Pressure Injuries in Nursing: Prevalence, Risk, and Evidence-based Research

This report focuses on the nursing practice of pressure injuries (PIs) based on evidence in hospitals, including prevalence, risk factors, and evidence-based research in healthcare systems. It provides recommendations for improving PI prevention and management.

Running Head: PI 0
Pressure Injuries
Nursing
Student Name:
Student University:

PI
Contents
Introduction................................................................................................................................2
Pressure Injuries.........................................................................................................................2
Prevalence or incidence of Pressure Injuries in Australia......................................................2
Risk Associated with PI in Australia.....................................................................................3
Evidence-based research in healthcare systems.........................................................................3
Purpose...................................................................................................................................4
Evidence Search.....................................................................................................................4
Critical Appraisal.......................................................................................................................5
Recommendations......................................................................................................................5
Conclusion..................................................................................................................................6
Bibliography...............................................................................................................................7
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Introduction
Pressure Injuries impact on consumers and health services as it is a highly avoidable
and takes longer time to heal. It requires a strong focus on prevention as required. The
clinical practice is done according to the National Safety and Quality Health Service for
prevention and management of Pressure Injury (PI) under the guidelines of SA Health
Pressure Injury Prevention and Management. The structure as framed describes the
requirements of training and education for taking care of the health workplace with skills,
attitudes, knowledge, and abilities. Under the guidelines, the development of a panel contract
has been made for purchasing and hiring various devices designed to minimize skin pressure
(Campbell, Coyer, & Osborne, 2016). The care of patients who are at risk or have pressure
injuries provides chair cushions or mattresses. The patients at risk get services to make sure
of families, caretakers, and patients with sufficient information about preventing PIs;
products, equipment, and devices for using the best-practice guidelines for effective
management and prevention of PIs (Doggett & Buck, 2018). In this report the aim is to focus
on the nursing practice of pressure injuries (PIs) based evidence in hospitals for identification
and justification of clinical problems using PICO tool for accuracy, appraising topic criteria
with recommendations for improving PIs in hospitals of Australia.
Pressure Injuries
PI destroys the area of tissue developed when compressed between a bony
prominences pressured outcome with cutting forces. The guidelines used above help in
increasing the awareness regarding PIs in healthcare experts and the objective is to provide
the best care to patients who are at risk and need to promote prevention (Jackson, et al.,
2016). It includes improvement in knowledge for the formation of PI physiology, identifying
contributing factors and high-risk patients, executing and evaluating intervention and
avoidance strategies, preventing complications related to PIs, enhancing management of PI
and providing optimum caretaker and family education.
Prevalence or incidence of Pressure Injuries in Australia
It is caused by constant pressure at any break of skin uprightness on soft tissue
compressed in external surface and bony prominences for an extended period of time which
results in poor blood flow, cutting, resistance and tissue ischemia contributing to PIs. The rate
of hospital acquired pressure injuries in hospitals of Australia was 9.7 injuries per 10,000
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hospitalisations in 2015-16 and the incidence rates between 1.5 and 38% (N Graves, 2014).
The damage of skin, bone, fascia, subcutaneous fat and muscle deeply by unbroken pressure.
The power to tolerate the pressure on tissues including the time and amount are the factors
affecting PI development (Ness, Hickling, Bell, & Collins, 2018). It prevents the supply of
oxygen and nutrients to the issue, outcome in ischemia and re-perfusion injury, cell
destruction leads and death of tissue eventually.
Risk Associated with PI in Australia
The PI’s patients include high risk as identified and individualized for prevention for
execution which lesser the tolerance of the skin to pressure for contact increment to high
pressure on the skin. The factors of PI risk are tissue tolerance and pressure where tissue
tolerance includes intrinsic factors such as chronic illness, nutrition, demographics, skin
temperature, and oxygen delivery; extrinsic factors such as cut, moisture, and roughness
whereas pressure includes diminished sensory awareness, movement, and activity (Walker, et
al., 2017). To reduce tissue tolerance; the ability of structural support and skin to tolerate the
effects of pressure where cushion protects when transferring pressure loads.
PI requires regular assessment, considering casual factors, executing prevention
strategies and accurate selection of pressure using reliving devices. The assessment of
identifying the patients’ risk of PI to executed immediately. It is important to provide
education to families and patients to manage and prevent PIs by working with a qualified
team. It is essential to inform the development of risk in hospitals and make them understand
to assist and contribute to the development of suitable and effective strategies for prevention
(Dealey, et al., 2015). The strategies to prevent PI include device management; inspection of
the patient’s skin, and repositioning.
Evidence-based research in healthcare systems
Clinical Question: In hospitalized critically ill patients, how does turning and repositioning
every two to four hours compared to the use of pressure redistributing support surfaces
prevent the occurrence of pressure ulcers?
Domain:
P: Critically ill patients
I: Turning & repositioning q 2-4 hours
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C: Pressure redistributing support surfaces compared with repositioning every 2-4 hours
O: Prevention of pressure injuries
Purpose
The purpose of this review is to assess which intervention best prevents pressure
injuries in critically ill patients.
Evidence Search
