Pressure Ulcer Assessment and Management | Reflection

Pressure Ulcer Assessment and Management | Reflection Chitse Wheeler Albon Description The purpose of this reflection is to contemplate on the critical incident that brought to my attention regarding the pressure ulcer assessment and management of staffs in care home. Utilizing a critical incident as a way of reflecting involves the identification of comportment deemed to have been particularly subsidiary or unhelpful in a given situation (Hannigan, 2001). I am working in a nursing home in unit catering elderly mentally ill clients. We have 25 residents most of them suffers from dementia. One incident happen to a 90 year old male client with dementia who was double incontinent and has been bed bound due to recent fall that have resulted him to have a fractured hip. He had a history of hypertension and angina 4 years ago. Throughout this essay I will referred the client to Mr. X to protect his identity and maintain confidentiality abiding the guidelines set by the Nursing and Midwifery Council (2014) I observed redness on the sacral area of Mr. X while doing personal care for him with another staff. According to European Pressure Ulcer Advisory ( EPUAP) guidelines, it was grade 1 pressure ulcer as there was intact skin with non-blanchable redness. He is more helpless against pressure damage, as his skin has ended up more delicate and more slender with age (NICE 2014). The nurse in charged was informed regarding our observation. She assessed the pressure area of Mr. X and told to staff that he needs to be assisted in changing his position every 2 hours and application of barrier cream during pad change. The next day, it was reported in the hand over that Mr. X developed a grade 2 pressure sores, a partial thickness loss of dermis presenting as a shallow ulcer open ulcer with a red pink wound. (EPUAP 2014). It also conveyed that the night staffs have not turn him for more than 8 hours and never completed the positional chart. The worst was Mr. C was the fourth resident with pressure ulcer in the unit. Feelings I felt confident because I have prior knowledge regarding pressure sore management and can share this to other care staff for better care for residents with pressure ulcers. However, I was shocked with what I heard in the handover and felt sorry for Mr X that in less than a day he incurs grade 2 bedsores. The effect of pressure ulcer to him and the amount of pain he was dealing. Pressure ulcers can result in clients limited functions, emotional anguish, and agony from pain. (Nelson et al 2009). According to Purshotaman (2013), pressures to bony areas in a 1 to 6 hour period can result to pressure ulcer and shear and friction also act as a synergy to acquire wound in clients who are malnourished, incontinent, bedridden or mentally disturbed. And within 24 hours or it take up to 5 days for pressure ulcer to develop. It was unacceptable that there are four residents who have pressure sore at the same time thus reflecting the quality of care rendered to clients. Pressure ulcer prevention involves an interdisciplinary approach to care. To achieve it, it requires coordination, organizational culture and operational practice that uphold teamwork and communication. Evaluation Pressure ulcers, otherwise called pressure or bed sore, are restricted areas of skin damage as a result of underlying destructed tissue brought on by excessive pressure stopping blood flow and bringing on an absence of oxygen and supplements to tissue cells. Eventually tissue cells die causing ulceration. The vital factors that leads to accumulation of pressure sore includes clients medical condition, medication, malnourishment, age, lack of fluid intakes or dehydration, incontinence, lack of mobility, skin condition and weight. The external influences that hasten its occurrence are pressure, shearing force, friction, moving and handling and moisture. There are several risk assessment tools available to use to determine the level of client having pressure ulcer which I have been familiar during my learning process. These scales are the Norton scale, Braden Scale and Waterlow scale. The most common scale adopted in my work place was the Waterlow scale. It includes additional factors such as age, nutritional status, skin type and disease especially those affecting circulation. The score should be determined during admission of the client, but it is an on-going process and must be carried out whenever a significant changes arise from clients condition ( L. Nazarko,2009). Even though the Waterlow scale identifies more risk factors than the other two assessment tools and widely used across the United Kingdom, it has still be criticised for its ability to over predict risk and ultimately result in the misuse of resource.( Edwards 1995; Mcgough, 1999). Most of the scales used have been develop based on opinions of the importance of possible risk. It might get different scores from nurses assessing the same clients (L. Nazarko, 2009). The predictability of these tools been challenged because it might over or under predict the risk of a person having pressure sore, gaining expensive cost of implications as preventive equipment is put into place that might not always be necessary.(Frank et al, 2003). Although the Waterlow scoring system includes more objective measurements like the Body Mass Index ( BMI ) and record of weight loss. It is still indefinite whether the reliability of the tool ratings has improved by these additions. It has been recognized that this is a fundamental defect of these tools and due to this clinical judgement must always support the conclusions made by the results. The aims of the Pressure ulcer risk assessment tools are to quantify and measure the risk of a person to have a pressure ulcer. To be able to determine the quality of the measurement, the evaluation of validity and reliability should always take place. However, the limitation of the validity and reliability of the pressure ulcer risk tools are generally recognized. According to EPUAP (2014), the solution to overcome these problems is to combine the scores of pressure ulcer risks tools with clinical judgement. In the studies of pressure ulcer tools, there have been few endeavours made to analyse, the diverse pressure ulcer risk assessment strategies. Pancorbo Hidalgo et al (2006) distinguished three studies, researching the Norton scale compared to clinical judgment and the effect on pressure ulcer frequency. From these studies, it was inferred that there was no confirmation, that the danger of pressure ulcer incidence was lessened by the utilization of the risk assessment tools. The Cochrane audit (2008), set out to focus, whether the utilization of pressure ulcer risk assessment, in all health care settings, reduced the frequency of pressure ulcers. As no studies met the criteria, the authors have been not able to answer the survey question. At present there is just feeble proof to support the legitimacy of pressure ulcer risk assessment scale tools and obtained scores contain fluctuating measures of estimation lapse. According to NICE (2014) guidelines, a client who is at risk having a pressure ulcer must be assessed within six hours of admission. However, Mr. X has been in the nursing home for years, his assessment should have been on-going as he was prone to develop it. During the assessment, a skin inspection must be completed on the most vulnerable areas the bony prominent part of the body like the