nursing research

The Prevalence of Pressure Ulcer and Pressure Injury  in the Hospital & Skilled Nursing Facility

NAME

Grand Canyon University

June 1, 2019

Background of Study

The research indicates that hospital-acquired pressure injury( HAPI) has been on the decline in America between 2010 and 2014 as a result of efforts by Medicaid and Medicare services as well as the Agency for Healthcare Research and Quality. In the study by (Rondinelli, Zuniga, Kipnis, Kawar, llu, & Escobar 2018) the background information shows that the study establishes that despite health care institutions having reduced rates of hospital-acquired pressure injuries, the situation is not eliminated. Resultantly, there is need for assessment in both health service and nursing research. The objective of the study is to offer a description of HAPI incidence, risk-adjusted hospital variation, and risk factors within the contemporary integrated healthcare system of California among 35- hospital inpatient cohort. The focus was given to Kaiser Permanente with conceptual consideration of immobility, tissue tolerance, decreased activity, change in sensation, and immobility. Other aspects like acute illness and chronic conditions. The study offers the following significance to the study to enhance understanding of HAPI, what causes it, and the prevalence cases.

Pressure ulcer (PU) is caused by multiple factors and its pathogenesis shows a multifactorial process that involved hormonal changes, inflammatory aspects, impaired blood perfusion, degenerative changes, and reduced immune protection. A disturbingly rising situation in PU cases among the old especially those who suffer from frailty and chronic illnesses calls for higher awareness of therapeutic and preventive measures like protecting the bony areas with pads and repositioning every 2 hours to combat this. In the second study conducted by Jaul, Barron, Rosenzwig, Menczel (2018) reports that among the elderly, pressure ulcers are prevalent, and they continue to rise as well as increase costs especially on the older adults who ail from chronic diseases. The study observes that currently there is a high level of awareness to extensive, preventive, and therapeutic processes for treating pressure ulcers with internal risk factors being comorbidities that agreeably increase pressure ulcers. The study pays attention to common chronic illnesses such as diabetes, cardiovascular complications, renal diseases, chronic pulmonary complications, and neurodegenerative disorders. Besides, conditions such as anemia, malnutrition, incontinence, disability, frailty, and hospitalization are essential in the multi-disciplinary study of PU in old patients. The objective of the research is to offer a description of acute and chronic conditions that are risk aspects in elder patients for developing PU.

How do these two articles support the nurse practice issue I chose?

The first article by Rondinelli et al. (2018) assists the study by answering the PICOT because it shows the prevalence of HAPI in healthcare as related causes. On the other hand, the second study inquiries into the prevalence of PU among elder patients are how risk factors increase such cases. Both studies have a relevant objective that answers the PICOT question of the study.

Method of Study:

In the first article, the method the study used was a longitudinal analysis of retrospective inpatient episodes for patients who were hospitalized between January 1st, 2013 and June 30th, 2015 (Rondinelli et al., 2018). The key outcome was the emergence of a HAPI over time. Among the predictors in the case included HAPI risk factors using the Comorbidity Point Score, the severity of illness through the Laboratory-Based Acute Physiology Score, and the Braden Scale for predicting Ulcer risk. There was the observation of the patients and documentation of information on HAPI across the 35 hospitals.

On the contrary, in the second study by Jaul, Barron, Rosenzwig, Menczel (2018), there is an overview of comorbidities with PU in three diverse patient settings which are the acute hospital, community, and long-term health care with patients who have chronic diseases, old, and with pressure ulcer grade 2 and over. The study too relied on the European and National Pressure Ulcer Advisory Panels’ conceptual framework, which covers indirect, potential, and direct causal risk factors, it becomes possible to assess chronic illnesses to determine the risk factors of chronic conditions and complicating situation that possibly have an impact to the risk for the development of PU.

Results of Study

From the first article by Rondinelli et al. (2018), it is indicated that out of an analysis that involved 1661 HAPI inpatients and 726,605 non-HAPI episodes, the HAPI prevalence was 0.57 among 1,000 patient days which is 0.2 percent of episodes. There were a significant protective HRs among female patients who were in the emergency room for a medical cause. It means an age, the severity of illness, comorbidity indexes, and the Braden score as essential predictors of the HAPI prevalence. The study indicates that HAPIs is fertile ground for research and quality improvements plans. Furthermore, the use of patients within the same context offered low baseline HAPI incidence, meaning in future studies there should be a recalibration of the model. The inclusion of diabetes led to a nonsignificant HR for a predictor that has a strong association with HAPI. Therefore, future studies require to analyze the administrative, hospital, and staffing aspects that can quantify the incidence-based interventions and how they impact on HAPI incidences. An exploration of large data sets, the potential of EMR-generated composing scores, and predictive analytics are necessary. Besides, comorbidity burden score, Braden Scales scores, and severity-of-illness scores are important here. There is substantial inter-hospital variation in HAPI incidence a situation remarkable where variables are included.

The results in the second study by Jaul, Barron, Rosenzwig, Menczel (2018) it is shown that advanced heart disease where there is low cardiac output and/or decreased oxygenation, impact in situations of blood perfusion and peripheral ischemia that contribute to the emergence of PU. When a patient has cerebrovascular accidents or dehydration or edema, then there are higher chances of having PU. With diabetes, a patient lacks sensory perception from diabetic neuropathy, hence non-healing wounds occur especially on the foot. Other vascular complications and pressure When people age, pulmonary functions go down, there is a decline in vital capacity, increase in airway dead space and a decline in hypoxia, ventilatory response which reduce lung functioning. Moreover, the issues of inflammation, advanced pulmonary disease cause PU. The prevention of PU among adults with severe pulmonary illnesses, calls for management of edema, minimization of bedrest while ill, optimization of nutrition, and optimization of endurance and activity.

For patients with a decline in the functioning of the kidney in aged individuals after the glomerular filtration rate and renal blood flow declines. More illnesses like hypertension and diabetes increase impaired kidney functioning cause issues of chronic illnesses and PU (Jaul, Barron, Rosenzwig, Menczel, 2018). Besides, musculoskeletal disorders, neurodegenerative disorders, and common conditions of malnutrition, anemia, and infectious disease prevent the healing of wounds and result in concurrent infections that cause PU. It is also inevitable for elders with incontinence, hospitalization, and polypharmacy increase incidences of PU. It thus becomes important that people who care for the elders and the elders themselves closely monitor risks and work against them for the better health of the people. it is important that using chronic participants could expose a lot of data on the prevalence of PU and help prevent it.

Ethical Considerations

In the first study by Rondinelli et al. (2018), there was a mutually exclusive agreement that sought approval from KP Northern California and Southern California Institutional Review Board for the safeguarding of the participants by checking braden scale during admissions and protecting, repositioning patients every 2 hours and protecting the bony areas of at risk patients with ABD pads. On the other hand, in Jaul, Barron, Rosenzwig, Menczel (2018) there is no ethical consideration.

References

Jaul, E., Barron, J., Rosenzwig, J.P., Menczel, J. (2018). An overview of co-morbidities and the development of pressure ulcers among older adults. BMC Geriatrics, 18, 305. doi:https://doi.org/10.1186/s12877-018-0997-7