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Scientific and Mathematical-Analytical Perspective of Inquiry

Scientific and Mathematical-Analytical Perspective of Inquiry

The development of pressure ulcers for patients in healthcare facilities continues to rise annually. This has been an ongoing problem for years, and the healthcare industry needs to address this issue in order to prevent its occurrences and improve patient care. This study will try to answer the questions, “what body systems are affected by pressure ulcers?” and What are the economic issues involved in pressure ulcers prevention?” According to the Agency for Healthcare Research & Quality (AHRQ) (2012), an estimated 2.5 million or more individuals develop pressure ulcers annually in the US alone. One of the main problems of pressure ulcers is pain and suffering for the patient and their families. Pressure ulcers also cause a lack of quality productive time, emotional distress, and financial loss to the family and the healthcare providers alike. Pressure ulcers can lead to health complications such as cellulitis, infection of the bone or the joints, cancer and sepsis, which can also lead to death. Early treatment and the use of evidence-based guidelines for pressure ulcer prevention is crucial in reducing their occurrences and improving patient outcome. Because the safety and well-being of the patient are of the utmost priority, healthcare employees must be knowledgeable in dealing with preventative measures that can put the patients at risk for pressure ulcer development. Also, healthcare facilities have the mandate to provide their employees with all the necessary tools required to do their job in order to ensure patient safety is always observed. Since the strategies used to operationalize the educational intervention performed in pressure ulcers prevention are important means for the dissemination of recommendations for prevention, the same strategies can be used by nursing managers, policymakers, educators, and researchers as facilitating strategies for the development and implementation of educational programs for the prevention of pressure ulcer in hospitals and other healthcare facilities.

Which body systems are affected by pressure ulcers?

The development of pressure ulcers is a complex process and is dependent on a wide variety of extrinsic and intrinsic risk factors (Tayyib, 2013). Even though the integumentary system is the most affected based on what is visible, all other body systems might be affected based on the severity and the stage at which the pressure ulcer is. Because pressure ulcers are caused by exerted pressure on a localized area for a prolonged period, the skin, soft tissue, muscle, and bone are the most affected. Blood vessels within the distorted tissue are compressed, angulated, or stretched out of their usual shape, and blood is unable to pass through them (Bhattacharya, 2015). This pressure leads to the development of localized ischemia, tissue inflammation, tissue anoxia, and necrosis. Some of the risk factors that increase the risk of developing pressure ulcers include but are not limited to physiologic factors that may impede microcirculation and non-physiologic factors such as age, mobility impairment, and urinary incontinence.

In stage 1 of pressure ulcers, the integumentary system is compromised. The Skin is mainly damaged by intermittent pressures in excess of mean capillary pressures that result in endothelial damage and platelet thrombosis (Barton, 2006). The skin surface is reddened but intact with non-blanch-able erythema. It may feel warmer or cooler, firmer or softer and may be more tender compared to surrounding tissues. To minimize complications for patients already exhibiting symptoms, evidence-based precautions can be deployed, which include but are not limited to encouraging able patients to reposition and frequently repositioning the patient with mobility issues. The use of protective paddings and use of air loss mattresses can be used to relieve the pressure on bony prominences. Keeping the skin clean and dry and providing adequate nutrition and hydration are recommended. At stage 2, the epidermis and or dermis is damaged and presents a blister or a discolored bruise. It may also present as a shallow crater. Decreasing pressure, cover and protect as well as proper nutrition are the key to a quick recovery. At stage 3, a deep wound with full thickness loss and fatty tissues is exposed. The ulcer appears crater-like. At stage 4, there is full thickness loss, and much of the surrounding tissue is damaged and necrotic. The muscles, tendons, and bones are damaged as well. The wound often has slough on it and or is covered by a scab. Necrotic tissue is a medium for bacteria and needs to be removed to promote healing. There are several ways to debride a wound which include mechanical debridement, which involves hydrotherapy; sharp debridement, which involves a sterile surgical scalpel to remove eschar and thick necrosis; autolytic, enzymatic and biosurgery are also recommended methods of debridement to promote healing.

What are the economic issues involved in pressure ulcer prevention?