sacrum, heels, elbows, shoulder, back of the head and toes and other parts of the body where shear or friction could take place. Pressure ulcers are assessed and graded according to the extent of damage of the tissue. The European and US National Pressure Ulcer Advisory panels (EPUAP and NPUAP) together with the Pan Pacific Pressure Injury Alliances (PPPIA) release the latest International Pressure Ulcer guidelines for pressure ulcer prevention and treatment. It’s an evidence based recommendation for the prevention and treatment that can be used throughout the world in any health care settin g by health care professionals. Pressure sores are categories from stage I to IV depending on the tissue damage. Addition to these, are two other categories the unstageable pressure ulcers and suspected deep tissue injury (EPUAP-NPUAP-PPPIA International Pressure Ulcer Guidelines 2014) The assessment implement used throughout my area of work, is the Waterlow Scale.The utilization of the Waterlow implement enables, the nurse to assess each patient according to their individual risk of developing pressure sores (Pancorbo-Hidalgo et al 2006)The tool uses an amalgamation of core and external risk factors that contribute to the development of pressure ulcers.. Nutritional assessment and screening tools like getting the Body Mass Index (BMI) are also utilized in the home for managing patients who are at risk of or have a pressure ulcer. The EPUAP (2014) recommends that as a minimum, assessment of nutritional status should include regular weighing of patients, skin assessment, documentation of food and fluid intake. Even so there are policies and procedures in place for management and prevention of pressure ulcer there were still a prevalent occurrence of pressure sores in the unit. Analysis The staffs’ knowledge about pressure ulcer prevention and management plays a very vital role. However, the lack of health care staffs’ education and trainings; and documentation resulted to numbers of patients having pressure ulcers in the unit. All health care professionals must receive relevant training and education regarding pressure ulcer risk prevention and management (NICE 2014).The information, skills and knowledge, gained from these training sessions, should then be shared down to other members of the team and embedded to practice. And all health care staffs involved in the care of clients with pressure ulcer needs to be updated on policies, guidelines and the latest patient educational information according to NICE guidelines (2014). Effective communication between staffs in the care of Mr X could have played a major role to make his pressure sore healed quicker and not worsen. Pressure ulcer prevention and management is a collaborative effort. The nurses should have taken the lead and make sure that the information about the course of care actions towards pressure ulcer management of Mr X has been disseminated to all staffs during the shifts which can be done during the handover. The nurses as leaders of the unit must take other staffs to join on board towards the same direction on a certain goal of clients care. As a student nurse, I have previous knowledge and experience about the pressure sore care and management before but the NMC(2014) oblige that I, to be a registered nurse in the United Kingdom, need to take an appropriate action to update my knowledge and skills to maintain and develop competence to safe practice. To be able to be competent, I need to acquire risk assessment skills while putting in my NMC code of conduct. I was able to assess and observe the redness of the sacral area of Mr X and have reported it immediately to the nurse in charge. Through this positive action of care, the nurse has provided immediate nursing care to Mr. X. Conclusion There is a proof that demonstrates that pressure ulcer risk assessment tools are valuable and useful when utilized as an aide for the obtainment of equipment. Then again, they cant be depended upon solely to give a holistic care to clients. It has been highlighted, that to guarantee holistic assessment of clients, it is important to complete a combination of assessment to be able to create a complete picture client’s health. In spite of the fact that The Waterlow scale covers various variables that need to be considered all through the assessment process, it has become apparent that the â€Å"at risk† score, can frequently be over or under scored relying upon the health care practitioner’s clinical judgement. Clinical judgment has turned out to be, a vital part of pressure ulcer prevention and management. The education and effective communication of the patient, relatives, carers and nurses has likewise been highlighted, as a critical part of consideration. Enabl ing the patient with data in regards to their ailment, may diminish the mending time and prevents further concerns. Action Plan To prevent and minimize the number of pressure ulcer staffs must attend training regarding pressure ulcer prevention and management. They should be also familiarizing with the policies and procedures when pressure ulcer is noticed so that if the same experience occurs in the future they familiarize the actions to be follow. In addition, health care staffs must be mindful that communication, teamwork, support and supervision have a big role to improve the quality of care of pressure ulcer management. Reporting, Supervision system and empowering staffs to confidently complete forms like positional charts, food and fluid charts and body map can be effective and a good way to improve communication between staff and for continuity of care of clients As a catalyst of change, I should be a role model to other staffs by abiding with the standard of care rendered with clients and promote their best interest by educating my colleagues and having effective communication between staffs and clients. However, not all staffs are willing for change. Change takes time but as long as there is a continuous education and system of good practice in place and staffs can see the results and benefits for clients, others and for themselves, more or less change can happen. Referrence: Nazarko, L. and Nazarko, L. (2002). Nursing in care homes. Oxford, UK: Blackwell Science. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance.(2014) Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Emily Haesler (Ed.). Cambridge Media: Perth, Australia;. Nice.org.uk, (2014). Pressure ulcers: prevention and management of pressure ulcers | Guidance and guidelines | NICE. [online] Available at: http://www.nice.org.uk/guidance/cg179 [Accessed 5 Jan. 2015]. Nice.org.uk, (2014). Pressure ulcers: prevention and management of pressure ulcers | Guidance and guidelines | NICE. [online] Available at: http://www.nice.org.uk/guidance/cg179 [Accessed 5 Jan. 2015]. Bryant, R. and Nix, D. (2012). Acute chronic wounds. St. Louis, Mo.: Elsevier/Mosby. Pancorbo Hidalgo et al (2006) McCabe, C., Timmins, F. and Campling, J. (2006). Communication skills for nursing practice. Basingstoke [England]: Palgrave Macmillan. (Hannigan, 2001). E. Purshotaman.(2013) 2013 International Conference on Biological, Medical and Chemical Engineering (BMCE2013. Lancaster, Pennsylvania: DEStech Publications, Inc E. Purshotaman Anon, (2015). 1st ed. [ebook] Available at: http://www.ahrq.gov/professionals/systems/long-term-care/resources/pressure-ulcers/pressureulcertoolkit/putoolkit.pdf [Accessed 6 Jan. 2015]. Nazarko, L. (2009). Nursing in Care Homes. New York, NY: John Wiley Sons.

