Pressure Ulcer Risk Assessment, Research Paper Example

Description of EBP Guideline

The development of successful nursing objectives represents an opportunity to develop new approaches for evidence-based practice. In particular, pressure ulcers pose a serious challenge to patients and lead to many high risk situations. Therefore, it is necessary to address specific evidence-based practice frameworks that will be effective in reducing the risk of this condition. It is important to identify existing quantitative research that has explored the different approaches to reducing the risk of pressure ulcers. Since this issue poses significant problems for individuals, it is more important than ever to address these concerns through the analysis of an exploratory method in order to determine if evidence-based practice methods are successful in treating patients effectively. The following discussion will consider a quantitative study that explores the dimensions of risk assessment using a scale method in order to determine if evidence-based practice solutions are effective in assessing the risk of pressure ulcers within a given patient population. It is important to note that expert guidance and feedback are necessary in order to establish evidence-based practice solutions that will lead to successful guidelines for assessing and reducing the risk of pressure ulcers in many patients.

Purpose of the Quantitative Study and Relevance to EBP Guideline

A study by Munro (2010) addressed the use of Dever’s Epidemiological Model in order to evaluate a perioperative risk assessment scale approach with respect to pressure ulcers. This risk assessment scale represents a combination of factors related to existing literature that required additional evaluation from experts in order to determine its efficacy and appropriateness for different population groups (Munro, 2010). In this context, the risk assessment scale must ultimately consider a number of critical areas that may contribute to an increased risk of pressure ulcers, such as moisture and its impact on the development of pressure ulcers (Munro, 2010). These circumstances reflect the capacity to evaluate risk assessment tools in order to accomplish new directives in assessing the risk of pressure ulcers for larger groups of patients across different settings (Munro, 2010). The problem in question is relevant because pressure ulcers require significant treatment and may lead to costs in excess of $1 billion, the reasons for which include the management of patients in the OR setting (Munro, 2010).

Researchability of the Study Questions or Problems

This research question is highly appropriate and effective because it addresses some of the most critical components that may contribute to an increased risk of pressure ulcers, particularly for patients in the OR (Munro, 2010). It is evident that a risk assessment scale is an essential component of any diagnostic and treatment program for patients in the OR to prevent pressure ulcers (Munro, 2010). However, the nature and degree of the risk assessment is challenging and difficult to address without the utilization of expert feedback and guidance in this focus area (Munro, 2010). Therefore, the proposed research questions must be addressed because they convey the importance of risk criteria to address these challenges in an effective manner (Munro, 2010). It is also necessary to evaluate the research questions in order to determine if there are sufficient prevention methods in place to assess risk and to determine if patients are at risk of acquiring pressure ulcers (Munro, 2010). Patients in the perioperative setting must receive a detailed risk assessment as early as possible in order to prevent serious and long-term complications as a result of pressure ulcers (Munro, 2010).

Adequacy and Relevance of the Literature Review

The article by Munro (2010) offers supporting evidence in order to determine the most feasible approach to risk assessment for pressure ulcers. To be specific, intrinsic and extrinsic factors are key contributors to the risk of pressure ulcers; therefore, it is necessary to address these factors in conjunction with the more typical assessment areas such as positioning and changes in the circulatory system that may contribute to weaker blood flow (Munro, 2010). Furthermore, the article considers the limited availability of exploratory research in the area of pressure ulcer development, but also risk assessment techniques, such as the Braden scale, were not sufficient in assessing this level of risk (Munro, 2010). The literature review also explored the dimensions of developing a risk assessment scale for pressure ulcers that could be less comprehensive and more simplistic in nature in order to identify risk accordingly (Munro, 2010). Another study that was referenced demonstrated the significance of actual surgical procedures and their role in increasing pressure ulcer risk, and it was determined that some of the key risk factors included limited mobility during and after surgery, poor feeling or sensation in different extremities, and the increased level of pressure in some areas that lead to significant skin vulnerabilities (Munro, 2010). It was also determined that longer surgeries posed a greater risk of pressure ulcers, along with other conditions such as vascular complications and age, amongst others (Munro, 2010). Each of these factors, along with reduced hemoglobin and serum albumin, posed a greater risk of pressure ulcers in many patients in the perioperative setting (Munro, 2010). Other risks included the prevalence of diabetes in patients, along with other comorbidities and the lack of mobility in most patients due to the necessity to have one or more surgical procedures (Munro, 2010). Finally, the type of patients who are at the greatest risk, along with the location of these patients (OR environments) play a significant role in determining how to develop a comprehensive risk assessment tool that would produce viable outcomes for patients and reduce their risk of pressure ulcers in measurable ways that will produce viable outcomes for researchers and clinicians alike who are responsible for treating patients with pressure ulcers (Munro, 2010).

