Analysis Of Pressure Injury Procedure Policy's Impact On Nursing Practice In Aged Care: An Essay.

Pressure injury proceedure policy. Please write an essay analysing the policy and describing how it informs current nursing practice in the aged care setting.

(1) Explain what evidence the paper is drawn from by doing your own research on the most current evidence in Australia (please use Nursing and midwifery board of Australia (NMBA), Australian government department of health; and the Australian wound management association); and

(2) how the policy supports the safe and quality care of an aged care patient.

Breaking down the Essay

• Introduction
• Talk about the pressure injury procedure and how it is important in regards to an aged care patient.
• Talk about how it is accessed to guide the nursing care of aged care patients and how it supports safe and quality care.
• How does the piece you chose link to the most up to date best practice evidence in Australia today? Compare to research findings explained above.
• Talk about how it is still current and relevant.
• Why is it important to work with the most up to date best practice evidence? How does the policy compare?

Evidence on Pressure Injury

According to the Australian wound management, the rate of pressure injury has been increasing over the years due to various factors such as new sets of standards, and ignorance among patients. A pressure injury can be defined as a localized injury to the underlying tissue of the skin or the skin itself that is usually over bony prominence. This injury usually develops as a result of friction and shearing forces, pressure, age-related skin, decreased mobility and could also be because of poor nutrition. It was previously known as bed sore, pressure ulcer or decubitus ulcer. Many of these injuries are preventable and it is also known that they take a long period to heal which affects the quality of life of the patients through susceptibility to pain, mood disturbance, sleep and infections (Erin, 2012). They also have an impact on mobility, rehabilitation and also a long term quality of life. According to the Australian Department of Health. (2017), medical practitioners should work together to enable the people understand how they can prevent themselves from this illness. It also asserts that Pressure injuries prevention is a responsibility of all health staff regardless of their position or location where they implement several prevention strategies which are aimed at lowering the risk of pressure injuries aided by the pressure injury prevention policy created to lower the illness’s rates. However, despite the prevention strategies, these injuries still occur in aged patients due to the failing skin in the end stages of their life. In this essay, we shall discuss how this pressure injury procedure policy can be accessed so as to guide in the nursing of aged care patients in Australia. We shall also compare the findings in this essay with the up-to-date best practice evidence in Australia.

According to the Nursing and midwifery board of Australia (2016), pressure injury procedure policy enables the nurses, who play a crucial role in providing care for the pressure injury patients, and also leading line in prevention, management and assessment of this issue, to understand pressure injury causes and risks by giving them tools required to assess the injuries correctly to ensure that patient outcomes are successful. It also enables intensive care nursing which reduces complications which improves patient outcomes. Once, pressure injuries were thought to be unavoidable incidents or occurrences, Emergency Nurses Association stated otherwise when they claimed that injuries usually follow a predictable pattern which makes them preventable (Nursing and midwifery board of Australia, 2016). Also, if pressure injuries risk factors are seen early, instituting appropriate interventions of preventions is the best way to tackle it. This policy states that keeping the patients skin dry and clean will help a lot in preventing pressure injuries. It also provides a continence plan for the aged care patients with incontinence that should be implemented using external or internal urine collection devices.

Policy Supporting Safe and Quality Care of Aged Care Patients

Pressure injury policy also indicates that, adult briefs should be avoided whenever possible as they are a source of moisture concealment and retention leading to skin damage, for aged patients with incontinence, which predisposes them to pressure injuries. There is also provision for the aged people who barely move when asleep, stating that they should be repositioned frequently as sleeping in the same position also predispose them to the injuries (Bliss, 2017). Generally, pressure injury policy ensures that the aged care patients are well taken care of reducing the occurrence of pressure injuries which they highly prone to due to the skin failure some of them experience. It also allow nurses to use pressure relieving devices which supports body weight redistribution but doesn’t negate the need for regular pressure area care as some of the high risk aged patients who use the pressure relieving devices might pave way for a decrease in turning frequency overnight to ensure sleeping patterns that are adequate hence it should be assessed on an individual basis to all the patients in the aged care centre.