While conducting research for evidence-based search strategy, pressure injuries
among healthcare systems of Australia is analysed (Lawrence, Fulbrook, & Miles, 2015). The
investigation is conducted in relation to journal articles and on the basis of investigation, the
clinical question is formulated. The journal articles collected relevantly from the year
between 2015-2018 to understand the related-issues and its preventions. The study is
qualitative and evaluated on the basis of evidence providing practices for Pressure Injury in
nursing. There are various tools, healthcare settings for the compliance of activities in
Australia where research aims to focus.
Articles:
 The pressure of obesity: The relationship between obesity, malnutrition and pressure
injuries in hospital inpatients
 Medical device-related pressure injuries: An exploratory descriptive study in an acute
tertiary hospital in Australia
 Hospital-acquired pressure injuries: Are they accurately reported? A prospective
descriptive study in a large tertiary hospital in Australia
 A randomized controlled trial of the clinical effectiveness of multi-layer silicone
foam dressings for the prevention of pressure injuries in high-risk aged care
residents: The Border III Trial
 A Pilot Randomized Controlled Trial Using Prophylactic Dressings to Minimize
Sacral Pressure Injuries in High-Risk Hospitalized Patients
 Improved wound management at lower cost: a sensible goal for Australia
Critical Appraisal
The education to caretakers, families, and patients it helpful to measure the ability in
hospitals regarding pressure injuries is essential. The qualified team includes actions and
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information to prevent PIs (Nguyen, Chaboyer, & Whitty, 2015). The effective strategies
include repositioning, device management, and patient’s skin inspection which is required for
the treatment. It is in direct contact to recognize the system causing PI. The workers inspect
and monitor the patient’s skin to prevent it which is related to a device. The strategies are
helpful for accurate repositioning of devices on regular basis, barriers protecting between the
patient’s skin and device, using the equipment of correct size suiting patient’s body size,
filling usage for softening hard base, using tape to secure patient from the equipment and
making sure to not to apply tight and utilize it where possible with some stretch and
elasticity, and minimum use of tape to secure patient safely from the device and allow
visualization at maximum of the patient’s skin. The practices work up to 80% after improving
where nurses reflect plans when approaching and communicating inspiration like perspective
and management (Barakat-Johnson, Barnett, Wand, & White, 2017). In the articles, the
methods are mentioned to measure the effective practices for minimizing the risks and taking
preventions after analysing it critically. The structure is made for positive outcomes of
hospitals in Australia related to PI.
Recommendations
It is the duty of qualified teams to make an approach and practices for minimizing the
risks for patients and securing their health. It is essential to offer nutrition to the patients for
maintaining the chances of risks by providing them daily fluid and diet and keep them
hydrated. The dietician follows the Paediatric Nutritional Screening Tool Assessment having
high-risks. The nutrition support is designed to correct or prevent nutritional deficits,
achieving or maintaining nitrogen balance positively, and restore the level of serum albumin
(Posthauer, Banks, Dorner, & Schols, 2015). The nutrients have a major interest in receiving
treatment and prevention of pressure injuries including vitamin C, protein, vitamin A,
arginine, and zinc. It is necessary to maintain suitable management and environment, and
securing the lives of patients safely through devices regularly in nursing and organization,
and hospitals of Australia. It is important to control and minimize the risks for curing PIs.
Conclusion
To conclude, the evidence is important in the hospitals for appraising criteria and
preparing various practices for measures and corrective actions while maintaining the
standards of experts and minimize the issues related to PI. Hence, this report reflects the
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practices in healthcare systems related to PI looking towards evidence-based nursing
practices. The discussion aims at improving strategies and executing plans for effective
healthcare systems for nurses. The use of the PICO tool is helpful in identifying various
studies and author's researches on the basis of pressure injuries. The articles helped for
knowing the increase of issues with the hospitals and patients, and minimizing the risks.
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Bibliography
Barakat-Johnson, M., Barnett, C., Wand, T., & White, K. (2017). Medical device-related
pressure injuries: An exploratory descriptive study in an acute tertiary hospital in
Australia. Journal of tissue viability, 26(4), 246-253.
Campbell, J., Coyer, F., & Osborne, S. (2016). Incontinence‐associated dermatitis: a cross‐
sectional prevalence study in the Australian acute care hospital setting. International
wound journal, 13(3), 403-411.
Dealey, C., Brindle, C., Black, J., Alves, P., Santamaria, N., Call, E., & Clark, M. (2015).
Challenges in pressure ulcer prevention. International wound journal, 12(3), 309-312.
Doggett, J., & Buck, A. (2018, January 4). A new approach to pressure injuries needed –
Wounds Australia. Retrieved September 8, 2019, from https://croakey.org/a-new-
approach-to-pressure-injuries-needed-wounds-australia/
Jackson, D., Hutchinson, M., Barnason, S., Li, W., Mannix, J., Neville, S., . . . Usher, K.
(2016). Towards international consensus on patient harm: perspectives on pressure
injury policy. Journal of nursing management, 24(7), 902-914.
Lawrence, P., Fulbrook, P., & Miles, S. (2015). A survey of Australian nurses' knowledge of
pressure injury/pressure ulcer management. Journal of Wound, Ostomy and
Continence Nursing, 42(5), 450-460.
N Graves, H. Z. (2014). Modelling the direct health care cost of chronic wounds in Australia.
Journal of the Australian Healthcare, 22(1), 20.
Ness, S., Hickling, D., Bell, J., & Collins, P. (2018). The pressures of obesity: the
relationship between obesity, malnutrition and pressure injuries in hospital inpatients.
Clinical Nutrition, 37(5), 1569-1574.
Nguyen, K.-H., Chaboyer, W., & Whitty, J. (2015). Pressure injury in Australian public
hospitals: a cost-of-illness study. Australian Health Review, 39(3), 329-336.
Posthauer, M., Banks, M., Dorner, B., & Schols, J. (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.
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Walker, R., Huxley, L., Juttner, M., Burmeister, E., Scott, J., & Aitken, L. (2017). A pilot
randomized controlled trial using prophylactic dressings to minimize sacral pressure
injuries in high-risk hospitalized patients. Clinical nursing research, 26(4), 484-503.
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