Evidence-Based Pressure Ulcer Prevention

Evidence-Based Pressure Ulcer Prevention Pressure Ulcer is commonly experienced by hospitalized adults. This skin condition is otherwise known as bed sores to which the patient’s skin as well as its underlying tissue breaks down due to pressure caused by prolonged non-movement of the affected skin areas. It provides discomfort to the patient especially to those who have medical conditions, which disable them from changing position. Pressure Ulcer can develop rapidly. However, there are several things that can help in prevention and help the patient in the healing process. The purpose of this paper is to develop a plan as to how the Pressure Ulcer can be prevented based on the evidence presented in the articles including the identified solution to the problem. The change plan will help the development of nursing practice when it comes to Pressure Ulcer and suggests that repositioning and turning the patient constantly will help in preventing the occurrence of this skin condition. Change Plan Using John Hopkins EBP Model Overview The John Hopkins Nursing EBP model or JHNEBP is a framework that is used to guide the translation of gathered evidence into practice (Buchko, 2012). It has encompasses three nursing foundations such as education, practice, and research. Nurses should use this model to as a guide to facilitate change because it includes both non-research and research evidence as they create basis for nurses’ decision making. Thus, this model also proves that both external and internal factors should be put in consideration before existing nursing practice may be changed. Practice Question Step 1 Recruiting inter-professional team will be composed of nurses, attending physician, and nursing aid. Step 2 The Evidence-Based Practice (EBP) question is â€Å"Do frequent turning of patients lead to reduction of occurrence of pressure ulcers in hospitalized adults?† For PICO elements, it is identified that (P) is the hospitalized adults that suffer from Pressure Ulcer; (I) would be the intervention approach of the problem, which is the frequent turning of the patient to prevent or recover from Pressure Ulcer symptoms; (C) is the considered alternative in treating the Pressure Ulcer such as using special cushions and mattresses, which can help in relieving the pressure in affected skin areas; and (O) pertains to the gradual healing of skin tissues that suffered from Pressure Ulcer. Step 3 Pressure Ulcer prevents the patient from a complete recovery as it provides addition pain due to damaged skin tissues. Cases of Pressure Ulcer continue to increase. In fact, Sullivan (2013) says that it increased by 80% between 1995 and 2008. Not only in the hospital, but residents of nursing homes also suffer from Pressure Ulcer and was reported that there was an approximate of 11% case increase in 2004 (Sullivan, 2013). This problem affects the healthcare on a broader scale. It provides additional healthcare facility costs, which may not be covered as it is a hospital-acquired health condition. Thus, the overall nursing practice will be more challenging due to the occurrence of Pressure Ulcer among adult patients. Steps 4 and 5 The team, which is composed of nurses, attending physician, and nursing aid will have their vital roles in achieving the targeted design for change. They are important as they hold different responsibilities. The nurses are responsible for ensuring that existing Pressure Ulcer will not become worse by constant checking the affected skin. The attending physician is responsible for knowing if there would be any other medical implication due to Pressure Ulcer occurrence. He is also responsible for providing additional medication, if needed, besides the existing medical condition. The nursing aid is responsible for providing assistance when it comes ensuring that the patient’s affected skin areas are well-ventilated through constant repositioning of the patient’s body. In combining their essential roles and responsibilities, prevention and treatment of Pressure Ulcer will be easier to achieve. Evidence Steps 6 and 7 – The change plan is supported by evidence to which the guidelines of handling patients with Pressure Ulcer are presented. Whitney et al. (2006) say that Pressure Ulcer is one of the challenges of health care providers. The change plan plans to prevent the increasing occurrence of such skin condition to which the articles stated that there were almost 3 million patients affected in the United States alone (Whitney et al., 2006). The research encompasses insights from clinical experts as well as their opinion about the problem. Scientific evidence were also presented in the research such as proper patient positioning, nutrition, support surfaces, preparation of wound bed and dressing, and the underlying principles that were developed per category. The research’s quality improvement data was presented in a form of various guidelines and nursing principles. One of the strength of this research is its ability to provide detailed guidelines as to how the Pressure Ulcer can be handled accordingly without providing additional sufferings to the patient. It also highlights the principle behind every guideline in order to explain why such guideline must be followed during the treatment process. Steps 8 and 9 – The evidence shows that frequent turning of patients will help in the reduction of the occurrence of Pressure Ulcer. There are various articles that presented the similar views and presumptions pertaining to the proper treatment of Pressure Ulcer. Kaitani, Tokunaga and Sanada (2010) suggest that there are risk factors that are related to the occurrence of Pressure Ulcer especially in critical care setting. One of the risk factors may start during the admission stage of the patient. The critical care setting involves medical conditions that will decrease the patient’s ability to move and change position from time to time. Therefore, it is important to know that at the beginning of admission stage, health care providers must be aware that the occurrence of Pressure Ulcer is high. In fact, almost 40 percent of the patients who suffer from Pressure Ulcer are the ones who are in the critical care setting or intensive care unit (Kaitani, Tokunaga Sanada, 2010 ). The authors concluded that that there is no connection between the occurrence of Pressure Ulcers among patients and the involve medication. Therefore, the frequency of positioning and turning the patient especially in the ICU is a prognostic indicator as to whether Pressure Ulcer will occur. This is also to reduce the probability of extended admission of the patient in the hospital. The redistribution of the pressure is the main goal of repositioning the patient in order to prevent the occurrence of Pressure Ulcer. Sprigle and Sonenblum (2011) assert that such skin condition occurs when there is a constant pressure on the affected skin area. That is why; it is essential to conduct a pressure magnitude management through postural supports and support surfaces as well as proper body posture. This approach can be done through weight shifting and turning frequency including the use of dynamic surfaces (Kaitani, Tokunaga Sanada, 2010). Besides frequent turning, positioning device can also help in distributing the weight of the patient and improving the blood flow on skin surface. Therefore periodic repositioning of the patient combined