Prevention Strategies for the Development of Pressure Ulcers

Prevention Strategies for the Development of Pressure Ulcers This assignment will examine the process and methods used when gathering empirical evidence, for a chosen based care issue, using different search strategies and medical databases. An appraisal and discussion of the chosen evidence will also be made, identifying how the evidence was gathered and its relevance to the chosen based care issue. The process of collecting such evidence and the importance of its use will be reflectedupon using a specific reflective model. The practice based care issue which has been chosen is ‘prevention of pressure ulcers’. A pressure ulcer is an area of localised damage to the skin and underlying tissue (EPUAP, 2009) which develops when there is persisting pressure on a bony site, obstructing healthycapillary flow , leading to tissue necrosis (Lyder, 2003).The rationale for selecting this type of research is due to the high prevalence rate of pressure ulcer among patients and the current lack of knowledge concerning guidelines of pressure ulcer prevention (Moore Price, 2004). I am very interested in this topic and feel a deeper knowledge of pressure ulcer development and risk assessment tools will enable me to provide better clinical practice. According to Davies (2008) health care professionals are striving constantly to improve and develop standards of care which evolves from the integration of research evidence, clinical expertise and patient needs and values (Institute of Medicine, 2001),this is al so known as evidence-based practice. The reflective model that I will be using is Rolfe et al (2001) ‘what’ model which composes of three main areas, what? So what? Now what? This model aims to identify the following; what was I trying to achieve? What is my new knowledge of understanding? What information is needed to face a similar situation again? Ichose this particular model compared to John’s model of reflection (1994) as I found it the easiest model for organisation and meaning to the process of reflection. .Reflection involves accessing previous experience to help in developing tacit and intuitive knowledge (Johnsand Freshwater, 2005) and the main principles of reflection include becoming mindful, understanding and learning from experience. Reflection facilitates an evaluation of one’s own practice, both as individuals and with their teams (Sines, Saunders Burford, 2013). It is vital that Nurses reflect and practice reflectively as it allows them to learn from experience and make better future judgement, becoming critical practitioners and facilitating excellent patient care. The critique model I will be using for the critical appraisal and discussion is the Critical Appraisal Skills Program (CASP) as it is a clear tool which identifies the worth of the articles I have found (CASP, 2013). Critical Appraisal After researching for relevant articles, I decided to choose three of the most relevant articles to critically appraise. Each of these three articles involves a study evaluating the effectiveness of prevention strategies for the development of pressure ulcers. The first single blind randomised control study by Webster et al (2011) aimed to evaluate the effectiveness of two pressure-ulcer screening tools against clinical judgement in preventing pressure ulcers. This study had a very clear and focused objective which stimulated the reader to continue reading due to the study avoiding the use of jargon or buzz words (Carr, 2001). This was an experimental and correlation study showing the link between two factors with the aim of producing quantative results. 1231 patients were randomly allocated to either a water low or ramstadius screeningtool or to a clinical judgement group. Randomised Control Trials (RCT) are comparative studies with an intervention group and a control group; the assignment of the subject is assigned through randomisation(Melnick Everitt, 2008). The advantages of using RCT are that it removes potential of bias in the allocation of participants and that randomisation tends to produce comparable groups; that is, measured as well as unknown or unmeasured prognostics factors and characteristics at the time of random allocation will be balanced (Friedman, Furberg Demets, 2010). The researchers ensured that patients allocated were excluded if their hospital stay was expected to be less than 3 days or if they had been in hospital 24 hours prior to the baseline assessment occurring. This is to allow thorough and regular direct observation of the incidence of hospital acquired pressure ulcers, allowing the researcher to attempt to control the studies validity and reliability (Marshall, 2004). In a research study it is vital that the researcher ensures that the subjects are aware of the process of the study and have given informed consent. In the case of this study, for pressure ulcer screening and observation, consent was not required. However, signed consent was sought from any patient who developed a pressure injury in order to validate the assigned pressure ulcer through clinical photography. The researchers also obtained institutional ethics approval which included the right to access the patient’s medical record for audit purposes. The incidences of hospital acquired pressure ulcers were similar between all groups. The authors found no evidence to show that two common pressure ulcers risk assessment tools were superior to clinical judgement to prevent pressure injury. The authors felt that resources associated with the use of these tools might be better spent on careful daily skin inspection and improving management targeted at specific risks. This is supported by the work of Sarabahiand Tiwari (2012) who suggests a regular and rigid schedule of inspection must be followed as part of the patients daily routine. Nurses undertaking the trial were more familiar with the Water low scoring system which could have led to contamination in the clinical judgementgroup. The limitation of this study is that they did not use patients from acute settings who could be at risk and therefore cannot use these results as a representation of all hospital settings. The second randomised controlled study by Nixon et al (2006) aimed to compare whether differences exist between alternating pressure overlays and alternating pressure mattresses in the development of new pressure ulcers. This criterion for this study involved participants aged at least 55 years who had been admitted to vascular, orthopaedic, medical, or care of elderly wards, and had limited mobility. The