Hospital Acquired Pressure Ulcers
Hospital Acquired Pressure Ulcers (HAPUs) are an epoch-making healthcare predicament globally. HAPU increases the time duration that a patient is admitted in hospital and simultaneously increases their complications, pain, suffering, morbidity and mortality, and healing process. It also takes a toll on the healthcare costs which has been estimated to amount to 2.2 to 3.6 billion dollars annually. Insurance provider reimbursement has significantly grown to be dependent on the outcome of patients especially since HAPUs is perceived to be an outcome of poor standards of nursing. Clocking 2008, stage three and stage four pressure ulcers are not reimbursable prompting healthcare organizations? effectuation of pressure ulcer prevention criteria and interventions to curb HAPU formation. Recent affirmation portrays that there are varied levels of success when employing soft silicone foam bordered dressings as an adjunctive inhibition therapy for pressure ulcer emergence.
Madeline Leininger?s Transcultural Nursing Theory disseminates that in the process of devising a nursing procedure for a patient, nurses need to take into consideration the cultural background of the patient. Cultural values and beliefs as a frame of reference have a principle impact in the life of the patient. The nurses also need to take into account the patients social life and environment when dealing with the disease (Ray 2016). Being knowledgeable of the patient?s cultural background is advantageous in pinpointing the source of the pressure ulcers and impede future occurrence.

Another vital factor that assists in limiting pressure ulcers is the knowledge from Health as Expanding Consciousness. Margaret A. Newman expounds that human is unitary and cannot be divided into parts. Insight into the patient?s pattern is utilitarian for convalescence and disease prevention (Alligood, 2014). Broadening consciousness in every aspect of the patient is a key step towards minimizing pressure ulcers. This is because the nurse will employ suitable prevention methods relying on the patient?s condition.
Referring to the Holistic Nursing Framework, the healing procedure needs to emphasize on the individual as a whole. A pressure ulcer is a malady that influences the skin and tissue of the patient. A more effective way of limiting the spread of the pressure ulcer pertains to applying oneself to the interconnectedness of the mind, spirit, body, emotions, relationships and the environment (Papathanasiou, Sklavou, & Kourkouta, 2013). Being informed about the medical history of the convalescent, affected by pressure ulcers can beneficial in limiting its occurrence.
Professional nursing practices and how they can assist in limiting pressure ulcers has been well disseminated through Transcultural Nursing, Health as Expanding Consciousness, and Holistic Nursing theories. All affairs pertaining to the patient should be focused on establishing a nursing plan for a patient afflicted with pressure ulcer. The procedure should guarantee that the cause is determined and the possibility of it reoccurring in future is averted after the nurse has closely examined the patient (Papathanasiou et al., 2013). This paper designs a clinical project proposal using the scientific method to develop an evidence-based project to improve patient outcomes.

Pressure ulcers are afflictions that occur on a patient?s skin and tissues when the body parts are put under pressure. They can also be referred to as bedsores since they affect convalescence?s that are bedridden hindering blood from flowing to the skin (Lyder, 2003). Since the section under pressure is not receiving any blood, it is lacking oxygen as well as nutrients resulting to the cells dying and formation of a wound. These afflictions can bring about issues that are life threatening, especially to cases such as musculoskeletal dysfunction, diabetes and disorders of the autonomic nervous system. Remedy of the wounds involve applying creams, dressings and in some cases surgery if need arises.
History and Problem Background
Body sections that cover bony areas are the ones prone to be affected by pressure or decubitus ulcers. These parts include the buttocks, hips, heels, back, ankles, among other areas of the body (Singh, Armstrong & Lipsky, 2005). They commonly occur to patients with disabilities, elderly patients, patients who are bedridden and those with sensitive skin. Pressure ulcers come about in phases, it commences with the manifestation of a reddish patch on the section that has been affected or discoloration of the skin. The afflicted section may appear darker, white or contain a purple color. The second phase has the skin opening up and death tissues forming around the wound and it appears pinkish. In some instances there is presence of fluid filled blisters (Singh, Armstrong & Lipsky, 2005). In the third stage, the lower layers of the skin are affected, there is presence of pus in the wounds and it is concave. The fourth phase of pressure ulcers is very critical. This is due to the severity that muscles and bones are affected and there is a dark matter called eschar on the sore. Once it has gotten to this level, it is considered unstageable. It manifests itself green or yellow with pus and it needs dedicated care to recuperate it. It is an established fact that the genesis of ulcers is due to a patient lying on one section of the body for a long period of time applying pressure on the skin. Abrading skin against a rough surface or object generates friction which harms the skin area. Donning soiled garments or clothes for a long period of time may cause irritation that facilitates the wounds on the skin to open. The manifestation comprise of discoloration, vitiation and softening of the skin which is accompanied by infections and pain. The end solution for sores that have become critical is to undergo surgery to reconstruct the damaged part.