Healthcare facility-acquired pressure ulcers are preventable but are common across the globe. In the US alone, the healthcare system costs an estimated $9.1-$11.6 billion annually (AHRQ, 2010). Pressure ulcers are known to cause pain and suffering, lack of productive time, and financial loss to the patient and to their families alike. Also, billions of extra dollars are being spent in the healthcare industry to treat pressure ulcers and other complications associated with them, such as wound treatment products and nursing care. The cost is primarily associated with the extended length of hospitalization. The Center for Medicare and Medicaid Services does not reimburse the cost of treatment of pressure ulcers and other complications acquired in healthcare facilities. Studies have shown that the development of a pressure ulcer independently increases the length of a patient’s hospital stay by 4-10 days (Scott, 2006). According to the Agency for Healthcare Research & Quality (2016), it is estimated that the cost per pressure ulcer in the US is $2,731, and it could be as high as $59,000 if the ulcer was associated with osteomyelitis. The agency also estimated that each pressure ulcer adds $43,180 in costs to an individual’s hospital stay. Today, the treatment of pressure ulcers depends on their severity and may range between $2,000- $20,000 per ulcer (Xakellis, 1996). The incremental cost for treating stage 1 is about $2,000. Stage 2 ranges between $3,000-$10,000, stage 3 ranges between $5,900-$14,840, and Stage 4 costs as much as $18,730-$21,410 (Spetz, 2013).

Other costs include loss of productive time for the patient and loss of work for their families due to hospitalization and visitation, forced early retirement, morbidity and mortality of patients with physiological and psychological effects which are beyond measure compared to their financial loss. The healthcare industry is also facing another problem with legal implications. According to the Agency for healthcare research and Quality, an estimated 17000 lawsuits are filed annually against the healthcare industry due to pressure ulcers, and as high as $ 312 million has been awarded as a settlement (Bennett, 2000). Since pressure ulcers are preventable, the cost to prevent them would be much less than treating them. In this regard, the healthcare industry can save money on treatment costs, minimize litigation and penalties, improve their performance metrics and reimbursement rates, and improve overall outcomes for their patients. This would include a preventative plan that includes a risk assessment policy, the training of nurses for preventive care, and the evaluation of results. Also, because the safety and well-being of the patient are of the utmost priority in all healthcare facilities, all employees must be knowledgeable in dealing with preventative measures that can put the patients at risk for pressure ulcer development. Healthcare facilities have the mandate to provide their employees with all the necessary tools required to do their job in order to ensure patient safety is always observed. In addition, it is important for them to invest in the education of their patients for they to contribute to their own care and prevention of pressure ulcers.

Prevention of pressure ulcers is a complex task and requires a multidiscipline approach for its effectiveness. One successful approach is the implementation of a pressure ulcer prevention care bundle (PUPCB). These are a set of organized, evidence-based interventions that encourage compliance and guidelines that, when used together in a systematic way leads to better patient outcomes. These specific care practices are among the ones considered most important in achieving the desired outcomes. Nurses and other caregivers at the bedside have a primary role in pressure ulcer prevention. Patients can also play a major part in contributing to their care which results in increased safety. Patient participation is endorsed by the World Health Organization (WHO 2013). Nurses partnering with patients in pressure ulcer prevention may be an effective strategy for reducing pressure ulcers among at-risk patients (Roberts, 2000).

Conclusion

The development of pressure ulcers in long-term care facilities continues to rise. Pressure ulcer development is a complex process and is dependent on a variety of extrinsic and intrinsic risk factors. Multiple body systems are affected, including the most obvious, the integumentary system depending on the stage of the ulcers. Patients and their families, including the healthcare industry, continue to lose money related to the treatment and prevention of pressure ulcers. Pressure ulcers cause pain and suffering in addition to financial loss associated with lawsuits and litigations, as well as the loss of productive time. Early intervention and implementation of evidence-based practices are known to reduce and improve patient outcomes. Healthcare facilities must invest a lot of money in educating their staff and patients on various interventions that promote patient participation to promote safety, and self-awareness.

References ;

Preventing Pressure Ulcers in Hospitals. (n.d.). Retrieved from https://www.ahrq.gov/patient- safety/settings/hospital/resource/pressure ulcer/tool/index.