with the positioning device are two important preventive methods against Pressure Ulcer and ideal supporting treatment procedure for existing Pressure Ulcer. Generally, the standard turning by nurses in intensive care unit or ICU does not consistently unload all the areas of skin-bed interface pressures (Peterson et al., 2010). The standard of handling patients with Pressure Ulcer is to prevent most of the skin areas to be under pressure to avoid tissue damage. However, evidence shows that even with the presence of frequent turning and repositioning is not a guarantee that Pressure Ulcer will not occur as there are still skin areas that are at risk of tissue breakdown (Peterson et al., 2010). Conversely, using the support materials is also not an assurance to prevent the occurrence of this skin condition. Such materials for maintaining the patient’s turned position may also influence the tissue unloading, which may jeopardized the affected areas. Therefore, it is presumable that there is still a gap between the theory and practice when it comes to Pressure Ulcer management. Moore (2010) says that besides the increased length of stay in the hospital, Pressure Ulcer may also increase the health service costs. However, such condition is preventable through proper management in order to provide strategically-planned health service. One of the strategies that can be used is the 30 degrees tilting of the patient’s body to avoid too much pressure on the skin (Moore, 2010). Based on the evidence presented, repositioning the patient who is at risk of Pressure Ulcer every three hours using this tilt technique will reduce the possibility of Pressure Ulcer occurrence. Step 10 – Based on the gathered evidence, the recommendation to prevent potential Pressure Ulcer is to conduct a constant turning of patient every 3 to 4 hours depending on the patient’s body weight. The heavier the patient is the shorter the time interval must be applied in repositioning the patient’s body. Thus, it is also recommended that patients, especially adults in ICU department must use positioning materials if possible. In this case, the body’s weight will be distributed evenly along with the frequent turning technique. It is also recommended to apply the 30 degrees tilt on the patient so that the weight will not produce too much pressure on the skin’s interface. Thus, the gravity pull will not be focused on the pressured area. Steps 11, 12, 13, and 14 – The plan for implementing the change will be based on the steps that need to be followed. Important procedures must emphasize on the implementation stage. This will be followed by the importance of conducting such procedures based on the evidence, which will also be presented. There will be a specified timeline to ensure the smooth transition for old to standard practice to developed change plan. For the first quarter of the year, an initial outcome will be evaluated using statistical reports of occurrence of Pressure Ulcer. A ratio between the number of patients and Pressure Ulcer occurrence will be the basis of quarterly reports, which are targeted to decrease after the fourth quarter. The reports will include the total number of patients within the first three months, patients at risk of the skin condition, and the number of repositioning done in every patient. Steps 15 and 16 – The desired outcome of the proposed change is to reduce the occurrence of Pressure Ulcer among adult patients especially in the critical care setting or ICU. It also aims to increase the awareness of techniques on how to apply the recommended strategies of the health care workers. The outcome will be measured based on the reports filed by the nursing staff, which is done separately from the existing medical condition of the patient. The results will be reported to the stakeholders in a quarterly basis, emphasizing how the strategies were conducted and what the specific results were. Step 17 – The plan will be implemented on a larger scale to which other units will be included. The plan will primarily start on the intensive care unit for the first quarter and will also be implemented to regular hospital ward after the first three months. To ensure that the plan will be implemented permanently, it will be raised to the office of the director to be one of the standard procedures of the hospital. Therefore, whether or not the patient is in ICU, constant monitoring of potential Pressure Ulcer will be part of the nursing round. Step 18 – Findings will be disseminated internally through monthly meetings to provide developments after the implementation. On the other hand, it will be externally disseminated by providing its advantages to other hospitals and healthcare setting. If possible and available, strategies, techniques and findings will be published on the hospital’s website to spread awareness throughout the concerned public. Conclusion Pressure Ulcer is an important problem that every health care provider must be aware of. The evidence presented is clear representation that such condition is preventable. Thus, should not be the reason for patients to extend their hospital confinement. The change model will ensure that every involved healthcare professional will be responsible in ensuring that the Pressure Ulcer will be prevented and treated accordingly to those who are already suffering from it. The three levels of change based on John Hopkins EBP process are essential aspects for the implementation of the change plan. Understanding the practice question would be the foundation of the process to which PICO elements will be analyzed for the success of change plan. On the other hand, the evidence will be the basis of the change plan as to how the and why the change plan is needed for the improvement of health service. Thus, the translation is the period to which the implementation will take place. It is essential to have these three levels of change so as to develop a strategic plan of the proposed change. In this case, once the plan has been implemented and permanently practiced, the occurrence of Pressure Ulcer will significantly decrease, which will help in the patient in the treatment process. References Buchko,B.L., Robinson,L.E. (2012). An Evidence-based Approach to Decrease Early Post-operative Urinary Retention Following Urogynecologic Surgery. Society of Urologic Nurses and Associates, 32(5), 260-264. Kaitani,T., Tokunaga,K., Matsui,N., Sanada,H. (2009). Risk factors related to the development of pressure ulcers in the critical care setting. Journal of Clinical Nursing, 19, 414-421. Moore,Z. (2010). Bridging the theory-practice gap in pressure ulcer prevention. British Journal of Nursing, 19(5), s15-8. Peterson,M.J., Schwab,W., Van Oostrom,J.H., Gravenstein,N., Caruso,L.J. (2010). Effects of turning on skin-bed interface pressures in healthy adults. Journal of Advanced Nursing, 66(7), 1556-1564. Sprigle,S., Sonenblum,S. (2011). Assessing evidence supporting redistribution of pressure for pressure ulcer prevention: A review. Journal of Rehabilitation Research Development, 48, 203-214. Sullivan,N. (2013). Preventing In-Facility Pressure Ulcers. In Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. Rockville City, MD: Agency for Healthcare Research and Quality. Whitney,J., Philipps,L., Aslam,R., Barbul,A., Gittrup,F., Gloud,L., . . . Robson,M.C. (2006). Guidelines for the treatment of pressure Ulcers. Wound Healing Society, 14, 663-679.