Statistics do not account for patients who suffer from pressure ulcers at home since they do not report it to relevant officials. Individuals who suffer from pressure ulcers while at the hospitals have their cases documented and the data is used for analysis and comparison contrast to those who recuperate at home. Due to this limitation the actual and approximate statistics of cases pertaining to pressure ulcers is not entirely canvassed.
Problem Statement
Pressure ulcers have been a bone of contention in hospitals due to the nonfulfillment of the caregivers in undertaking preventive measure and changing the position of immobile patients.
Purpose of the Study
The objective of this study is to minimize pressure ulcers in an acute setting and to complement health care quality while simultaneously diminish the complications affiliated with them.
Literature Review
Referencing Lyder (2003), pressure ulcers pose an epoch-making peril to patients in health care settings. This is because the cost of treatment and management of each pressure ulcers amounts to $40 in the United States. The cause of some deaths, especially among the elderly population is as a result of pressure ulcers. Thus health caregivers are urged to improve their medical attention skills while attending to them in order to minimize the deaths. Education for clinicians is a fundamental factor in curbing the ulcers because it boosts the performance of the clinicians.
Research shows that there is a high possibility of patients suffering from diabetes acquiring bedsores which in some cases might lead to limb amputation. If the medical fraternity is well trained and knowledgeable on how to attend, and care for the patients in hospitals and other health care facilities, they can oversee the patient?s well-being and curb the reported cases. Turning beds is a tool than can also be employed in assisting to turn the patient?s position as well as rotating them (McInnes et. al 2015). Foot care clinical practice guidelines should also be incorporated into the system to accommodate patients who are suffering from diabetes. Diabetic patients are required to undergo foot examination every year to guarantee that there is no presence of anatomical deformities. After undergoing this inspection they can be allocated risk categories using the system they have established.
Langer, Knerr, Kuss, Behrens and Schlomer (2003) conducted a research that showed 10 percent of patients in hospitals have a higher probability of suffering from pressure ulcers. The elderly population is the one which was mostly highlighted. Individuals who are not accorded proper nutrition are also at risk, hence maintaining a healthy diet could go a long way in preventing the occurrence of pressure ulcers. Dehydration debilitates the skin making the patient vulnerable to the pressure sores, as a precaution the patient is required to take nutrition supplements like vitamin C and Zinc (Langer, Knerr, Kuss, Behrens & schlomer, 2003).
Other preventive initiative for the physically disabled is to constantly changing their position to minimize pressure on particular parts of their anatomy. It is advisable to rotate and change their positions after every two hours. This is done in order to facilitate circulation of blood to the entire body of the patient. Nurses and every other practitioner should make certain that the patient?s skin is unsullied and dry by wiping it with a cloth dipped in warm soapy water. Thereafter the skin is lightly dried with a clean towel to prevent irritation. Body parts that tend to rub against each other should be made more comfortable by situating pillows in between them (Qaseem, Mir, Starkey, and Denberg, 2015). Exercise should be encouraged to bedridden patients even if they don?t have the ability to step out of bed. This exercises help in keeping them healthy. They include arm lifts, moving the legs and neck among others.
Even with availability of this information there is still a knowledge gap in ascertaining the safety of managing pressure ulcers in the hospital setting and at home. This is a hindrance for health professionals in monitoring the standards of patient care. To complicate things more, there is no standardized modus operandi of defining the eligibility of wounds and the most appropriate intervention for each type of wound. As a result there is a greater need for more research to found the suitable care for pressure ulcers at health care centers and at home taking into consideration the type of injuries, in order to help the patient recuperate. Pressure ulcers can cause cancer on the section where it is affected if it is not diagnosed and treated early, thus additional research is needed to expound and disseminate information on the critical aspect of the ulcer.
The methodology that has been employed in this project is a qualitative research. The focus of the research is to investigate Hospital Acquired Pressure Ulcers and how the health care personnel and caregivers are treating the immobile and the level of their standards.
Consent form
See Appendices A
See Appendices B
Data Gathering
Data collection is a systematic process of gathering and analyzing information collected that are of a specific interest set to answer stated research questions, try hypotheses and evaluate the outcomes (Lynch & Vickery, 2010). In this essay, it will give details on the data collection methods for the possible intervention of hospital-acquired pressure ulcers. The essay will also incorporate several aspects that will ensure protocol is followed, reliability and integrity of the data collected and the outcome of the results.
Hospital-acquired pressure ulcers are becoming a national concern due to patient morbidity, the cost of treatment and reimbursement concerns. Many of the issues raised are because pressure ulcers are and can be prevented from occurring (Lynch & Vickery, 2010). In this essay, a setting will be provided, on how data on pressure ulcers can be collected, and further provide meaningful information on the best strategies for combating the issue.
