Evidence based practice paper
Bkomama
Borma.docxRunning head: BEST NURSING PRACTICE IN TISSUE INTEGRITY 1
BEST NURSING PRACTICE 2
Best Nursing Care Practice in Tissue Integrity
Borama Edao
Herzing University
Best Nursing Care Practice in Tissue Integrity
One of the most important and basic needs of a patient is keeping their body’s first line of defense or skin healthy from the invasion of pathogens. Effective defense mechanism from numerous invasive microorganisms keeps healthy and intact tissue/skin. This research paper discusses the best nursing care practices to maintain tissue integrity, particularly from venous stasis ulcers. Before going deep into the best nursing care practice in maintaining tissue integrity from venous stasis ulcer general description of pressure ulcers will be discussed. According to Hughes (2014), “A pressure ulcer is a localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure in combination with shear.”
As a nursing student and resident assistant in an assisted living facility, a student nurse has experienced the best nursing care practices in maintaining tissue integrity. There are multiple nursing intervention practices in those healthcare facilities where student nurses had a chance to intervene in best nursing practices to maintain skin or tissue integrity. “Pressure ulcers are generally considered to be preventable. As such, the presence of pressure ulcers is often seen as a quality of care indicator. They represent a major source of emotional and financial distress for patients, significantly affecting quality of life” (Hughes, 2014). As a nursing student being part of a service in alleviating the discomfort faced by the patients due to pressure ulcers and intervening to maintain their tissue integrity is priceless.
As it is discussed in the previous paragraph, prolonged soft tissue compression between a bony prominence and the outer surfaces cause pressure ulcer resulting in skin breakdown. There are well structured best nursing care practices used in healthcare facilities to maintain tissue integrity and to prevent pressure ulcers. The most commonly followed five-step model practices in most healthcare facilities are listed as follows. The first step is frequent skin inspections that ensure red areas to be treated quickly. The second step is ensuring patients are assessed and have the most appropriate mattress, seating, and other devices that help in maintaining skin or tissue integrity. The third step is turning or repositioning the patient per the plan when in bed or ensuring that they can stand and walk. The fourth step is to manage continence or leaking wounds and preventing dry skin, which is one of the increased moisture management. The fifth step is providing the appropriate nutrition to meet patient needs in maintaining their tissue integrity (Hughes, 2014). Working in a healthcare environment and attending clinical rotations, student nurse has witnessed and was involved in the best nursing care practices to prevent a pressure ulcer.
The core concept of this paper is to have the best nursing practice in maintaining tissue integrity that ensures the highest standard of care. Therefore, the healthcare provider has to construct pressure ulcer prevention strategies that keep the tissue or skin healthy or intact. To construct the prevention strategies, the provider or the nurse has to have a good understanding of the risk factors that may contribute to the development of pressure ulcers. According to Hughes (2014), “A number of intrinsic factors may contribute to the development of pressure ulcers, including increasing age, level of activity and mobility, poor oxygen perfusion, body weight, poor nutritional intake and dehydration, general health status and morbidities, e.g. diabetes. Extrinsic factors contributing to pressure ulcer development include pressure, friction, shearing, temperature, moisture, and medication.” Therefore, understanding the intrinsic factors leading to pressure ulcers anticipates the healthcare personnel to construct the prevention strategies such as teaching the patient how maintaining healthy body weight can decrease the precipitating factors that cause pressure ulcers. Encourage the patient to get involved in an appropriate exercise in preventing morbidity that leads to pressure ulcers.Student nurse should educate patients about the health conditions that cause poor oxygen perfusion. Teach patient the prevention measures to the health conditions that lead to poor oxygen perfusion and venous insufficiency. On the other hand, understanding the extrinsic factors contributing to pressure ulcer makes the healthcare personnel extra cautious when taking care of the patient.
However, while repositioning a patient, the caregiver or the nurse has to avoid friction and shear caused by the bed or bed sheet surface to the skin. Therefore, healthcare facilities usually decide assistive care instructions and number of assistive personnel for repositioning based on the condition of the patient. The assignment for the assistive personnel during the process can be extensive assistance, one (1 personnel), or extensive assistance two (2 personnel). “Safety is the primary concern when determining a patient’s position for a procedure. The number of personnel and devices must be adequate to safely transfer or position the patient preoperatively or intraoperatively. Transferring is accomplished with a lateral device that reduces friction and shear” (Walton-Geer, 2009). The repositioning task is performed in a similar way of care during safe transfer and positioning during procedural preparation.
