Sample Size And Sampling Procedure
The sample size was determined using a formula of estimating a single population proportion for cross sectional study. Since the population size is less than 10, 000 , the final sample size was estimated using correction formula. The final sample size obtained including 10% non-response rate was 252. Then, the number of participants in each selected hospitals to obtain similar proportion of participants were determined using the population proportionate sampling . It is estimated using the formula: n=/N total, where, n=Proportion of nurses participate in the study in a given public hospital, nf=Final sample size obtained using correction formula , N=is the total number of nurses in the selected public hospitals .
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The Majority Of Pressure Ulcers Are Avoidable
Research presented by the NHS’s ‘Stop the Pressure’ campaign suggests that a massive 95% of all pressure ulcers can be avoided with effective patient care. With the correct patient care, we could be saving millions of pounds and improving care for patients, carers and care operators.
95% of pressure ulcers are preventable by using SSKIN
My purpose in writing this post is to increase awareness around the SSKIN acronym which clearly and visually breaks down five easy-to-remember steps that ensure effective pressure care. The acronym applies to both the prevention and the treatment of pressure ulcers/sores…
Specialty Bedding Materials And Equipment Can Be Used For Pressure Ulcer Prevention
Speciality bedding, materials and Medical Equipment can be very useful for pressure ulcer prevention. Cushioned padding such as heel protectors, for example, can reduce pressure on sensitive areas of the feet. An air cushion or gel cushion can be used when patients are spending long periods sitting in a wheelchair or chair. An air mattress topper can also be used to help reduce the amount of pressure on specific areas of the body when in bed. Another effective way to prevent pressure ulcers is to put pillows between parts of the body that press against each other. For example, under the tailbone, shoulders, heels, and elbows. If the patient is lying predominantly on their side, put a pillow between the knees and ankles.
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What Are Pressure Sores
Pressure sores are wounds to the skin caused by sitting or lying in a certain position for too long which results in tissue damage. Pressure sores usually start off quite small but can worsen very quickly. Pressure sores can often develop in areas that cover the bony parts of the body for example in the ankles, side of knees or shoulder blades. They are more common in those who have limited mobility as moving positions is hard.
Active Or Static Pressure Redistribution
Arjos Alpha Active pressure redistribution mattress overlay system offers two different modes to meet prevention and treatment objectives:
Active/alternating mode: periodically redistributing pressure away from vulnerable areas, by alternately inflating and deflating cells beneath the resident/patient. Ideal for prevention of pressure ulcers in high risk residents/patients, particularly those cannot be frequently repositioned.
Reactive/static mode: cell pressure is equalised to redistribute the body weight over a greater surface area. Ideal for residents/patients in rehabilitation or those who cannot tolerate a moving surface.
In addition to pressure beds, you can also obtain separate pressure relief mattresses or mattress overlays, which may be more cost-effective.
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What Factors Go Into Bed Sore Risk
Bed sores most often form when the skin covering the bony parts of the body are under constant pressure. The most common surfaces for pressure ulcers include the heels, ankles, hips, tailbone, knees, shoulder blades, and the back of the head. Once the sores start developing, the skin around the affected area may initially look red, feel itchy, or even feel warm to the touch. Ultimately, they can spread deep into the underlying muscle and bone the results can take anywhere from days to years to properly heal.
Many of the risk factors correlate with age , smoking habits, dry skin, limited mobility preventing changes in position, mental status, incontinence, malnutrition, and any physical restraints that might be necessary. They can occur when someone is bedridden or otherwise immobile, but also on patients who are unconscious or unable to sense pain.
Another bed sore risk is friction injury. Its a kind of rug burn when the top layer of skin separates from the dermis or bottom skin layer. One step further than a friction injury is skin shearing, which is the combination of pressure and friction that affects the outer and inner layers of skin. These pressure injuries can be incredibly painful and lead to other medical conditions.
Padding Positioning And Turning In Bed
- Use a regular schedule of turning at night. Depending on weight and skin tolerance, your turning schedule may vary from every 2 to every 6 hours. Ask your health care provider for advice about a turning schedule. When turning and moving in bed, lift rather than slide across sheets.
- Use pillows and foam pads to protect bony areas. No two skin surfaces should rest against each other!
- Unless your doctor tells you to do it, avoid elevating the head of your bed, which can put too much pressure on your buttocks and lower back areas.
- For individuals at the highest risk for pressure sores, your health care provider may prescribe a special mattress, mattress overlay or bed for long-term use.
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How To Prevent Pressure Ulcers
Maintaining a watchful eye on a loved one’s skin and keeping them comfortable with frequent adjustments is key for preventing these dangerous and painful sores. If someone needs to rest in bed at all times, shift their position often to reduce the amount of pressure applied to one spot.