Most of the incidence reports of pressure ulcers are from patients under intensive care unit, and those who are bedridden. Only patients in intensive care units and those who are bedridden will be included in the research. Further, data will be collected on patients with the ulcers so as to show how quickly they can be resolved, or what other factors contribute to the ulcers worsening further causing the death of patients.
The collection method will be a detailed form that will contain data of the patient from the time they were hospitalized to the end of the research. Also, it will include details of the already suffering from the pressure ulcers and the care they are being given to heal the wounds. Nurses will be the primary source of data collection and will be tasked with filling the form on a daily basis. Each reporting nurse will have her personal sheet to record the data; this will help improve the data integrity. The nurses will also have additional training on matters concerning hospital-acquired ulcers and the research program that will be ongoing.
The research will have a timeline of a whole year, divided into two sections of six months. After every six months, an evaluation will be done to provide a conclusion on the timeline best in treating the already acquired ulcers, and also measure the introduced directives in providing care to the patients. Two type of test will be monitored in the whole research project. The measures will be incidence and prevalence rates. Incidence rate will be a description of the percentage or number of people developing new ulcers while in the facility or a given unit.
Incidence rate will document direct evidence on the quality of care in the hospital; more new ulcers will mean the quality of care in the hospital is not satisfied. Prevalence rate will describe the number of people or percentage that will have pressure ulcers while at the hospital. Prevalence rate will document on ulcers that appear on the onset of the research or either a new ulcer while the investigation is ongoing. Prevalence rate will provide an insight of how long the ulcer can take to be cured or how persistent it is in providing care.
The project will not be triangulated, as all the research will be done in one hospital setting so that it can provide the best results in its effort to quell and mitigate acquired pressure ulcers (Bonnel & Smith, 2014). To calculate the pressure ulcers prevalence or incidence rates, the nurses need to know who does have an ulcer and when it developed. This information will be obtained by performing a comprehensive skin inspection on each patient and document the results for ease access to the information for analysis.
To ensure the validity of the data collected, a standard form will be used that every nurse will apply to record information. The form will categorically be recording information on hospital-acquired pressure ulcers, and not any other ailment. For reliability, every nurse will have an individual form to fill, that will be cross-checked for consistency when the data is being filed. The examination results will be recorded daily, noting the location, number and the stages of the ulcers along with the patient details. Although it?s hard to create a new form daily for the nurse to perform and record the results, the detailed inspection will be done on every week that will cover a comprehensive and thorough check for ulcers for the patients.
The project will make use of technological tools such as computers and analytical software for analyzing the data collected. The tools and resources that will be used in this process will be an adaptation of a standard form that will be able to document electronic records. Some of the tools that will be incorporated in this research will be the TOOL 5A, Floor Log that can summarize the results of a daily comprehensive skin assessment on the patients. Further, this tool can be used by registered nurses and nursing assistants, creating an avenue for data integrity and security (Bonnel & Smith, 2014).
Once the details are recorded, a qualified professional will be tasked with providing a detailed analysis of the daily records and at the end of each month give a report on the prevalence of hospital-acquired pressure ulcers (Bonnel & Smith, 2014). The results will be used to provide a conclusion whether the rates are going down or are increasing, giving an indication of the quality of care for the patients with pressure ulcers and those that acquire it at the stay of the hospital.
Further the results will help the hospital to come up with a standard protocol that can be used to care for the patients who acquire the ulcers from the very first day to the last day of being discharged. Additionally, the analysis will help give nurses information on ways to provide aftercare services when the patients are discharged.
Data Analysis
Data analysis will be expected to assess the data collected pertaining to patients suffering from pressure ulcers in a hospital. This analysis is set to analyze two types of tests: incidence rate and prevalence rate. By evaluating incidence rate one is able to have an idea of the exact number of individuals who are getting new ulcers while under the care of the hospital. It will also ascertain and provide evidence on the standards of health care offered by the hospital. If the statistics portray that there are more ulcer cases that will indicate that the services of the hospital are unsatisfactory. On the other hand prevalence rate will be gathering information on ulcers that will appear on the commencement of the project or the occurrence of a new ulcer while the project is underway. Prevalence rate expounds on what duration the ulcer will take before it is cured or how tenacious it is to treatment (Korostevela, 2009).
