Hospitals that overlook the role of certain medical devices in causing pressure ulcers are missing an opportunity to prevent as many as one-third of all hospital-acquired pressure ulcers. Patients who develop pressure ulcers are at increased risk of needing longer hospitals stays and of requiring readmission after discharge. They also face a higher risk of dying while in the hospital or after discharge than those patients who do not develop pressure ulcers.
I do not have any challenge 03 5. Discussion The practicing nurses who participated in the study generally had inadequate knowledge about how pressure ulcers developed.
They also did not have current knowledge on how to stage the pressure ulcers, nor did they know the prognosis of unpreventable and unmanaged pressure ulcers that often lead to permanent disability and bone destruction.
They had inadequate understanding of the importance of interdisciplinary management. Similar findings were also reported in spinal cord injury units in the United States [ 8 ].
According to Louis knowing that pressure ulcers develop in stages was important in prediction, prevention, and their management to determine patient care outcomes. Participants had some level of knowledge about risk factors although fewer knew about systemic risk factors such as hypoxemia, anemia, ischemia, and neurologic diseases.
It is contended that pressure ulcer management is one of the nursing activities that require an interdisciplinary approach [ 9 ]. The interdisciplinary team involves in addition to a nurse, a patient educator, wound care physician, physiotherapist, and a dietician [ 8 ].
Pressure ulcer management and prevention also involves diet, physical exercise, wound care, and patient education. The nurse who is the main care provider should be knowledgeable and in position to mobilize the care team.
Participants had inadequate knowledge about the need for a balanced diet among patients at risk. This was also true among nurses in Belgium [ 10 ]. Nutrition is even more important with the geriatric patients [ 3 ].
Teaching a patient about pressure ulcer prevention is paramount and is the best practice in patient management. Firstly it empowers the patient to follow instructions given by the care nurse and, secondly, it increases patient readiness to collaboration with the health care team.
Additionally, keeping the skin and beddings of the patient dry is another important prevention intervention that nurses implemented and this is consistent with what Italian nurses consider as nursing activities [ 11 ]. This practice might not be directly targeting pressure ulcers alone, but also well documented that it is a good prevention measure [ 1213 ].
This was also reflected in the practice of the nurses in this study. In another study [ 10 ] substantive tissue damage on bony prominences took place during the first 3 to 4 hours of pressure, confirming the importance of turning patients regularly.
In addition, in a study [ 15 ] performed on postsurgical patients, it was found that patients who were not turned developed first stage ulcers in just two hours.
In resource limited settings like Uganda regular turning of the patient may be the only available means to reduce the incidence of pressure ulcers, a practice undertaken by the patients' care taker under the supervision of the nurse.
One of the extrinsic risk factors for pressure ulcer development was pressure on bony prominences [ 16 — 20 ]. Prevention should be one of the health care teams' priorities and in this study only a few nurses used pressure relieving devices on their wards.
This is different from findings in a study in Belgium [ 17 ] where This study revealed that nurses were also not using a pressure ulcer risk assessment tool and were not even aware of the existence of such tools. The importance of using a risk assessment tool in predicting pressure ulcers cannot be underemphasized [ 22 ].
In addition a good number of staff nurses had not consulted with any other health professional while taking care of patient at risk or with pressure ulcers.
This may affect proper pressure ulcer care management of patients in the interdisciplinary approach; better outcome is expected [ 2223 ]. Implications for Nursing Practice With noticeable increase in chronic diseases, trauma, and increasing number of aging population, nurses are required to be in position of providing pressure ulcer care and prevention.
Their capacity to manage pressure ulcers needs to be enhanced through continuing education with support of the nursing administrators. Additionally, protocols to guide pressure ulcer care need to be developed and disseminated for use during care. Recommendations for Future Research There is need to carry out research based on the available risk assessment tools so as to identify individuals prone to pressure ulcers so that prevention and management is predictable.
It would be imperative for the nurses to know, adopt, and implement evidence based risk assessment tools such as the Braden scale and also development or adoption of existing pressure ulcer protocols such that the nurses would not need to guess at the best strategies for pressure ulcer prevention and rapid healing.
Conclusions The prevention and management of pressure ulcers is of great importance. However, nurses at Mulago Hospital have given it low priority stemming from inadequate knowledge and heavy workload such as one nurse having many patients to attend to.
The nurse training schools and universities need to examine their curricula to address issues related to pressure ulcers prevention and treatment. Hospitals also need to devote more resources to prevent and manage pressure ulcers.
Professionals should also meet their responsibility to provide continuous nursing education CNE and continuous medical education CME to staffs about pressure ulcers. Included and reflected in this education should be the importance of interdisciplinary collaboration.
The authors are also grateful to the nurses who participated in the study. Conflict of Interests The authors have no conflict of interests. Pressure ulcer prevalence, incidence, risk factors, and impact. Clinics in Geriatric Medicine.
Pressure ulcer risk factors among hospitalized patients with activity limitation.Multipayer Patient-Centered Medical Home Implementation costs of wound development and care are substantial and will escalate for the pressure ulcer evidence based practices, and pressure ulcer pro-gram gaps.
We focused on identifying guidelines and programs. NPUAP Pressure Injury Stages The National Pressure Ulcer Advisory Panel redefined the definition of a pressure injuries during the NPUAP Staging Consensus Conference that was held April , in Rosemont (Chicago), IL.
Each year, more than million people in the United States develop pressure ulcers. These skin lesions bring pain, associated risk for serious infection, and increased health care utilization.
|NPUAP Pressure Injury Stages | The National Pressure Ulcer Advisory Panel - NPUAP||The updated staging definitions were presented at a meeting of over professionals.|
The aim of this toolkit is to assist hospital staff in implementing effective pressure ulcer prevention practices through an interdisciplinary approach to care. A pressure ulcer is also called a pressure sore, bedsore, or decubitus ulcer. Pressure ulcers can form over any bony area but are most common on the back, .
Pressure ulcers that begin in the perioperative setting appear to have a more complex etiology related to circulatory and metabolic changes. 4 The primary risk factors for development of a pressure ulcer in the perioperative patient are immobility and the inability to perceive pain from unrelieved pressure when under anesthesia, in addition to.
Pressure Ulcers Caused by Medical Devices Identified at Later Stages," 74% of pressure ulcers caused by medical devices were found when they were classified as stages III (pressure ulcer extends to tissue beneath the skin) or IV or as unstageable.