Additionally, make sure they’re kept dry. Moisture can lead to ulcers, so using a moisture barrier cream to protect against wetness can help keep skin clean and dry. You may need to keep their clothes and bedding switched out regularly.
If your loved one uses a wheelchair predominantly, foams can relieve pressure from sitting in the same position all day. Shifting an immobile person is a lot of tough work, but ultimately should keep them happier and healthier.
Reduce Friction And Shear
Friction is the rubbing of skin on an external surface, usually bed sheets. Friction to the most commonly affected areas can be reduced with protective devices. Heel and elbow cradles are typically made of egg-crate material and Velcro on.
Skin protecting dressings, such as films and thin hydrocolloid bandages can protect the skin from repeated friction but wont help reduce pressure.
The most important thing you can do to prevent injury from the friction is to make sure you dont create any yourself when youre repositioning your loved one. Use a draw sheet to help you lift your loved one off the bed when you lift and reposition.
Shear is created when the deeper fatty tissues and blood vessels are damaged by a combination of friction and gravity. The best way to avoid this type of injury is to avoid a semi-Fowler and upright position in bed. A semi-fowler position is where the head is raised less than 30 degrees and upright positions more than 30 degrees.
Now, you obviously cant avoid these positions all of the time. Many patients need to be semi-Fowler to help ease shortness of breath or prevent gastric reflux and all patients need to be in an upright position to eat safely.
To minimize the risk of shear injury in a semi-Fowler or upright position, take precautions to prevent your loved one from sliding down in bed. You can do this by raising the foot of the bed and propping the knees up with pillows.
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What Causes Pressure Sores
These annoyingly uncomfortable sores are injuries resulting from prolonged pressure and result in injuries to the skin and underlying tissue. Our skin is much more delicate than we know and placing too much pressure in any given place for a long period of time can cause damage. Most of these sores tend to show up in bonier areas of the body such as the hips, buttocks, tailbone, ankles and heels. As a result, the skin can become thin, flaky, puffy, clammy, discoloured or even broken. Unfortunately, these sores can develop quickly, and they can be extremely hard to get rid of. For this reason, one of the best things to do is to actually prevent them from happening in the first place.
Study Setting And Sample
The study was in Addis Ababa, the capital city of Ethiopia which contains 13 public referral hospitals . There are 34 private hospitals, 86 health centers and various NGOs and health institutions. The data in this study included nurses working from patient admission units in six randomly selected public referral hospitals . The units included were medical, surgical, orthopedics, intensive care unit, gynecology, pediatrics, dermatology, burn and oncology.
How Can A Mattress Help In Pressure Ulcer Prevention
A mattress can help prevent bedsores from appearing by evenly distributing the weight so that no one spot receives an overly concentrated amount of pressure. This is often challenging with individuals who are bedridden or immobile, however, frequent adjustments are critical for prevention.
Various types of mattresses work well for preventing these ulcers.
Air loss cushions work by simulating a weightless sensation, relieving pressure from the afflicted area. Dynamic beds work by inflating bubble cells for support and deflating ones near the infected region for relief.
Static mattress work by using modern foams to distribute weight and reduce the chance of bedsores and prolonged tension. Finally, hybrid mattresses are a combination of a static and a dynamic mattress, using features beneficial to both designs, and work well for high-risk individuals.
Take Ergonomics Into Account
It is vital to get a good fit between your equipment and your immediate environment. Ergonomics also accounts for any issues like mobility so that all aspects of your environment help you to perform tasks. Ergonomics should be considered when choosing furniture such as beds, bed-side chairs and mattresses.
What is a pressure ulcer?
It is an injury to the skin and underlying tissue that is the result of prolonged pressure. They often develop on skin covering bony areas such as heels, ankles, hips, shoulder blades, spine, backs of arms and legs. People most at risk of developing pressure sores have medical conditions which limit their mobility and spend the majority of their time in bed or in a chair. Bedsores can develop in just a few hours or over several days. They can heal when treated correctly.
What are the symptoms of pressure ulcers?
Warning signs to look for include unusual changes in the colour or texture of the skin, swelling, areas of the skin that feel cooler or warmer to the touch than other areas, pus-like draining or tender areas. Damage can range from red, unbroken skin to a deep injury that involves muscle and bone.
What are the causes of pressure ulcers?
How to Prevent pressure ulcers?
How to treat pressure ulcers?
How to prevent pressure ulcers in nursing homes?
How to treat pressure ulcers in hospitals?
Who is most at risk of developing pressure ulcers?
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Electric Beds Help To Relieve Pressure
If you have pressure sores it is important to relieve pressure at least every 2 hours. With electric beds, you can adjust your bed to put you in a position that does not put direct pressure on your affected area of skin. This helps to prevent or worsen ulcers developing. Instead of shifting your body to move your position in bed, you can let the electric bed do the work for you. This prevents your skin from unnecessarily rubbing against your mattress and sheets whilst you shift positions.