Girl with the Pearl Earrings Essay

There could be many different interpretations of the ending scene when the pearl earrings are returned to Griet. The look on Griet’s face is a look of shock, some anger, and recollection. Catharina gave Griet the pearl earrings because she cannot bear to wear them, nor stand the sight of them since the day she saw the painting. Vermeer betrayed Catharina and the earrings are the biggest reminder of the betrayal, so to move on from the time Griet spent as their maid and rid all those memories from her mind she needed to give away the earrings. Catharina could have given them to anyone, sold them, or even just threw them away; instead she chose to give them to Griet. She gave them to Griet, to let Griet know that she is not mad at her and she understands Griet did nothing wrong. Catharina shows that her anger and hurt comes from Vermeer’s betrayal when she, with tears in her eyes, looks at Vermeer and asks â€Å"Why don’t you paint me? † In which Vermeer replies that she doesn’t understand. Catharina then in a rage tries to slash the painting, but Vermeer stops her. She then shifts her anger to the only thing she can do, which is make Griet leave. Catharina making Griet leave was misplaced anger, it was anger she wanted to take out on her husband and the painting but couldn’t. Therefore to make it up to Griet for making her leave, she sent her the pearl earrings. She was an emotional wreck in tears and screaming, outranged by her husband’s actions and Griet was a weak young girl she could at the time let her anger out on. After a few days of thinking she realized she was wrong and had Tanneke take the gift to Griet. Vermeer not only betrayed his wife but he also betrayed Griet at the end. When Catharina tells Griet to leave Griet looks at Vermeer to say something, to let Catharina know she has done nothing wrong. Vermeer says nothing though and just lets her leave, which is devastating to her. Griet then even tries one more time to go to talk to him before she leaves to give it one more chance, but he just lets her leave. Vermeer is to blame for all that happened, but lets his wife take the blame out on Griet and then lets Griet take the blame that should be his. He hurts everyone in this story, instead of being a man and taking up for his wrong actions, he is childlike. The sudden music that plays in the movie when Griet opens the earrings is a shocking sound, in disbelief that Catharina has given them to her and is not mad. Griet at first is shocked, and you can see it all over her face. Then she clutches them in her hand as to say thank you and looks off in the other direction as thinking â€Å"What should I do now? † I did not think I would enjoy this novel because I’m not very into historical fiction but I actually enjoyed the novel and movie very much. It was extremely interesting to me, kept me constantly thinking about what each character was thinking. I do however wish the ending had a little more, like maybe letting us know where Griet ended up but I guess we are just supposed to figure that out our selves.