Kate Chopins The Awakening and Henrik Ibsens A Dolls House Essay

Kate Chopin's work, The Awakening, and Henrik Ibsen's play, A Doll's House, were composed at a time when men dictated women in every part of life. They are both superior examples of literary works greatly ahead of their time. Each work exemplifies the strict social standards placed on women and how they destructively affected the women. They also demonstrate how the women were able to overcome over these social ethics and get towards a life of vaster fulfillment. The characters in The Awakening and A Doll's House were very similar. In addition, the trials that they faced were also very similar. Both of the female characters are confronted with the fact that they have an authoritarian for a husband, and create an exit scheme to leave them. For Nora this includes deserting her family and running away, while Edna makes the choice that Nora could not do and commits suicide. Nora and Edna also harbor a secret that ultimately leads to their choice to leave their families. In addition, bot h writings also seem to have similar themes. They both explore the idea of freedom and discovering one’s own identity. Furthermore, they show how a woman in late 1800s often had no freedom from what society anticipated of them. As an outcome, the only way they could find their own identity was by leaving these social standards inflicted by their family life. Ibsen and Chopin appear to purposely present their main characters in this way and use their gifts for writing to foretell a transformation in society that needs to and will eventually occur. There are many similarities between the two: each protagonist seems happy about their marriage in the beginning, controlled by their husband, has a secret, and eventually realizes they are someone. Edna Pon... ...vald, she tells him, â€Å"I don’t believe that any longer. I believe that before all else I am a reasonable human being, just as you are—or, at all events, that I must try and become one. I know quite well, Torvald, that most people would think you right, and that views of that kind are to be found in books; but I can no longer content myself with what most people say, or with what is found in books. I must think over things for myself and get to understand them.† (Ibsen 112) Therefore, in the end both Edna and Nora left in dramatic ways, one leaving a life and the other leaving a family. Bibliography Ibsen, Henrik. A Doll's House. Coradella Collegiate Books, 11 Oct. 2004. PDF. Chopin, Kate, McMichael, George L., J. S. Leonard, and Shelley Fisher. Fishkin. The Awakening. Anthology of American Literature. Tenth ed. Vol. II. Boston: Longman, 2011. 697-786. Print.