What Does Current Guidance Say On This Issue
NICE published a guideline in 2014 on the prevention and management of pressure ulcers. This recommends using a high-specification foam mattress for all adults who are admitted to secondary care or at high risk of developing a pressure ulcer in primary and community care settings. It also says that high-specification foam mattresses should be used for adults who have a pressure ulcer.
Trusts currently consider the use of a dynamic support surface, such as an alternating pressure mattress, based on clinical circumstances and local guidance.
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Pressure Ulcer Treatment Products
There is numerous kind of products on the market to prevent and treat pressure ulcer, but they may not all work perfectly for everybody. The symptom and severity level of the sores determine the right pressure sore treatment product.
There is some manufacturer that offers pressure ulcer and bedsore management which include the following.
Posey manufactures and distributes quality and safe products such as foot elevators, heel pillows, heel guards, elbow protectors, memory foam cushions and many more.
Med-Line produces and distributes more than 350,000 products which include pressure ulcer prevention products and supplies.
The Med-Line innovative products can be seen in hospitals, surgery centers, extended-care facilities, home care dealers, physician offices, retail outlets, and home health agencies.
Their products for pressure ulcer treatment include elbow protectors, heel protectors, convoluted foam boots and many others.
Briggs Health Care
This company serves over 50,000 people in the acute care, physician, senior care, and retail markets. They distribute more than 10,000 products which include products for pressure sores treatment too.
What Are The Implications
Pressure mattresses were equally effective at preventing pressure ulcers in this study.
More patients requested a change from an alternating pressure mattress due to discomfort. In some cases, this type of mattress also made rehabilitation difficult as it can restrict therapist movements compared with foam.
There are cost implications as alternating pressure devices are more expensive than foam mattresses. A separate study has looked at the cost-effectiveness of these mattresses, one compared with the other.
It seems that for now, the choice of mattress type used to prevent pressure ulcers could better take into account patient preferences, rehabilitation needs and risk.
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Ways To Reduce The Risk Of Developing Pressure Wounds
We also know that the following tips may help reduce the risk of developing pressure wounds:
Itâs this last point that weâll explore more
Overall Theme: Prevention Of Pressure Ulcers Is Important In The Care Of Geriatric Patients
All the nurses interviewed stated that the topic of pressure ulcers was of essential importance in nursing care, in particular when caring for geriatric patients. It was expressed that skin care and observations hereof is considered as one of the fundamental nursing tasks in nursing geriatric patients.
During the interviews, four sub-themes emerged and all sub-themes were chosen according to how the nurses explained their experiences with perception and perception of pressure ulcers: Nursing resources on the ward, Basic nursing skillslift the duvet, Introduction of new nurses on the wardbedside teaching and Missing articulation of pressure ulcers.
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Vive Health Alternative Pressure Pad
This product fits on top of hospital beds. People who have pressure sores or are at risk of developing those because of increased time spent in bed may benefit from this topper pad.
The manufacturers have equipped the pad with 130 individually sealed air bubbles to provide durable support that can withstand up to 300 lb of weight.
The variable pressure pump that controls the pressure within the air bubbles cycles through different levels of pressure to:
- distribute the persons weight evenly
- increase blood circulation
Pressure Injury Prevention And Treatment Is Ongoing Challenge To Care Environments
As patient age and acuity levels continue to rise, increasing frailty, complex underlying chronic diseases and rising obesity add to the daily challenges faced by clinicians.
These challenges include pressure injuries or otherwise known as pressure ulcers or bed wounds and/or bed sores.
Despite advances in bed surface technologies, education, guidelines and facility-based continuous improvement programmes, pressure injury prevalence and incidence remain high in many care settings.
Arjos pressure injury prevention solutions, such as our alternating pressure mattress replacement system along with a range of other support services are subject to a clinical focus in our Pressure Injury Prevention Clinical Evidence Summary.
Pressure Injury Prevention Clinical Evidence Summary
The clinical evidence summary offers you an introduction to pressure injuries and focuses on 5 key areas:
The Risks: Pressure, shear and time: a toxic combination
The Pyramid of Care: A visual guide to address risk factors
Active pressure redistribution surfaces
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What Causes Bedsores
A bedsore develops when blood supply to the skin is cut off for more than 2 to 3 hours. As the skin dies, the bedsore first starts as a red, painful area, which eventually turns purple. Left untreated, the skin can break open and the area can become infected.
A bedsore can become deep. It can extend into the muscle and bone. Once a bedsore develops, it is often very slow to heal. Depending on the severity of the bedsore, the person’s physical condition, and the presence of other diseases , bedsores can take days, months, or even years to heal. They may need surgery to help the healing process.
Bedsores often happen on the:
- Buttocks area
- Heels of the feet
- Backs and sides of the knees