How is the nursing intervention in patients with pressure ulcers associated with the risk factors of hospitalized patients?

Quality of Care and Application of Pressure Ulcer Prevention Measures

Introduction to the Problem

Pressure ulcers constitute one of the most frequent problems in daily nursing practice, being a great challenge and a great responsibility in both prevention and treatment due to autonomy of action. Pressure ulcers have been a serious problem that has mainly affected people who must remain bedridden for long periods due to trauma or illness (Hampton, 2020). There is evidence that this complication was known from very ancient times.

Currently, worldwide, there are records on pressure ulcers; in terms of prevention, WHO (2020) establishes that 3 to 11% of hospitalized people develop pressure ulcers. The incidence of people with ulcers per pressure is 8.5%. In medical centers for veterans, it is 7.4%, and in nursing homes, 23.9%. The prevalence of pressure ulcers in the hospital environment can reach up to 45% in chronically ill patients and over 9% of all hospitalized people, constituting a health problem in chronic conditions and people in acute states.

According to the CDC (2019) in the United States, pressure ulcers were reported in 5% to 32% of patients admitted to a district general hospital (the exact rate depends on the combination of cases) and in 4% to 7% of patients in the community settings. On the other hand, according to the National Commission for the Prevention and Treatment of Pressure Ulcers (2019) there are no records of incidence and prevalence of pressure ulcers at an international level; however, the costs involved in management are high considering the costs of America and Europe. On the other hand, Menzel (2018) indicates that in recent years, a demographic transition has been underway in Western societies, with a vertiginous increase in the number of people over 65 years of age and, in particular, those over 80 years of age.

This type of ulcer causes suffering and considerably increases the morbidity and mortality of the affected persons. That is why prevention is an important aspect; This seeks to avoid prolonged pressure and conduct a routine inspection of susceptible areas. WHO (2020) states that although a person of any age develops pressure ulcers if they do not change position frequently, this risk is increased in older adults due to age-related skin changes, including loss of moisture, subcutaneous fat, and increased blood pressure. Pressure ulcers constitute a significant public health problem due to their repercussions in different areas, such as the health level of those who suffer from them, users’ quality of life and their environments, the consumption of resources for the health system, in situations that are often avoidable. Most pressure ulcers can be 95% preventable.

Clearly Identify the Problem

The appearance of pressure ulcers is a process that is closely related to the nursing care provided to the patient in internal medicine units in hospitals in the United States. There is no doubt that the higher the quality and extent of such care, the lower the incidence of pressure ulcers. In this context, caring for a patient with pressure ulcers entails an increase in the time required in health care and a consequent increase in the workload (Lyder, 2018).

On the other hand, it should be noted that when a patient develops a pressure ulcer, their predisposition to suffer from various disorders derived from it increases, such as pain, infections, and physical deterioration. All this, in turn, affects a series of factors of a diverse nature (personal, family, health, etc.). Bedsores or pressure ulcers are lesions that occur in the skin and deep tissues, produced by the prolonged support of the skin against bone areas. They occur preferably in the points of support of the body or more significant pressure such as the buttocks, region close to the coccyx, heels, shoulders, knees (Lyder, 2018).

Pressure ulcers affect people who are immobile in bed for a long time, lying on their back, or having fecal and urinary incontinence. They can also occur in the elderly, people with diabetes, arteriosclerosis, terminal diseases, malnutrition, obesity, among others. Pressure ulcers are caused by a lack of blood supply to an area, causing laceration of the skin due to prolonged pressure on bony or cartilaginous prominences (Hampton, 2020)

Significance of the problem to Nursing

The nursing professional has a primary role in health promotion, which is the strategy that allows you to seek an optimal health status for a specific population, where health education plays a fundamental role. Health promotion provides citizen-patients with the necessary means to improve their health and exercise greater control over it (nursing professional¸2018).

If ulcers are not treated in time, they can cause necrosis (destruction of tissues, gangrene), purulent secretions, lousy odor, bone lesions, and general discomfort in patients. Bedsores have severe epidemiological consequences; they are associated with severe infection and necrosis. The economic cost of treating bedsores is very high and time-consuming. The most frequent location about the pressure areas is – 65% in the pelvic area – 30% in the lower and upper extremities – 5% in other areas such as the occipital (posterior region of the head), scapulae (back), nose (when carrying a nasogastric tube) (WHO, 2020).

The first warning sign is erythema or redness of the area. Pressure ulcers can and should be avoided with good nursing care within a general plan that includes the multidisciplinary work of the doctor, nurse, patient, and family. It is necessary to find the ideal treatment for each type of ulcer and, in many cases, use different treatments, depending on the evolution. The important thing is to make the individual consultations in health units promptly.

This research is vital for nursing because it aims to show that from the nursing intervention, the excellent evolution and resolution of pressure ulcers depend, in addition to being a clear indicator of the quality of care both at the intra-hospital and extra-hospital level because they seriously aggravate the general condition patient due to increased risk of infection and metabolic complications.

Purpose of the research

Failure to resolve the nursing intervention in patients with pressure ulcers associated with risk factors in hospitalized patients will increase the risk of developing pressure ulcers, and inmates who are already scared run the risk of gangrene and aggravate their condition not because of the pathology for which he was admitted, but because of complications in pressure ulcers (Hampton, 2020). There is low immunity; therefore, patients are exposed to remain immunosuppressed, a situation that deteriorates their health, taking them to extremes that compromise their life and speedy recovery, with the concern of family members and the home health that would further raise hospital costs. In such a way that the purpose of this study is to identify the impact of nursing actions in the prevention, intervention, and care of pressure ulcers in immobilized patients or with mobility limitations to demonstrate the importance of pacification and education for the prevention of skin injuries from nursing, and thus, reduce hospital costs and minimize the suffering of patients.

Research Questions

How is the nursing intervention in patients with pressure ulcers associated with the risk factors of hospitalized patients?

Are patients at risk of developing pressure ulcers assessed?

Are there enough supplies to provide nursing care according to the needs of the patient?

What are the risk factors for pressure ulcers?