Barton, A. (2006). The pathogenesis of skin wounds due to pressure. Journal of Tissue Viability, 16(3), 12–15. doi: 10.1016/s0965-206x (06)63003-9

Bhattacharya, S., & Mishra, R. K. (2015). Pressure ulcers: Current understanding and newer modalities of treatment. Indian Journal of Plastic Surgery, 48(01), 004–016. doi 10.4103/0970-0358.

Bennett, R. G., Osullivan, J., Devito, E. M., & Remsburg, R. (2000). The Increasing Medical Malpractice Risk Related to Pressure Ulcers in the United States. Journal of the American Geriatrics Society, 48(1), 73–81. doi: 10.1111/j.1532-5415. 2000.tb03033.x

Roberts, S., McInnes, E., Wallis, M., et al. Nurses’ perceptions of a pressure ulcer prevention care bundle: a qualitative descriptive study. BMC Nurs 15, 64 (2016). https://doi.org/10.1186/s12912-016-0188-9

Scott, J. R., Gibran, N. S., Engrav, L. H., Mack, C. D., & Rivara, F. P. (2006). Incidence and Characteristics of Hospitalized Patients with Pressure Ulcers: State of Washington, 1987 to 2000. Plastic and Reconstructive Surgery, 117(2), 630–634. doi 10.1097/01.prs.0000197210.94131.39

Spetz, J., Brown, D. S., Aydin, C., & Donaldson, N. (2013). The value of reducing hospital-acquired pressure ulcer prevalence: an illustrative analysis. The Journal of nursing administration, 43(4), 235–241. https://doi.org/10.1097/NNA.0b013e3182895a3c

Tayyib, N., Coyer, F., & Lewis, P. (2013). Pressure ulcers in the adult intensive care unit: A literature review of patient risk factors and risk assessment scales. Journal of Nursing Education and Practice, 3(11), 28–42. Retrieved from http://qut.summon.serialssolutions.com/2.0.0/l.

Lyder CH, Ayello EA. Pressure ulcers: a patient safety issue. Chapter 12 in: Hughes RG, ed. Patient safety and quality: an evidence-based handbook for nurses. (Prepared with support from the Robert Wood Johnson Foundation.) Rockville, MD: Agency for Healthcare Research and Quality; April 2008. AHRQ Publication No. 08-0043.

World Health Organization. (2013). Patients for patient safety. Partnerships for safer health care. Geneva: WHO.

Xakellis GC, Frantz R. The cost of healing pressure ulcers across multiple health care settings. Advances in Wound Care: The Journal for Prevention and Healing. 1996 Nov-Dec;9(6):18-22.

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Question 


Compose a focused paper that explains and describes your healthcare issue/topic from the scientific and mathematical/analytical perspectives of inquiry. (You will cover two perspectives in one paper.)

Address your general topic by forming and answering two levels of research questions for each inquiry.

Scientific and Mathematical-Analytical Perspective of Inquiry

Scientific and Mathematical-Analytical Perspective of Inquiry

Choose a “Level 1 Research Question/Writing Prompt” from both of the lists below to answer in the paper.

Compose a “Level 2 Research Question/Writing Prompt” for each kind of inquiry that provides detail, specificity, and focus to your inquiry, research, and writing.

State your research questions in the introduction of your paper.

Answer each research question and support your assertions with evidence (research) to form the body of your paper.

In the conclusion of the paper, briefly review the issues, research questions, answers, and insights.

Level 1 Research Questions/Writing Prompts
SCIENTIFIC Perspective of Inquiry

  • What are the anatomical, physiological, pathological, or epidemiological issues?
  • Which body systems are affected?
  • What happens at the cellular or genetic level?
  • Which chemical or biological issues are most important?
Level 1 Research Questions/Writing Prompts
MATHEMATICAL/ANALYTICAL Perspective of Inquiry

  • What are the economic issues involved?
  • Which economic theories or approaches best explain the issue?
  • What are the statistical facts related to the issue?
  • Which statistical processes used to study the issue provide for the best explanation or understanding?

Your paper must be five pages in length and reference four to six scholarly, peer-reviewed resources. Be sure to follow the current APA Style (e.g., spacing, font, headers, titles, abstracts, and page numbering).

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