Pressure Wounds Prevention Interventions and Evaluation Interventions
My project focuses on preventing bed-bound patients from getting pressure ulcers that would prolong their hospital stay. The interventions of choice would be performing manual positioning, nutrition, support surfaces, and skin care. The first intervention is mechanical loading or manual positioning which includes turning and repositioning of the patient in intervals. The nurses are involved in helping reduce the mechanical load for the patient. The repositioning will be conducted in intervals of two hours regardless of the type of mattress the patient is on. Also, the turning will not exceed 30o (Getie et al., 2020). Secondly, nutritional intervention will be given to all patients. All patients will be subjected to a balanced diet. Furthermore, the patients will be given nutritional supplements on top of their meals. The patients will get a nutritional assessment from a dietician who will recommend supplementation of the diet deficiency they are experiencing. Over-supplementation of patients without deficiencies of vitamins, protein, or minerals should be avoided (Getie et al., 2020).
Thirdly, skin care will be done on all patients. A skin assessment would be conducted frequently. During the assessment, the nurse will assess the skin colour, temperature, turgor, integrity, and moisture. Skin baths will be conducted daily using non-drying products. The skin would be kept dry and clean to prevent irritants and increasing friction force that causes skin breakdown. The nurse will use topical nicotinoyl to maintain skin health. Skin care should not involve vigorous massaging over reddened bony prominences, the use of hot water, and exposure to low humidity (Getie et al., 2020).
Lastly, the use of support surfaces will be used to redistribute pressure. For patients who are at low risk of developing ulcers, they will use solid or convoluted mattresses. Moderate to high-risk patients will be put on low-air-loss and alternating mattresses while high-risk patients will be put on electric beds with silicone-coated beads. The nurses will conduct an assessment of the specific needs of a patient to select the most appropriate surface for the patient. However, all patients will require repositioning and turning no matter what surface they are on (Getie et al., 2020).
Evaluation
Evaluation for this project will use an outcome evaluation design. Outcome evaluation design assesses relative and principal effects and is the ideal type to assess an intervention on program participants (Goodrich, 2020). In this project, the interventions will be evaluated by looking at the pressure wound incidence rate, the pressure wound severity, and nutritional status improvement. First, evaluating the pressure wound incidence rate will occur by measuring the new number of pressure ulcers in the patients after and before intervention implementation. An increase in the incidence rate will show intervention ineffectiveness while a decrease in the incidence rate will show intervention effectiveness (Zaidi, 2022).
The severity of pressure wounds, on the other hand, involves assessment of the pressure ulcer and gauging the process of wound healing. The assessments entail assessing the location, colour, and size of the wound, the type and amount of exudate, the type and frequency of pain, evidence of healing or necrosis, and wound edges description. Effective interventions will show reduced wound exudate, pain, and healing process while ineffective interventions will show necrosis, increased exudate, and pain (Zaidi, 2022). Lastly, adequate nutrition will have a positive outcome in wound healing while inadequate nutrition will result in delayed wound healing and the presence of necrosis.
References
Getie, A., Baylie, A., Bante, A., Geda, B., & Mesfin, F. (2020). Pressure ulcer prevention practices and associated factors among nurses in public hospitals of Harari regional state and Dire Dawa city administration, Eastern Ethiopia. PLOS ONE, 15(12), e0243875. https://doi.org/10.1371/journal.pone.0243875
Goodrich, D. (2020). Evaluation and study designs for implementation and quality improvement. The QUERI Roadmap for Implementation and Quality Improvement – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK566228/
Zaidi, S. R. H. (2022, August 9). Pressure ulcer. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK553107/
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