Agreement between Purpose, Design, and Methods

The utilization of Dever’s Epidemiological Model is reflective of the need for a risk assessment approach to managing pressure ulcers in perioperative patients (Munro, 2010). This model is relevant because it provides additional insight into the health status of patients and its impact on the development of complications and different forms of disease that may pose a risk for patients requiring surgery (Munro, 2010). This model identifies some of the key risk factors that are common in perioperative patients who pose a tendency to develop pressure ulcers (Munro, 2010). The key factors under consideration include physiological function, lack of mobility, and the type of surgery that is required (Munro, 2010). This model is comprised of four basic concepts: 1) biology; 2) lifestyle; 3) health care; and 4) the environment (Munro, 2010). Each of these factors is critical to the success of any risk assessment method because they evaluate the importance of patient risk on an individual basis, which then translates into specific treatment and prevention methods for patients to reduce the potential formation of pressure ulcers (Munro, 2010).

Suitability of the Sampling Procedure and the Sample

The environment in which the study was conducted provides a sound and reasonable environment for evaluation, with an appropriate size of 250 beds and 14 separate ORs (Munro, 2010). The subjects that were recruited for the study were also appropriate because they conduct the perioperative risk assessment for pressure ulcers (Munro, 2010). A total of 12 nurses at different levels were selected for the study, along with three anesthesiologists in order to address circulation and other challenges for immobile patients (Munro, 2010). The nurses are classified as experts in the field of perioperative nursing and are likely to recognize specific patterns associated with pressure ulcers in many patients (Munro, 2010). These nurses are also involved in the direct care of perioperative patients and will be effective communicators regarding their needs and challenges (Munro, 2010). To be specific, nurses selected for the evaluation were required to have at least five years of experience in perioperative nursing, and the selected anesthesiologists were also required to have the same level of experience (Munro, 2013).

Correctness of Analytic Procedures

For this study, data collection was conducted using the Munro Pressure Ulcer Risk-Assessment Scale for Perioperative Patients (Munro, 2013). This assessment was categorized into different levels and demonstrated the importance of feedback in determining if the instrument would achieve the stated purpose (Munro, 2013). This instrument sought information from the study participants in a number of areas in order to determine if risk and prevention could be achieved in this manner (Munro, 2013). In similar studies, perioperative nurses are important contributors to the development of new perspectives in order to ensure that pressure ulcer prevention could be achieved through a risk assessment tool (Primiano et.al, 2011). It was determined that a number of factors play a role in the development of pressure ulcers, such as bed surfaces and heel pressure (Primiano et.al, 2011). Under these conditions, it is evident that perioperative nurses play a critical role in determining pressure ulcer risk, particularly when they have an effective risk assessment tool to use on a regular basis in the perioperative setting (Primiano et.al, 2011). This data will demonstrate the need for a tool that embodies continuous improvement and the reduction of risk associated with pressure ulcers, as well as the challenges that are likely to occur when patients in the perioperative setting are immobile for periods of time and put unnecessary pressure on specific areas of the body that may contribute to pressure ulcers (Primiano et.al, 2011). It is important to demonstrate the value of a pressure ulcer protocol that will accomplish the desired objectives and also potentially reduce the risk of developing pressure ulcers in the future (Primiano et.al, 2011).

