Pressure ulcers in the skin

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Evidence based nursing
Outline of Clinical Issue
Brief description
Pressure injuries occur due to a breach in the skin as a result of unrelieved pressure on tissues that have been pressed between an
external hard surface and a bone. Along with these, other contributing factors include friction, poor blood flow and tissue ischaemia.
The time period for which the skin is exposed is also of the essence for the intensity of breach of the skin. Pressure ulcers are
described by a harm to the skin and fundamental tissues brought about by the pressure (Elsabrout et al. 2018). The hazard factors
for this complexity incorporate idleness, high skin temperature, dampness, and the nearness of frictional and shear powers (Science
Direct, 2016). In this manner, the danger of pressure ulcers would increment in instances of obviousness, loss of motion, and
neurological infections or patients admitted to Intensive care units (ICUs).
Significance of the issue
Healthy skin is a property of value nursing care. The predominance of skin breakdown and pressure injuries (PI's) has turned into a
standard by which emergency clinics are assessed and surveyed, with the advancement of PI's perceived as a patient wellbeing
issue as they can expand bleakness and mortality. Most PI's are preventable if suitable measures are executed (Ncbi , 2019).
Background information
The tissue’s capacity to endure the weight including the force and span are elements influencing PI advancement. Restricted
territories of tissues that have drawn out weight cause the impediment of the bloodstream, anticipating the stockpile of supplements
and oxygen to the tissue, bringing about ischaemia and damage, prompting cell pulverization and in the long run tissue death (Al-
Otaibi et al. 2019.
Prevalence and incidence rate of the problem
The assessed pressure damage commonness in Australian hospitals ranges from 9.5% to 17.6%, and in a nursing home and long
term care settings are evaluated to be around 8.9%. the joined outcomes announced 1,195 individuals or one out of ten (10%
pervasiveness rate) were found to have at least 1 pressure injuries on skin examination. 669 or six out of ten of these injuries being
an emergency clinic or wellbeing administration gained (Richard-Denis et al. 2017).
Risks involved
Risks factors include lack of mobility, sensation in the affected areas and the blood flow in the area can also be affected. Severe
complications include bone and joint infection that occurs from a pressure ulcer that has burrowed to the joints or to the bones. Such
an infection can harm the joint cartilage and the bone which can cause more serious and permanent immobility (Science Direct ,
2019).
Need for using an evidence-based approach
Evidence-based practice approach differs structure the much well known conventional type of practice where work frameworks keep
on resembling, they have been with no real changes. While, in evidence-based practice, a clinical issue is tackled through research
and evidence. This is substantially more logical and consistent instead of putting together practice choices with respect to

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Evidence based nursing
convention, instincts or individual inclinations (Forni et al. 2018). It additionally guarantees that the practice examples are uniform as
they are based on logical evidence.
Clinical Question
Identify your clinical question, using the PICO format
Population How are the patients who are bedridden
affected by pressure injuries or ulcers?
Intervention How does the use of air mattresses or liquid
mattresses impact on the recovery or
prevalence of pressure injuries?
Comparison Why are air mattresses or liquid mattresses
preferred than standard hospital mattresses?
Outcome What is the impact air mattresses or liquid
mattresses on the prevalence of pressure
injuries?
Identify the domain
The domain is of harm to patients while being in long term care.
Evidence Search

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Evidence based nursing
Description of the evidence-based search strategy
The basic topic was that of pressure injuries that were seen in patients that have been bedridden in hospitals or in long term care.
This narrowed down the domain and purpose of the search articles. The search strategy began with keywords and narrowing down
on a single intervention for pressure injuries. This was seen to be the use of air or liquid mattresses and hence was used to narrow
the search through the use of proper operators (Pernik et al. 2016). The evidence was also narrowed on the basis of the medical
database as it ensures that the information is reliable and valid. Then the search was even constricted based on the year of
publication.
Recency of information
The recency of the information is essential so as to ensure that the information is relevant and still applicable to the present context.
Four of the five articles are fairly recent and have been published after 2015 whereas one dates back to 2009. This article was
chosen irrespective of the date because the information was found to be relevant and impactful.
How you narrowed your search to find relevant information
The topic chosen was that of pressure wounds as it is a common nursing issue in hospitals and an evidence-based intervention is
required. The search was limited by adding a specific group of people who have suffered from this issue. The research articles only
deal with pressure injuries of patients who have been in long term care in hospitals. The next concept used to narrow down the
search was the chosen intervention for the problem that was air or liquid mattresses.
Hierarchy of evidence

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Evidence based nursing
Types of studies that you considered appropriate to include
The survey, systematic review, 2 randomized clinical trial and a meta-analysis were included due to their high rank in the hierarchy of
evidence and the strength of the data which objective and free from any bias.
Key search terms
Pressure injuries, pressure injuries from hospital beds, pressure injury intervention, air or liquid mattresses for pressure injuries,
preventing pressure injuries.
Key search strategies
Boolean operators were used and citations from the chosen article were used to find similar ones.
Inclusion or exclusion criteria that you applied and why
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