Since the core concept of this paper is to have the best nursing practice in maintaining tissue integrity that ensures the highest standard of care, student nurse’s experience taking care of a patient with venous stasis ulcer is discussed. The student nurse had a chance to take care of a patient with a high risk of pressure ulcer; the patient was amorbidly obese 72 years old female with a history of diabetes mellitus and a smoker for more than 30 years. The patient also has a history of a sedentary lifestyle, high consumption of processed or fast food, and high alcoholconsumption. The patient had left lateral malleolus pressure ulcers and was high risk of falling.“Leg ulcers are defined as chronic non-healing wounds on the legs or feet. Leg ulcers may be arterial, diabetic, vasculitic, traumatic or malignant in nature, but venous leg ulcers are the most common type” (Regmi, 2012).The patient who was getting care from the student nurse has leg pressure ulcer on the left lateral malleolus, and the nursing team in the facility was taking all measures to maintain tissue integrity.The expected outcome from the intervention was to maintain the skin integrity and heal the wound, resolve patient’s reduced quality of life, prevent further tissue damage with less financial cost to both parties.
According to the evidence-based research statement in the previous paragraph about leg ulcers, the most common type of leg ulcer is venous leg ulcer. The chronic non-healing wound on the patient’s left lateral malleolus was venous leg ulcers. The venous leg ulcer on the patient’s left leg was very challenging to manage and took a long time to heal than other kinds of leg pressure ulcers. The pathophysiological process that affected the patient’s care for their venous leg ulcers was; patient's age, etiology of the ulceration, diabetes, smoking, and location of the wound (over the bony prominence). According to Regmi(2012), “3.6%of leg ulcers occur in people over the age of 65. The prevalence of leg ulcers to be 1-2%in the adult population in the western world,with approximately 90% of ulcers being vascularin origin and the remaining 10% accounted forby other skin problems suchas diabetic ulcers orskin cancer.” The venous leg ulcer on the patient was a category three pressure ulcer, and the facility was using KerraPro pressure-reducing pads over a foam dressing with hydrofibre. This best nursing care practice was very effective in relieving pressure and protecting the wound from additional trauma such as friction and shear from the bed and bedsheet surfaces. In addition to the use of the Silicone pressure-reducing pads, the nursing team in the facility was following all the pressure ulcer prevention steps such as skin inspection, providing appropriate surface, proper way of repositioning, increased wound moisture management, and appropriate nutritional provision.
Even though, the nursing intervention used to maintain the skin integrity of the patient discussed in this paper; evidence-based researches describe that to confirm effective nursing intervention of venous leg ulcer it is crucial to identify the reason of the ulceration and assess accurately. “Cheesbrough (2002) suggested that venous leg ulcers are often treated or managed inappropriately as a result of inadequate assessment and that ulcers are notdiseases, but rather signs and symptoms of othervascular conditions such as vasculitis and venousinsufficiency” (Regmi, 2012). Therefore, if the patient’s ulcer assessment is not thorough or detailed and does not rule out other possible causes of the ulceration, the intervention to maintain tissue integrity will be ineffective. As a result, there will be prolonged wound healing, and the patient, as well as the healthcare provider, faces increased unsuccessful financial cost, and the patient suffers from the discomfort.It is obvious that when a person/patient has a wound/ulcer on the lower extremity particularly in a location where they use it for wearing shoes, mobility becomes difficult. Thus, the impaired mobility by the patient will reduce patient’s quality of life. The role of a nurse, student nurse, and healthcare provider is to resolve patient’s reduced quality of life and heal the wound quickly and with less cost.
In conclusion, since the skin is the body’s first line of defense against pathogen’s invasion, one of the basic needs of the patient is to maintain tissue integrity. Multiple nursing interventions keep the tissue of a patient intact or prevent further destruction of tissue integrity. It is discussed that student nurse’s being part of a service alleviating the discomfort faced by patients due to venous pressure ulcers and intervening to maintain their tissue integrity is priceless. Maintaining tissue integrity that ensures the highest standard of care, resolving the patient’s reduced quality of life, and intervention with less financial cost to both parties is the best nursing practice. The expected outcome from the intervention was to maintain the skin integrity and heal the wound, resolve patient’s reduced quality of life, prevent further tissue damage with less financial cost to both parties. Accurate and thorough assessment and identifying the reason for the ulceration is crucial to ensure effective nursing intervention of venous ulcer.
References
Hughes, M. A. (2014). Silicone pressure-reducing pads for the prevention and treatment of pressure ulcers. British Journal of Community Nursing, 19(Sup3), S46-52. Retrieved fromhttps://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=103960615&site=ehost-live
Regmi, S., & Regmi, K. (2012). Best practice in the management of venous leg ulcers. Nursing Standard (through 2013), 26(32), 56-56, 58, 60 passim. Retrieved from https://prx-herzing.lirn.net/login?url=https://search.proquest.com/docview/1004125876?accountid=167104
Walton-Geer, P. (2009). Prevention of pressure ulcers in the surgical patient: The official voice of perioperative nursing the official voice of perioperative nursing. AORN Journal, 89(3), 538-48; quiz 549-51. doi: http://dx.doi.org/10.1016/j.aorn.2008.12.022
