is it really OK? Implementing prevention measures may help keep these areas of pressure stress or injury from becoming worse.

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## Data Processing And Analysis

The data collected were checked for completeness and entered into Epi data V.4.6.0.2. Analyses were done by SPSS V.25. Bivariate and multivariate logistic regression models were used to identify factors associated with PI prevention practice. In bivariate analysis, the association was tested with each independent variable and dependent variable separately. The variables with a p0.25 in bivariate analysis were taken into the multivariable model to control for all possible confounders. ORs with 95%CI were estimated to identify the factors associated with PI prevention practice using multivariable logistic regression analysis. The level of statistical significance was declared at a p< 0.05.

## Study Area Design And Period

An institution based cross-sectional study was conducted in public hospitals of Harari Regional state and Dire Dawa city administration, Eastern Ethiopia from the 1st February to the 1st March, 2018. Harar is the capital city of Harari regional state, which is 523 Km away to East from capital city of Ethiopia, Addis Ababa. Based on 2007 census conducted by Central Statistical Agency of Ethiopia , Harari region has a total population of 183,415 of whom 92,316 were male . In Harar there are five Hospitals. This study was conducted in three government hospitals. Hiwot Fana Specialized University Hospital is a teaching hospital of Haramaya University with a total of 161 beds. Jugal Hospital is a regional referral hospital of Harari regional state with 95 beds. There are a total of 363 nurses working in governmental hospitals of Harari regional state.

Dire Dawa City Administration located in the eastern part of the country at a distance of 515 km from the capital city. According to the 2007 Census, Dire Dawa had a total population of 341,834, of whom 170,373 women . Currently, there are two government hospitals in this city Dilchora referral hospital and Sabian Primary hospital. Dilchora is a referral hospital of Dire Dawa city administration with a total of 190 nurses and Sabian Primary Hospital is also another Hospital of Dire Dawa city administration with a total of 60 nurses.

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## If You Use A Wheelchair

Make sure your wheelchair is the right size for you.

• Have your doctor or physical therapist check the fit once or twice a year.
• If you gain weight, ask your doctor or physical therapist to check how you fit your wheelchair.
• If you feel pressure anywhere, have your doctor or physical therapist check your wheelchair.

Sit on a foam or gel seat cushion that fits your wheelchair. Natural sheepskin pads are also helpful to reduce pressure on the skin. DO NOT sit on a donut-shaped cushions.

You or your caregiver should shift your weight in your wheelchair every 15 to 20 minutes. This will take pressure off certain areas and maintain blood flow:

• Lean to one side, then lean to the other side

If you transfer yourself , lift your body up with your arms. DO NOT drag yourself. If you are having trouble transferring into your wheelchair, ask a physical therapist to teach you the proper technique.

If your caregiver transfers you, make sure they know the proper way to move you.

## Pressure Ulcer Prevention Strategies

Any patient with reduced mobility should be taught how to prevent pressure ulcers. The following are general but important tips:

• CHANGE POSITION FREQUENTLY! The patient should move their position no less than every 2 hours, and if chair or bedbound, perform passive or active range of motion exercises while in a chair or in bed.
• Be vigilant about skincare especially if incontinent of urine or feces.
• Clean the skin with mild soap and warm water or a no-rinse cleanser. Gently pat dry. Use skin protectant to protect skin vulnerable to excess moisture.
• Apply lotion to dry skin.
• Change bedding and clothing frequently.
• Watch for buttons on the clothing and wrinkles in the bedding that irritate the skin.
• If not contraindicated make sure the patient is drinking eight 8-oz glasses of water a day and getting a diet with plenty of protein.
• If not contraindicated make sure the patient adds calories. Some good strategies on increasing calorie intake
• Add butter or margarine to foods when cooking and put on foods that are already cooked.
• Add cream sauce or melt cheese over vegetables.
• Eat peanut butter sandwiches, or put peanut butter on vegetables or fruits, such as carrots or apples.
• Mix whole milk or half-and-half with canned soups.
• Add protein supplements to yogurt, milkshakes, fruit smoothies, or pudding.
• Drink milkshakes between meals.

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