Pressure injury policy also establishes the need for the aged patients with considerable mobility changes to have goals of care which are established by a multidisciplinary team collaborating with the caregivers (McInnes et.al, 2015). Also the patients who are receiving palliative care, especially, should have appropriate goals included in their management plan as palliative care has a stronger focus to manage comfort, symptoms which improve their quality of life. Pressure injury policy seeks to help the nurses in aged care centres to improve the knowledge of the underlying physiology of the pressure injury formation and to recognize pressure injury factors that contribute to its occurrence. It also helps the nurses identify the aged patients with the highest risk of getting the injuries, which help them document and implement prevention and intervention strategies and to also prevent any complications which are associated with these injuries from arising. These improve the patients quality of life to minimize the risk of pressure injuries dramatically declines.

Pressure injury policy enables the nurses to conduct a quality-of-life and psychological assessment, in order to assess pressure injury’s impact on the quality of life of the patients and their caregivers as well. This assessment will help determine the patient goals, along with the determination and ability that they have to participate in the care plan. Also states that, when an aged patient has this injury and is deemed healable, the commitment of the patient and that of the caregivers is very important in achieving outcomes which are successful and resource-efficient (Edomonds et.al, 2014). Also, through pressure injury policy, the nurses are able to ensure the safety of the aged patients by making sure that they make lifestyle choices that will not predispose them to pressure injuries as lifestyle factors are considered to be very important when identifying risks involved in the development of pressure injuries. This is because the aged people have a very high risk of developing pressure given their advancing age. This is due to the decline of their mental and general nutritional status, decreased mobility, incontinence, sensory perception deficits and also their skin’s changing characteristics. Therefore, being aware of the increasing risks will assist the nurses in targeting high-risk patients for prevention programs which ends up improving the quality of their lives.

Tools and Multidisciplinary Support for Aged Care Patients

According to Australian Wound Management Association, pressure injuries remains a health problem that keeps occurring frequently in Australia despite their avoidable nature and also despite the physical, emotional, financial and social burden they present to the caregivers and the individual patients. From the perspective of the Australian health system, the high readmission rate, increased length of stay in the hospital and also the cost of wound management are burdening as pressure injury care cost is estimated at 14 million dollars annually for the residential respite and aged care sector in Australia (Miles et.al, 2013). The pressure injury prevention policy is clearly demonstrable in Australia due to the inclusion of standard 8: management and prevention of pressure injuries in the Australian National Safety and Quality Health Service Standards as it appears to contribute to the gradual decline in the prevalence of pressure injuries in an aged care setting. The clinical guidelines laid out are one of the strategies that are associated with the improved benefits for the patients and healthcare systems which includes a decrease in prevalence rates of preventable diseases.

In Australia, the policy is also addressing the care of older adults, individuals who have spinal cord injury and also those in critical care and palliative care settings. This policy also focuses on various factors like the support surfaces and also the positioning of aged adults who can’t move by themselves which prevents pressure injuries. It also recommends that skin temperature and changes in surrounding tissues consistency be prioritized when skin assessment is conducted or while classifying pressure injuries. This is also due to the impact of body temperature and skin moisture which are factors that should be considered during comprehensive risk assessment as they influence microclimate which increases pressure injury risk. On implementation of this policy, it addresses the management and assessment of facilitators and barriers to its implementation, where it focuses on the organization and facility level strategies which promote the uptake of the best practices of pressure injury prevention. Pressure injury policy also addresses the process, outcome and structure indicators of pressure injury management and prevention strategy (Coleman et.al, 2013). Lastly, this policy addresses the caregivers and the aged patients recommending on the responsibilities of the patients in ensuring that they get optimal care.

Pressure injury policy is still relevant as it has created sustainability of an individualized prevention maintenance or protocol of a healed injury which depends on access to appropriate services and equipment in collaboration with the individual with a high risk of pressure injury, service providers, caregivers and the healthcare professionals. This is because the successful sustainability of the policy programs is dependent on strong management and leadership skills so as to identify the injury prevention as a key priority so as to ensure optimal outcomes. Also, goals of care such as quality-of-life issues, wound closure and also symptom control might not occur until underlying causes of pressure injury is optimized hence the importance of pressure injury policy which recommends, assess, potentially revises and also re-evaluates the treatment plan so as to address the gaps for modification (Allman et.al, 2015). Also by using validated tools, prevention and treatment plan goals can be determined by the clinicians. This is because pressure injury prevention is the ultimate goal.