Difficult Relationships Between Adults And Children Essay

In many of the stories, the writers describe difficult relationships between adults and children. Compare the relationships that the writers present to the reader in two stories and explore the ways the relationships between the adults and children change as the stories develop. In this essay, I will be exploring the relationships between adults and children in â€Å"Flight† and â€Å"Your Shoes†. It seems to me that both stories have children and adults that are in similar positions. The content and style of the stories are similar in some ways and different in other ways. For example, the main problem in both stories is the daughter leaving home for the first time. Another example of a difference is â€Å"Flight† is written in third-person whereas â€Å"Your Shoes† is not. â€Å"Your Shoes† is a story told from the perspective of a mother who has suffered a great loss, as her daughter has run away. She seems to be forced to realise that she is very upset with aspects of her life. The mother is writing a letter to her daughter describing all the unhappy things that have happened to her. For example, her childhood and details of her marriage. All this seems to stem from the fact that her mother has recently died. â€Å"Flight† is a story about leaving home and becoming independent. The story tells of an old man who keeps birds and seems to be very protective of his last granddaughter. He has seen his other granddaughters leave home, marry, and grow up. He seems to be slightly jealous of Steven who is Alice’s boyfriend. In the story, the birds seem to symbolise the granddaughter. This also could be interpreted as the birds symbolising how the grandfather would like the granddaughter to be like. In the end, the grandfather lets the granddaughter go and this is symbolised in the release of his favourite pigeon. It seems to me that the relationship in â€Å"Flight† between Alice and her grandfather is quite close. I think this because both seem to have a mutual understanding of each other. One example of this would be Steven giving a pigeon to the grandfather. I think this is the case, as I don’t think Steven would have given a bird to the granddad on his own accord. Therefore, this would mean Alice thoughtfully made Steven give the bird to show the granddad that he could look after the bird instead of her. â€Å"Your shoes† is quite different. The author of â€Å"Your shoes† has developed the mothers character in such a way the reader can get a real good insight in what the mother is thinking. This gives us much more detail then anything we got from the Grandfather in â€Å"Flight†. The mother seems to the reader frustrated that people don’t act in the â€Å"proper† way. In the end the mother is left holding her daughters shoes as if they were her substitute. This is quite an extreme from the reaction the grandfather took as he was able to let her daughter take â€Å"flight†. During both stories, the relationships between the adults and the children all seem to mature for better or worse. In â€Å"flight† the relationship between Alice and her Granddad all changes when Steven presents a pigeon to the granddad. The Granddad seems get a revelation and changes his view on the relationship between Steven and Alice. He accepts the fact that his little granddaughter has grown up. This is symbolised in him releasing his favourite pigeon. In â€Å"Your Shoes† we can not see the relationship at first hand but from the detailed insights from the mother we can assume a lot of things. I think that the relationship between mother and daughter was never very strong. Firstly, the daughter who was very fond of her grandmother had died. The mother detested her own mother and we assume that it must have hurt that her daughter preferred her Grandmother to herself. Then finally the daughter running away seems to symbolise there whole relationship. This is quite somewhat different from â€Å"Flight† as mother in â€Å"Your Shoes† seems to go mad, in the end sucking on her daughters shoelaces. In conclusion, both stories seem to have similar relationships at the starting of the story as the children want to grow up. Then both relationships shoot off in different directions, as the mother in â€Å"Your shoes† was unable to let go while the Grandfather in â€Å"Flight† let his granddaughter free.

Essay on Improving the Quality of Education - 1256 Words

Improving the Quality of Education The traditional school calendar is nine months in school and three months out. It was put into place when we were an agrarian society and the whole family was needed to work in the fields and to harvest the crops. Children were an important part of the family farm, and this took precedence over a formal education. Now that our society is no longer agrarian, and has not been so for more than a hundred and thirty years, it may be time for a change. We have heard how the United States ranks in comparison to other post-industrial countries in regards to education. One idea that has proven to be successful in improving the education level of students is â€Å"year round schooling†. Year round schooling†¦show more content†¦The implementation of year round schooling has met with opposition in some areas because of the lack of understanding and availability of information. One of the first misconceptions is that teachers and students would be attending school for the whole year without a break. It has also been said that moving to year round school would cause a breakdown of family relationships and traditions. In addition, the loss of the summer vacation would disrupt normal childhood growth and development. Some groups have argued that with the reduction in the number of summer vacationers, the economy of seasonal communities would be adversely affected. Also, with less high school age students available to work, a shortage of available staff for needed summer positions would leave jobs unfilled. The change to year round school would take some adjustments by all groups. The teachers, students, and their family members would have to adjust to having multiple vacations that were spread out over the entire year. 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