Finding College Students Writing Online

Finding College Students Writing Online Details of College Students Writing Besides which there was a great deal more of life to reside. Quite simply, acquiring a role model, or maybe even a mentor is crucial in learning and staying on track. At the opposite end of the college composition course the work has to be evaluated. When it has to do with improving writing skillsfor everybody, not only for studentsfeedback plays a significant role during the approach. Even though it might appear to be a grey area at first, strict rules govern how and as soon as an original source has to be cited, whatever the style guide used. Moreover, giving presentations in the job place, you must understand who you're speaking too and presenting too. The path to better writing take time Rome wasn't built daily, fantastic things take some time, and stunning writing is something which is the end result of hard work and passion. For instance, if someone yells out, Parking! College Students Writing Fundamentals Explained Regarding citation, be sure to understand just what citation form the professor desires. One of the most important purposes of writing assessment is to give feedback to students. There's little if any evidence of revision. If you would like to get a research paper, online writing service like ours is exactly what you require. By way of example, ensure that everyone knows the questions have to be suitable for the classroom setting. Our editors will verify the info. Let's say you should purchase essay for college. When a reader makes the decision to present your article a go, it's likely as they are interested in just what the title promised them, so the more quickly you can get to discussing that subject matter, the likelier they are supposed to stay. It shows reluctant writers an easy means to incorporate the essential elements. For instance, you can emphasize the value of producing clear and concise outlines before they begin writing. Some tools can help you with grammar and spelling. Before you begin, it can be useful to review examples to have ideas for your resumes and cover letters. The Benefits of College Students Writing The result might be that if a student gets confused or discouraged, they will likely remain so. Needless to say, there are dozens and dozens of resources for college students online. Since you may see, students are sure to face many challenges should they wish to turn into a member of the buy essay club. Consult your students to compose a relatively little number of words on a particular subject every single day. College Students Writing for Dummies Experience is most likely the very best cure. Social media has a broader audience and is more inclined to hold a person's attention. Concentrate on the content first. While Columbia is famous for its preparation in journalism, they also provide an extremely nice creative writing program. Michigan's notable creative writing MFA program remains top-ranking for the last few decades, and that doesn't seem to change anytime soon. Read below for advice on how to compose a strong college resume. On top of that, nearly every college writing center gives support totally free of charge. Quite simply, you are going to be in a position to finish each and every school assignment faster by utilizing help you are able to come across online. Remember that the aim of the goal is to comprehend what you would like to get accomplished in the paper and what type of paper you would like to write i.e. Informative paper or persuasive. Even better, students will find they can alter the template to fit their precise needs, adding points, deleting unneeded info and creating the best paper. Problem is, most of us have zero idea how to compose a productive email. Other crucial rules regarding numbers are available here. An excellent first draft can nearly always be made better by revision, editing, and rewriting. Then make certain all of your details contribute to that message. Then, concentrate on making comments about the content itself before you start to consider the organization and fashion of the paper.

Technology And Teen Communication Teens - 1274 Words

Dylan Fatzynytz Mrs. Thayer Writing Skills 8-06 April 16, 2016 Technology and Teen Communication When teens were introduced to technology every thing in social aspects was downsized dramatically. Teens unproductive and addictive technology use has, and will continue to impact their verbal, and other communication skills. Teenagers rely to much on technology for everything. The teenagers are overusing technology to an extreme. Technology use even a little usage affects communication skills. Their is very little positive things that come out of teen technology use. Teenagers rely heavily on technology for school, connecting with people, and for their jobs. If technology gets taking away from them, they will not be as productive as they can be without long term use of technology. For example it will take a while for them to catch on to the process of whatever it is that they are trying to do and accomplish with no electronics. Most of teens are forgetting how to use key things to the learning process Which is going threw all k-12th grades with a good education and going into collage. The 21st generation of teenagers are growing up to know less and less about the true learning of schools. It is going to get worse and worse as they grow up and have kids and grandkids. The use of technology is to abundant with growing teens. They mostly get side tracked when, when the kids have the devices at there house it interferes with the kid and teens relationship with theirShow MoreRelatedMobile Technology And Its Effect On Our Society939 Words   |  4 P agesMobile Technology Communication has become an essential and also is employed by teens. Thirty years before, it was used only by business, while at present it becomes a small little technology device, which has been accepted by all sections of human society. 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