Evidence Based Practice in Pressure Ulcer Management among Older Adults

This paper analyzes the application of evidence-based practice (EBP) for effective nursing management of pressure ulcers among older adults. It discusses the importance of EBP in improving patient outcomes, satisfaction, and reducing overall cost of care. The paper also explores various interventions such as repositioning, proper nutrition, and use of ointments for pressure ulcer management. Training of nursing professionals in recognizing early signs and symptoms of pressure ulcers is emphasized. The conclusion highlights the need for early identification and personalized interventions based on the severity, age, and body weight of the patient.

Running head: EVIDENCE BASED PRACTICE
Evidence Based Practice in Pressure Ulcer Management among Older Adults
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Table of Contents
Introduction......................................................................................................................................2
Pressure ulcers in older adults.........................................................................................................2
Evidence-Based Practice in Pressure Ulcer Management...............................................................3
Training of the nursing professionals..............................................................................................5
Conclusion.......................................................................................................................................6
References........................................................................................................................................8

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Introduction
Evidence-based practice (EBP) in the nursing profession can be regarded as an approach
that is used for clinical problem solving for the improvement of the quality of life of the patients.
EBP uses evidences that are extracted from the systematic reviews and based on the feedbacks
received from the doctors and patients. Proper application of the EBP helps in improving
outcome of patients’ care while increasing the level of patients’ satisfaction and reducing overall
cost of care. Apart from patients’ satisfaction, EBP also helps in improving the satisfaction level
of the nursing professionals. The satisfaction is achieved by empowering the nurses through
providing job-satisfaction and increase in team-bonding (Melnyk, Gallagher-Ford &Zellefrow,
2017). The following paper aims to analyse the how application of EBP can be used for effective
nursing management of pressure ulcers among the older adults
Pressure ulcers in older adults
According to Rasero et al. (2015), progressive aging of the population is associated with
increased rate of disability. Physical disability and neurological falls results in the generation of
accidental fall among the older adults. Apart from accidental falls, there are other geriatric
syndromes that result in the development of pressure lesions or pressure ulcers, Pressure ulcers
are complex healthcare problems with multifactorial etiologies. Proper application of the EBP
helps in reducing the severity of the problems (Rasero et al., 2015).
Evidence-Based Practice in Pressure Ulcer Management
Evidence-based practice suggests that repositioning helps in the effective management of
pressure ulcers. Repositioning is defined as frequent turning or changing position of the patients

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with or without the use of the pressure reducing mattress. However, the frequencies of reposition
will vary depending on the site of pressure ulcer development, the age of the patients and the
severity of pressure ulcers. The positioning of the pressure ulcers varies from 30 degree tilt
position or 90 degree lateral or supine position. In some cases recumbent position at an angle of
45 degree from head to back of the body is suitable for the standard care of pressure
ulcer(Mervis& Phillips, 2019). Boyko, Longaker and Yang (2018) are of the opinion in order to
increase the effective management of the pressure ulcer; preposition must be assisted with use of
padded beds and proper nutritional management and maintaining of the moisture quotient of the
skin.
Posthauer et al. (2015) stated that nutrition plays an important role in the effective
management of the pressure ulcers among the older adults. Consumption of healthy and
nutritional diet that is rich in fruits and vegetables helps to retain the moisture of the skin. At the
same time consumption of adequate fluid helps to keep the skin hydrate. Both these factors,
moisture and hydration prevents tissue rupture or skin breakage arising out of friction from the
surface of the bed. Proper consumption of healthy diet also helps in restoring fast healing of the
wounds formed during pressure ulcers and this in turn helps in faster recovery for pressure
ulcers. Boyko, Longaker and Yang (2018) stated that use of external resources like dressings and
medications are not effective in the pressure ulcer management. In-take of medication in older
adults for a prolong period of time invites in unwanted side-effects that are detrimental for
geriatric patients. Moreover, removal and replacement of dressings is painful, has chances of
local infection and also prevents aeration to the affected surface and thus increasing the severity
of pressure ulcers. However, consumption of healthy diet helps to restore the elasticity of the
skin from core of the body and thus helping to prevent the chances of pressure ulcers. The

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evidence-based practice conducted by Saghaleini et al. (2018) stated that nutritional deprivation
and insufficient intake of diet are two principal factors for the development of pressure ulcers
while impairing the process of wound healing. Inadequate intake of nutritional food or
malnourishment increases the vulnerability of developing pressure ulcers. The nutritional support
must be directed towards increased protein intake. This is because it has been found that fall in
the blood serum level of albumin helps in the development of pressure ulcer with higher level of
mortality and morbidity. Apart from increased protein intake, the intake of carbohydrate must be
reduced. Increased consumption of protein helps in the development of muscle mass and low
consumption of carbohydrate case weight loss and thus aiding in pressure ulcer management
(Saghaleini et al., 2018).
Tayyib and Coyer (2016) vouched in favour of silicon foam dressing for reducing in the
pressure ulcer development in the sacrum and in the hell area. The silicon foam mattress helps in
absorbing the frictional force between the skin and the bed-cover or the surface of the bed and
thus helping to management of pressure ulcer and reduction in the severity of the disease.
Santamaria et al. (2016) argued that apart from using silicon foam bed, soft silicone multi-
layered foam dressing is effective in healing sacral and the heel pressure ulcer and thus promote
fast recovery from the trauma of pressure ulcer. The padded silicon foam dressing helps to
absorb the additional frictional force and thus helping to reduce the severity of pressure ulcer.
Westby et al. (2017) stated that as per the evidence-based practice guidelines, for the effective
management of the pressure ulcers, apart from repositioning and proper nutritional management,
application of the topic agents also holds prime importance. The EBP practice approach
highlighted by Westby et al. (2017) with the help of the systematic review showed that use of the

