An increase in the utilization of technical conditions necessary for the existence of modern people leads to an increase in the absolute number of man-caused accidents and diseases. In this regard, it is associated with multiple injuries and prolonged stay of the patient in the intensive care unit. Characteristic conditions that include impaired consciousness, unstable fractures, and immobility can affect the performance of medical practitioners, if care deficiency leads to the formation of pressure sores.
The most pressing problem concerning bedsores is an increased demand for efficiency and improvement of the preventive methods against the formation of pressure ulcers. Training nurses may prevent bedsores in patients who are at the highest risk of developing pressure ulcers. The paper will discuss the problem of pressure ulcers in elderly patients, role of nurses, healthcare policies, and ethical issues.
Pressure ulcers are chronic ulcers of soft tissue that occur in patients with sensory disturbances (usually located in a fixed state) due to compression, friction of skin or as a result of a combination of these factors (Whitney et al., 2006, p. 664). The treatment of patients with pressure ulcers is serious medical and social problem. With the development of pressure ulcers, the duration of patients’ hospitalization has increased. There is a need for additional dressings, medicines, tools, and equipment. In some cases, the treatment of pressure ulcers requires surgery. In addition to the economic costs that are associated with the treatment of pressure ulcers, the intangible expenses should be taken into account.
They include severe physical and mental suffering that is experienced by the patient. The occurrence of pressure ulcers is often accompanied by severe pain, depression, and infectious complications (abscess, suppurative arthritis, osteomyelitis, sepsis). The development of pressure ulcers is invariably associated with a high mortality rate. Undoubtedly, the initial reason for the development of pressure ulcers is immobility and its pathological prolonged pressure on certain areas of the body. In addition, there are a great number of individual risk factors related to this condition. Modern methods of treatment and care are based on a holistic approach to the patient and are not confined to the treatment of pressure ulcers. The treatment of pressure ulcers in the elderly is a complex process, so it is better to prevent their occurrence. Adequate prevention of pressure ulcers will eventually lead to the reduction in direct medical costs that are associated with the treatment of pressure ulcers, as well as direct non-medical, indirect and intangible costs.
Nursing process, as well as medical treatment, is a basic system of medical care. The treatment and prevention of pressure ulcers is quite a challenge, both for the patient and for his/her family members and medical personnel. Despite multidisciplinary responsibility, the key role is played by nurses. They help to establish contacts with groups that provide help to these patients, and provide training and support to those who work with heavy or dying patients. People with disabilities living in nursing homes are at an increased risk of developing pressure ulcers. Therefore, the staff in such institutions should be trained in the prevention and treatment of pressure ulcers. “The responsibility ranges from the chief nursing officer to the bedside nurse to make sure treatment plans are implemented and evaluated, not just developed” (Wurster, 2007). Checking the condition of the skin should be an inherent part of the nursing process, both at home and in the hospital. The first step in the treatment of pressure ulcers is the reduction of pressure. Nurses should take into account the importance of changing patients’ position (Whitney et al., 2006, p. 667). A patient with bedsores should be regularly turned and put rightly. If the patient uses a wheelchair, it is necessary to change his/her position as frequently as possible. The nurses have to provide supporting devices. Special gaskets, linings, mattresses and beds are widely used for the prevention and treatment of pressure sores. Doctors and nurses, who are engaged in palliative medicine, provide pain relief to the patient and help the family to determine the goals of the treatment of pressure ulcers in the terminal patients. The task of a nurse is to develop an individual plan of care for the patients, so that the patient and his/her family would be able to adapt to changes that may arise in relation to the health problems.
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The potential issues include difficulties in monitoring patients’ positions, ineffectiveness of turn reminders, and shortage of the staff. “To address the need for improved pressure ulcer prevention and treatment methods, Leaf Healthcare has developed the Leaf Patient Monitoring System” (Leaf Healthcare, 2014). This innovative system of monitoring is aimed at improving the efficiency and care by coordinating turning. The system provides information regarding the patient’s position, enabling staff to identify which patients need assisted turning. The system ensures that patients are not neglected. Moreover, it can reasonably coordinate and optimize turning schedule for a group of patients and, thus, contribute to prioritizing turning needs.
The prevention of pressure ulcers should be an intensive care unit for nurses. The problem is more serious when there are staff shortages and turnover. The development of pressure ulcers is directly related to the number of nurse and bedside time. Professional care for critically ill patients consists in the highest quality care. The art of care lies in caring for the patient with individual characteristics, character, habits, and desires. Creating favorable environment for patients, delicate and tactful attitude, and willingness to help at any moment are the prerequisites of qualitative nursing care.
The problem of accessibility, quality of care and safety of the population is probably the most vividly discussed and relevant issue. There is a need to compare healthcare policies to provide a combination of a sufficient level of quality and cost-effectiveness of medical interventions. An alternative strategy should be aimed at achieving a high level of health care quality and safety of the population at all levels of the provision of medical services.