Clarity of Findings

Based upon existing challenges associated with pressure ulcers, there is a significant need to develop protocols that will have an impact on the prevention of these ulcers in patients where there is a great risk, such as those in the perioperative setting (Munro, 2010). The methods used by the researcher and the scale itself offered a strong basis for the development of new perspectives in order to ensure that patient outcomes that do not include pressure ulcers are achieved in the perioperative setting (Munro, 2010). The author’s use of specific tools is aligned with evidence-based practice objectives throughout the nursing field and supports the development of new methods in order to ensure that patient outcomes are met in an effective manner (Lobiondo-Wood and Haber, 2010).However, it is evident that as assessment tools emerge to prevent pressure ulcers, their application and utility in nursing practice remains to be seen on a wide scale (Chaves et.al, 2010). In this context, it is important to identify areas where there are significant opportunities to utilize these assessment tools in order to achieve a measurable reduction in the development of pressure ulcers in perioperative patients (Chaves et.al, 2010). When these guidelines increase in frequency and are used throughout many perioperative nursing settings, their status as evidence-based tools will be reaffirmed (Chaves et.al, 2010). In spite of the limited use of these protocols in some perioperative settings, they are nonetheless emergent forces in the prevention of pressure ulcers in patients who are immobile for lengthy periods of time and who face a high risk of developing these sores for this reason (Chaves et.al, 2010).

Since pressure sores are a common phenomenon in many operating rooms, it is important to identify the potential protocols and risk assessment tools that will be most effective in treating patients and in enabling perioperative patients to reduce their risk of pressure sores and related complications. These elements play an important role in supporting the development of new protocols that will encourage nurses with knowledge and expertise in perioperative nursing to use specific guidelines in an effort to prevent pressure ulcers in their patients. Munro’s research article and tool are effective indicators of the potential advantages of risk assessment tools for pressure ulcers in perioperative patients. In addition, these tools have a significant influence on nursing education and knowledge regarding pressure sores so that nurses are able to recognize negative patterns associated with pressure ulcers and their formation.

Patients who are at risk for pressure ulcers often experience a number of preexisting conditions that preclude these events, such as diabetes. Furthermore, individual patients must be evaluated in terms of weight or BMI, as well as the length of immobility and other factors. Each of these issues is important in demonstrating the value of effective patient care protocols and the creation of an environment whereby risk assessments for pressure ulcers are a common procedure. Under these circumstances, it is possible for perioperative nurses to address the potential risks associated with pressure sores as early as possible in the patient assessment stage so that these risks are reduced through specific steps that are associated with achieving effective outcomes. The issues related to patient outcomes must include a measurable reduction of pressure sores and the development of a framework that will accommodate patient care needs in a timely manner. Pressure ulcers may pose serious problems for patients; therefore, they must be addressed as early as possible to establish a prevention and/or treatment response within this patient population.

References

Chaves, L.M., Grypdonck, MHF, and Defloor, T. (2010). Protocols for pressure ulcer prevention: are they evidence-based? Journal of Advanced Nursing, 66(3), 562-572.

LoBiondo-Wood, G., and Haber, J. (2010). Nursing research: Methods and critical appraisal for evidence-based practice (7th ed.). St. Louis: Mosby Elsevier.

Munro, C.A. (2010). The development of a pressure ulcer risk-assessment scale forperioperative patients. AORN Journal, 92, 272-287.

Primiano, M., Friend, M., McClure, C., Nardi, S., Fix, L., Schafer, M., Savochka, K., and McNett, M. (2011). Pressure ulcer prevalence and risk factors during prolonged surgical procedures. AORN Journal, 94, 555-566