Conclusion

The importance of working using the up to date practices is because they are supported by the best evidence available where the policy’s implementation will require patient level reflection and also considering resources available, clinical circumstances and the patient-clinician relationship, or nurse preferences. It also helps on reflecting direct clinical evidence paucity by addressing the aspects of treatment and the prevention of pressure injuries (Junkin et.al, 2017). The policy provides for extensive guidance in the areas of interest and also contains a more comprehensive address on management and prevention of pressure injuries in populations with special interest like aged care setting. Also, the policy recommends the application of polyurethane foam dressing by bony prominences which minimize the exposure to shear and friction forces. The best quality of evidence that supports these was gotten from a recent study in Australia that suggested that, in selecting a prophylactic dressing, its impact to microclimate should be given much consideration as it helps in preventing pressure injuries due to the continued skin assessments.

Pressure injury policy is of paramount significance. But despite the focus on prevention, pressure injury incidents in aged care patients haven’t significantly decreased. This shows that an integrated prevention approach is required across all health care system areas in Australia so as to make a difference in the incident rates. For optimal effectiveness and acceptance, the integrated teams should include other departments such as housekeeping, the patients and their families. According to the Australian department of health (2017), several strategies such as liaising with case managers and planning care and regular contracts can aid in addressing chronic health issues such as pressure injuries in aged care setting. Additionally, communication and collaboration across all the sectors and departments are crucial to ensuring that the outcomes are optimal and patient-centred for the management and prevention of pressure injuries in these patients. In all injury management or prevention cases, customized care plans should be implemented. Monitoring clinical outcomes is crucial to driving practice and culture changes necessary to manage and prevent pressure injuries. Implementation of this policy and identifying the facility barriers to resolve these issues is imperative in supporting the changes required. Pressure injury policy have been recognized as a quality measure in Australia in both hospitals and long-term care and hospital pressure injury rates, nationally, are being reported and are also facilities being named. Time has come to ensure the prevention of pressure injuries becomes a key component in all aspects of safe patient care.

References:

Allman, R. M., Goode, P. S., Burst, N., Bartolucci, A. A., & Thomas, D. R. (2015). Pressure ulcers, hospital complications, and disease severity: impact on hospital costs and length of stay. Advances in wound care: the journal for prevention and healing, 12(1), 22-30.

August, D. L., Edmonds, L., Brown, D. K., Murphy, M., & Kandasamy, Y. (2014). Pressure injuries to the skin in a neonatal unit: fact or fiction. Journal of Neonatal Nursing, 20(3), 129-137.

Australian Department of Health. (2017). Best-practice examples of chronic disease management in Australia. Retrieved from https://www.health.gov.au/internet/main/publishing.nsf/content/health-care-homes-best-practice

Australian wound management. Wounds Australia responds to the new edition of the national safety and quality health care standards. Retrieved from. https://www.woundsaustralia.com.au/pages/wac.php

Bliss, M. R. (2017). Pressure injuries: causes and prevention. Hospital medicine : 2017), 59(11), 841-844.

Coleman, S., Gorecki, C., Nelson, E. A., Closs, S. J., Defloor, T., Halfens, R., ... & Nixon, J. (2013). Patient risk factors for pressure ulcer development: systematic review. International journal of nursing studies, 50(7), 974-1003.

Erin, T. (2012).  Illness as Narrative. Composition Studies, 40(2), 45-50

Junkin, J., & Selekof, J. L. (2017). Prevalence of incontinence and associated skin injury in the aged care patient. Journal of Wound Ostomy & Continence Nursing, 34(3), 260-269.

McInnes, E., Jammali?Blasi, A., Bell?Syer, S. E., Dumville, J. C., Middleton, V., & Cullum, N. (2015). Support surfaces for pressure ulcer prevention. Cochrane Database of Systematic Reviews, (9).

Miles, S. J., Nowicki, T., & Fulbrook, P. (2013). Repositioning to prevent pressure injuries: evidence for practice. Australian Nursing and Midwifery Journal, 21(6), 32.

Nursing and midwifery board of Australia. (2016). Enrolled nurse standards for practice.