The treatment of bedsores is a complex process, requiring enormous costs of caring for the sick during a long time. Difficulties also arise during the daily hygiene in terms of the need to protect the diseased, and change the position as well as during the antidecubital procedures. There is a need to teach medical personnel the specific techniques required for the assessment of highly pigmented skin, as well as develop the ability to distinguish pressure ulcers from other wounds. Healing monitoring should be performed with the use of approved funds. If healing does not occur as expected, regimens should be modified. It is necessary to analyze the quality of nutrition and provide additional nutrition in accordance with the recommendations of the nutritionist. It is necessary to evaluate the pain and choose the best ways to mitigate it.
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It is important to select a suitable bearing surface and take caution when it comes to changing the position of the patient’s body. When choosing the bandage, it is necessary to take into account the individual characteristics of every wound including the severity of exudation, the condition of the wound, infection, location and condition of the surrounding skin (National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance, 2014). Medical practitioners can consider using specialized treatments, such as vacuum therapy. Treatment of decubitus sores is associated with an increased demand for anti-bedsore treatment to inhibit the development of existing decubitus and protect the patient from the occurrence of new lesions due to insufficient blood supply to the tissues. Pressure sores worsen the patient’s state of health and can lead to serious complications.
In comparison with the treatment, there is the economic feasibility of early-onset prevention of pressure ulcers in people who are at a risk of their formation, particularly in those who use diapers (due to urinary incontinence), as well as in paralyzed patients. Every dollar invested in the proper care will guarantee huge savings not only financially, but also non-materially helping to prevent pain and suffering of the patient, as well as relieve caregivers from unnecessary work that cannot be measured by money. Care systems should take rational steps to ensure the assessment and screening of pressure ulcers. Prevention strategies should be documented and implemented without delay. Therefore, compared to the healthcare policies in relation to pressure ulcers, prevention strategies prove their effectiveness.
The main ethical issues in terms of the treatment of pressure ulcers are associated with improper care and perception of the patients. The quality of life becomes a crucial issue for modern people. Human suffering, cost of care, and ethical problems are of crucial importance for the system of healthcare. “Population at risk for pressure ulcers” can be “considered less worthy recipients of scarce resources than other citizens” (Maklebust & Sieggreen, 2001). People who have no opportunity to contribute to the society may receive improper care. Accordingly, a terminally ill person is an outcast of the society, not only because of the loss of formal status and role, connections and relationships, but also because of a negative perception of the patient. The diagnosis of the disease is often perceived as a verdict, after which an invisible wall of alienation and stigma grows between the patient and the outside world. The feelings of loneliness, isolation, sense of hopelessness and despair are added to the physical suffering of the patient.
The decision regarding the ethical issue in relation to bedsores treatment consists in ensuring proper treatment measures. “The ethical obligation is to provide care that is consistent with the patient’s goal” (Maklebust & Sieggreen, 2001) Caring for immobile elderly patients is associated with certain difficulties. The nurses need much more time to perform a variety of procedures and manipulations. A nurse should remember that people become more vulnerable with age. They often exaggerate the severity of their own state, making unfounded complaints. Sleep disorders, which are common for elderly bedridden patients, lead to a breach of recommended daily routine. The nurses should remember that the most traumatic psychogenic factors leading to the emergence of somatic complications are indifference and formal attitude to the nursing duties. A serious problem in providing care for patients with pressure ulcers is a stressful situation, negative emotional load on nurses, their physical and psychological exhaustion. The constant clash with the patient’s suffering requires a lot of spiritual and physical strength to provide conditions and means for their recovery. The staff outflows as well as their selection and training are serious problems.
Today, many countries invest in strengthening the care level, especially in terms of the development of home-based care programs. At the same time, hospitals play a crucial role in the delivery of complex specialized care. Hospitals represent a significant part of healthcare system and play an essential role in shaping the perception of health systems. The prolonged nature of chronic diseases requires a comprehensive response, which brings together affordable technologies and trained workforce. Home-based care systems do not have proper equipment to provide comprehensive response.
Nevertheless, home-based health delivery system has certain advantages. Thus, in such conditions, the patient receives more attention. In regard to pressure ulcers, an individual approach is of crucial importance.
Adequate anti-bedsore activities should be carried out after the nursing staff training. Students, who are going to work with patients suffering from particular wounds, should develop and increase their skills and knowledge to meet patients’ needs. A learning program has to prepare students to perform their duties in the delivery of wound care.
Students should know physiology of pressure damage, epidemiology, grades of pressure ulcers, methods of patients’ assessment, care pathways, and methods of treatment. Moreover, students should acquire knowledge about pain, as well as social and psychological challenges that are related to pressure ulcers. Moreover, in order to improve the quality of care for the patients with pressure ulcers, it is important to design refresher courses and in-service training. The nurses have to revise and update their knowledge to translate methods of pressure ulcers prevention into practice. There is a need to ensure that the elderly person receives not only physical but also psychological help. In the course of the patient care, it is important to consider the characteristics of the individual patient, as well as his/her mood.
The implementation of care for elderly patients is a rather complicated and responsible task that requires special skills and much attention and patience. Home-based health delivery system has many advantages as it ensures an individual approach in the course of patient treatment. The most important principle of general care, which must be kept in mind, is respect for the patient’s personality. Nurses play a crucial role in caring for such patients. The students’ programs should be designed to prepare high-qualified nurses that possess knowledge about the difficulties and peculiarities of the treatment of pressure ulcers.