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topical ointments help to retain the moisture of the skin and thereby helping to reduce the
chances of forming pressure sores or pressure ulcers.
The review conducted by Kelechi, Johnson and Yates (2015) to highlight the best
practice of the pressure ulcer management showed that for effective management of the chronic
venous leg ulcers, the use of compression sticking is not always helpful. As compression
stockings reduces the blood flow in that area leading to increase in the severity of the disease.
Kelechi, Johnson and Yates (2015) also stated that it is the duty of the nursing professionals to
conduct assessment for the early recognition of the signs and symptoms of the pressure ulcers in
order to initiate the early diagnosis and implementation of early intervention. Mosti (2018)
further stated that use of the pressure stocking or compressor stocking lead to impaired venous
hemodynamic causing skin damage and increased severity of pressure ulcer.
Training of the nursing professionals
From the above analysis of the review of the literature it can be stated that evidence-
based practice for the effective management of the pressure ulcers deal with early identification
of the signs and symptoms of the pressure ulcers among the older adults. This will be followed
by the application of personalized intervention in order to manage pressure ulcers. The main
interventions preferred for the management of the pressure ulcers among the older adults include
proper management of the nutrition, repositioning of the patients, and use of skin ointments. The
use of compressor stockings for the management of the pressure ulcers is not recommended for
the effective management of the pressure ulcers as it hampers the flow of the venous blood
increasing the severity of the disease (Boyko, Longaker & Yang, 2018). Saghaleini et al. (2018)
are of the opinion that while framing the care plan for the effective management of the pressure

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ulcers with the help of established EBP; it is the duty of the nursing professional to have a
customizable approach. Under this person-centred approach, the height, weight, age and the
diabetic status of the target individual must be monitored. It has been reported that person with
high blood pressure or obese or underweight are more likely to become victim of pressure ulcer.
The selection of the posture of the body and repositioning for the management of pressure ulcers
must also be customised depending upon the nature and site of complications. The training of the
nurses must be given in the domain of use of soft silicon padded dressing as well. However, the
use of dressings is not always recommended for the treatment of the pressure ulcer as it reduces
the aeration of the infected area resulting in the delay in the overall process of wound healing
(Boyko, Longaker & Yang, 2018).
The training of the nursing professionals must be given under the healthcare settings
under the guidance of the trained geriatric nursing professionals as this will help in getting a
knowledge about the early signs and symptoms of the pressure ulcers.
Conclusion
Thus from the above discussion, it can be concluded that the EBP for the effective
management of pressure ulcer early identification of the signs and the symptoms of the pressure
ulcer is important. This will be followed by the selection of the proper intervention for the
management of the pressure. The selection of the interventions depends on the severity of the
pressure ulcer, the age and the body weight of the patient. The main interventions used include
intake of the proper nutrition, patient repositioning, use of ointment, padded bed and in rare
cases, use of dressings. S

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References
Boyko, T. V., Longaker, M. T., & Yang, G. P. (2018). Review of the current management of
pressure ulcers. Advances in wound care, 7(2), 57-67.
Kelechi, T. J., Johnson, J. J., & Yates, S. (2015). Chronic venous disease and venous leg ulcers:
an evidence-based update. Journal of Vascular Nursing, 33(2), 36-46.
Mervis, J. S., & Phillips, T. J. (2019). Pressure ulcers: prevention and management. Journal of
the American Academy of Dermatology.
Mosti, G. (2018). Compression Therapy for Venous Ulcer. In Venous Disorders (pp. 159-169).
Springer, Singapore.
Posthauer, M. E., Banks, M., Dorner, B., &Schols, J. M. (2015). The role of nutrition for
pressure ulcer management: national pressure ulcer advisory panel, European pressure
ulcer advisory panel, and pan pacific pressure injury alliance white paper. Advances in
skin & wound care, 28(4), 175-188.
Rasero, L., Simonetti, M., Falciani, F., Fabbri, C., Collini, F., & Dal Molin, A. (2015). Pressure
ulcers in older adults: a prevalence study. Advances in skin & wound care, 28(10), 461-
464.
Saghaleini, S. H., Dehghan, K., Shadvar, K., Sanaie, S., Mahmoodpoor, A., &Ostadi, Z. (2018).
Pressure ulcer and nutrition. Indian journal of critical care medicine: peer-reviewed,
official publication of Indian Society of Critical Care Medicine, 22(4), 283.
Santamaria, N., Gerdtz, M., Sage, S., McCann, J., Freeman, A., Vassiliou, T., ...& Knott, J.
(2015). A randomised controlled trial of the effectiveness of soft silicone multi‐layered
foam dressings in the prevention of sacral and heel pressure ulcers in trauma and
critically ill patients: the border trial. International wound journal, 12(3), 302-308.
Tayyib, N., & Coyer, F. (2016). Effectiveness of pressure ulcer prevention strategies for adult
patients in intensive care units: a systematic review. Worldviews on Evidence‐Based
Nursing, 13(6), 432-444.
Westby, M. J., Dumville, J. C., Soares, M. O., Stubbs, N., & Norman, G. (2017). Dressings and
topical agents for treating pressure ulcers. Cochrane Database of Systematic Reviews, (6).