Commencement of the analysis of data begins after the relevant and appropriate information has been collected that will be directed to provide answers to the research query. The data collected is manipulated in various ways such as plotting it to find a correlation or by employing Microsoft Excel to create pivot tables. The pivot table is used to sort and filter data by different variables that will assist in calculating various aspects such as the mean, minimum, maximum and standard deviation of the gathered data. The data manipulation enables one to assess whether the data is collected is relevant or more information needs to be gathered to answer the research query. Strong analytical tools and software are required will be needed. These tools manipulate and handle data using a methodology that focus on achieving the correct results. Most commonly used software packages are Minitab, R, Stata and visio for advanced data analysis (Bonnel & Smith)
The data will be interpreted after a thorough analysis and further research has been performed. When data is being interpreted, multiple questions need to be addressed. Some of the questions include: whether the data gathered answers the original question and how. Does the data assist in defending against any objections and how. Does the derived conclusion have any limitations? Should new angles be included in the research? If the analyzed data answer the questions then a conclusion can be made. The results will then offer a directive to consider the best course of action (Bonnel & Smith, 2014). The failure of the caregivers to change the immobile patients and attend to them accordingly is measured through descriptive statistics tests such as standard deviation, means and percentages. This data analysis evaluation is classified under qualitative methodology.

Bonnel, W. E. & Smith, K. V. (2014). Proposal writing for nursing capstones and clinical projects. Springer Publishing Company
Korosteleva, O. (2009). Clinical statistics: Introducing clinical trials, survival analysis, and longitudinal data analysis. Sudbury, Mass: Jones and Bartlett Publishers.
Langer, G., Knerr, A., Kuss, O., Behrens, J., & Schl?mer, G. J. (2003). Nutritional Interventions for Preventing and Treating Pressure Ulcers. The Cochrane Library. Retrieved from
Qaseem, A., Mir, T. P., Starkey, M., & Denberg, T. D. (2015). Risk Assessment and Prevention of Pressure Ulcers: A Clinical Practice Guideline from the American College of Physicians. Annals of Internal Medicine, 162(5), 359-369. Retrieved from
Singh, N., Armstrong, D. G., & Lipsky, B. A. (2005). Preventing Foot Ulcers in Patients with Diabetes. Jama, 293(2), 217-228. Retrieved from
Ambutas, S., Staffileno, B. A., & Fogg, L. (2014). Reducing Nasal Pressure Ulcers With an Alternative Taping Device. MEDSURG Nursing, 23(2), 96-100.
Kuffler, D. P. (2015). Improving the ability to eliminate wounds and pressure ulcers. Wound Repair & Regeneration, 23(3), 312-317. doi:10.1111/wrr.12284
B??th, C., Idvall, E., Gunningberg, L., & Hommel, A. (2014). Pressure-reducing interventions among persons with pressure ulcers: results from the first three national pressure ulcer prevalence surveys in Sweden. Journal Of Evaluation In Clinical Practice, 20(1), 58-65. doi:10.1111/jep.12079

Appendix A
Consent Form for Participation in a Research Study
Principal Investigator:
Study Title:
This invitation is for your involvement in a study on hospital-acquired pressure ulcers. The study aims at ascertaining the prevalence of hospital-acquired pressure ulcers. This form of ulcers is a growing national concern in the health care delivery process. Therefore, the study hopes to establish that fact and to pave the way for interventions that can be put in place to deal with the menace. You have therefore been pointed out as a prospective participant in the study.
The study involves data collection on the above-stated condition to determine the cause-effect relationship. From this data, ways of prevention of the problem can be determined and implemented. The data will also help to set effective regulatory mandates to ensure such cases do not occur during hospitalization. The mitigation of the occurrence of hospital acquired pressure ulcers to negligible or zero cases forms the basis of this study. It is for this reason you are being called upon to take part and lend the help you can.
You have been chosen, of course with your consent, to be part of this study because your input will be an integral component to the success of this endeavour and particularly for the general good of the health care provision industry. Your participation will set rolling the solution to this problem amidst the heightened interest on the above subject matter.
In case any of you agree to take part in this educating process, you will be called upon to share some basic and general information about yourself for the purpose of identification. You hold the key to what information you are willing to share and as such none should be coerced from you except by your ready agreement to share. You will be required to fill out some questionnaires as honestly as possible and do a one on one interview. Lastly, a skin assessment will be conducted, and this will require both your signed consent and verbal acceptance, without which it cannot and will not be done. All this demands some time commitment of which you are free to choose and limit as per the dictates of your conscious.
The participation, in this case, is purely voluntary. You are guaranteed that no adverse effects will result from the study. It is merely harmless. Moreover, you will be talked through all the procedures so you understand clearly the process and only then will you be allowed to make a decision for or against it. There are no guaranteed personal benefits from the study except the satisfaction of participating in a project for the common good of many others. That is to say that no payment is offered for taking part in the study.
Just as participation is voluntary, withdrawal is as well. You can opt out of the study at any time without any consequences on your part. You can as well selectively choose the sections of the research you wish to take part in and reject the others. Another alternative is to decline to be part of the study entirely. All these choices are left to you, and neither choice will be forced upon anyone. Any information gathered in this survey is considered confidential and will not be shared with anyone else without the written permission from the owner.

___________________ ____________________ ________________
Participant Signature: Print Name: Date:
Obtaining consent
Appendix B


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