Signature Assignment - Evidence-Based Project Proposal

Negative Pressure Wound Therapy for Pressure Ulcers

Name

Institution

Negative Pressure Wound Therapy for pressure ulcers

A selected topic from the approved list: Implementing a clinical practice guideline for the treatment of pressure ulcers among the old.

PICOT question: For elderly patients above 60 years with pressure ulcers (P) will the negative pressure wound therapy (I) as opposed to standard moist wound therapy (C) improve the healing of the pressure ulcer (O) during their two-week stay at the hospital (T).

Introduction

Pressure ulcers are cellular necroses that develop when soft tissues of the skin are compressed between a bone and hard surface for a long time. This results in the reduction of blood flow in these areas which in turn damages the skin. According to epidemiology studies, the prevalence of pressure ulcers is between 7% and 12%. 71% of these are among patients aged 60 years and above. 70% of the complications observed among elderly patients hospitalized in various institutions are pressure ulcers. Pressure ulcers lead to prolonged lengths of stay in the hospitals thus having a great impact on the economy. Treatment costs for pressure ulcers are also very high. This treatment depends on the time when the ulcer has been diagnosed and the stage it is. The estimated annual cost of treating pressure ulcers in the United States exceeds $20 billion (Mervis & Phillips, 2019).

Various risk factors are associated with pressure ulcers and these may be intrinsic or extrinsic. Intrinsic factors involve a lack of mobility and other chronic diseases that may lead to the development of pressure ulcers. Age is also an intrinsic risk factor in pressure wounds. Poor nutrition, decreased sensibility towards pain, as well as the use of certain medications, are also intrinsic factors that can cause pressure ulcers. There are four main extrinsic risk factors associated with the development of pressure wounds. Among these are pressure, shear, moisture, and friction. The time of exposure to pressure is a risk factor in the development of pressure ulcers. Even less than an hour of unrelieved pressure is enough to cause tissue damage (Bereded et al, 2018).

The elderly are more susceptible to developing pressure ulcers. This is because with the advancement of age certain changes occur in the body which makes the skin more fragile. The cell layers become thinner and the skin becomes more sensitive. Response to pain reduces which causes the elderly not to respond fast to pressure. The inflammatory response is also reduced leading to increased vulnerability to injury. Most elderly persons also do not have the knowledge of the risk factors associated with pressure ulcers making it difficult for them to protect themselves from these risk factors (Jaul et al, 2018).

Pressure ulcers among the elderly may advance to become chronic for no clear reasons. A large number of pressure ulcers among the elderly become chronic wounds whose complications lead to the death of the patient. Pressure ulcers result in other pathological conditions. To effectively assess and manage pressure ulcers among the elderly, an approach that is comprehensive and multidisciplinary has to be adopted so that the patient can be understood better. Nurses have to consider the underlying pathological conditions of the patient and how severe their primary illness is. Understanding their nutritional status as well as the social and emotional support available for them is just as important as focusing on the wound itself (Jaul et al, 2018).

The most important thing in treating and managing pressure ulcers is reducing any risk factors that could lead to the development of pressure ulcers. However, if the pressure ulcer has already developed, the goal is to treat it using the best intervention so that underlying illnesses can be managed. Treatment also aims at controlling the symptoms of the wound to ensure that the overall well-being of the patient is enhanced. There has been advancement in the treatment approaches to pressure ulcers. These have ensured that control of symptoms and complications prevention is enhanced (Kottner et al, 2019).

Problem overview

Various approaches have been recommended for the treatment of pressure ulcers among the elderly. There are however notable shortcomings in these approaches which result in gaps of treatment. This has necessitated the development of more evidence-based solutions. This research will focus on negative pressure wound therapy and the standard moist wound therapy as interventions to treat pressure ulcers among the elderly.

The standard moist wound therapy has for a long time been used to treat pressure wounds. This intervention involves keeping a wound in a moist environment to enable it to heal faster. According to research, moist wounds tend to heal faster than dry wounds. Since the late 1980s, various researches have been conducted with reference to standard moist wound therapy which has led to the development of wound dressing products. This intervention prevents the wound from developing as a scab which means that little time is required for the wound to heal. It also decreases the chances of infection on the wound and preserves the growth factors in the wound. The fact that it reduces pain and scarring are also among the factors that caused it to be adopted as the standard therapy for pressure ulcers (Boyko et al, 2018).

Advancement in technology resulted in the development of negative pressure wound therapy. In this, a machine is attached to the wound dressing covering the pressure ulcer. This machine is aimed at exerting negative on the wound which sucks tissue and wound fluid from the ulcer leaving it dry to enhance healing. Clinicians still remain unclear on how to use this technology to treat pressure ulcers effectively. Research has shown that negative pressure wound therapy reduces the area covered by the wound faster than other intervention methods. Research has also indicated that negative pressure wound therapy is a superior treatment option for pressure ulcers compared to the rest (Fernandez et al, 2017).

Lack of compliance with therapy guidelines has been a barrier to the effectiveness of negative pressure wound therapy. Although negative wound therapy has been found to improve the healing of pressure wounds in various instances, there is still a question on whether this approach is superior to the standard moist wound therapy especially in the treatment of pressure ulcers among the elderly. Negative pressure wound therapy has proven to be more effective than the optimal wound bed preparation approach this means that if conducted the right way, negative pressure wound therapy has the potential to heal pressure wounds better than other approaches. There have been several limitations to studies conducted to compare the negative wound therapy and the standard moist wound therapy. It is therefore not clear which of the two interventions can lead to the faster healing of pressure ulcers among the elderly within two weeks (Seidel et al, 2020).

As knowledge and expertise regarding negative wound therapy continue to evolve, it continues to expand and make more effective the approaches of treating pressure ulcers among the elderly. The choices of treatment also continue to expand. Nurses, therefore, need to expand their knowledge on the effectiveness of the negative pressure wound therapy and the standard moist wound therapy in treating pressure ulcers among the elderly. Expanding knowledge means determining which one of the two approaches is more effective in treating pressure ulcers among the elderly. The fact that there is no consensus yet on which of the two approaches is the most effective leaves us with the question of which approach can treat pressure ulcers faster and more effectively. This research aims to answer this question by establishing if negative pressure wound therapy can heal pressure wounds among the elderly faster than the standard moist wound therapy.

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