methodology used for this study was pragmatic, open, multicentre and randomised controlled trial. An open label study is where the investigator and experimental units knows which treatment the experimental unit is to receive. Although this type ofstudy is simple and easy to design, it could cause the individual to favour the type of treatment, leading to possible bias (Ambrosisus, 2007). A multicentre method involves the study being conducted by several institutions. An advantage to conducting a multicenter is that it increases the number of patients available to participate (Bhandari Joensson, 2011), which in the this trial is a large 1972, leading to the findings beinghighly likely to be representative of what would happen in usual clinical practice. The design of this study involved patients beingallocated to either an alternating pressure overlay or an alternating pressure mattress, within 24 hours of hospital admission, with the expected length of stay of at least seven days. Clinical research nurses assessed skin status twice weekly for 30 days and then once a week up to 60 days for the development of pressure ulcers. A limitation of this study is the lack of blinded outcome assessment due to difficulty in disguising or masking the mattresses, however, according to Khan, Kunz, Kleijen Antes (2011) only few observational studies manage to implement appropriate measures to achieve blinding. The researcher tried to combat this through independent skin assessments which were taken by the Nurses to avoid any bias.Ethical approval for this study was approved by theNorth West multicentre research ethics committee and local ethics committees in order to undertake this research. This study had a clear aim to evaluate the effects on p ressure ulcer risk and was able to undertake the study with fairly low rates of ulcer incidence, meaning the patients were subjected to minimal harm.The most important issue arising in the ethical review of scientific research involves preventing human participants, is risk of harm (Smith Waddington, 2013)therefore it was extremely important that the researchers were able to conduct this study with low incidence rates. The results of this study were that the patients allocated to either an alternating pressure overlay or alternating pressure mattress that developed a new pressure ulcer of grade 2 or worse did not differ, highlighting the need for other preventive measures. The final study by Moore et al (2011) aimed to compare the incidence of pressure ulcers among older persons nursed using two different repositioning regimens. The researchers aim is very clear, evaluating the effectiveness of positioning patients 3 hourly and 6hourly at night time. The methodology used was a pragmatic, multi-centre, open label, prospective and cluster-randomised controlled trial, similar to the study above, the findings are highly likely to be representative of what would happen in usual clinical practice due to a multicentre approach being commonly accepted as providing a more representative population (Luchetti Amadio, 2008). Cluster randomised control trial involves randomizing professionals so it is much easier to keep the intervention separate from the control groups but methodological, statistical and ethical issues must be taken into account in making sense of cluster trials(Gilbody Bower, 2010). This study did indeed ensure that ethical approval was received by participants before the study commenced. The results obtained through the research were that repositioning patients with a pressure ulcer every three hours at night, using the 30 degree tilt, reduces the risk of pressure ulcers compared with usual care which issupported by the recommendations of the International pressure ulcer prevention guidelines (2009). Arguably, the research is well written with a good amount of supporting literature, stating clearly the incidence of pressure ulcers with a good rationale for the studies aim. This study included results of other similar researchers who have found similar results of repositioning, giving scope for further research such asDefloor et al (2005). The limitation of this study is that the target of 398 participants was hard to find which caused the variance in the size of the clusters to be different, which could have had a major effect on the research gathered. Another limitation is that most participants were 80 years or older which means it cannot be a representative of mos t patients, as expected. Reflection Using the Rolfe et al (2001) reflective model, I will evaluate the actions in undertaking my searches and what I found. As mentioned above, the stages of the reflective model includes what? So what? Now What? The first stage (what?) involved the process of searching for my articles in relation to the subject issue‘pressure ulcer prevention’. Using the databases,Pubmed, Scopus and JSTOR I searched for articles using key words such as, prevention, pressure ulcer, pressure sore and risk assessment. In order to limit the amount of results gathered I used the Boolean operators ‘and’ and ‘or’ as well as advanced searches such a ‘UK based’ and ‘No older than 2005’; ensuring a realistic amount of hits were gathered, relevant to the subject issue. In order to identify relevant articles, I read through the titles and abstracts, as this gave me an idea of how relevant the articles were. Once I read through a few studies, I was able to choose 3 studies to critically evaluate. The second stage (So what?) involved identifying the difficulties which I encountered when conducting the search. I found the searching quite challenging as many of the results either came back as a large amount of hits or a small number of hits based around irrelevant research to my subject. Using keywords and re wording phrases such as ‘pressure sores’ instead of ‘pressure ulcers’ enabled me to widen my search. The final stage (Now what?) involved reflecting on the search which I had undertaken as well as the results obtained. I had to conduct many different searches and keywords to find effective results. The problem I encountered was that many results obtained were regarding wound care and not prevention; if I was to repeat this search again I would ensure I put ‘NOT wound care’. I feel further exploration of medical databases would be beneficial for future research to give me a better understanding of search terms and criterion available. Prior to carrying out this assignment, I was certain that risk assessment tools played a major part in the role of pressure sore prevention. However, risk assessments such as water low, have been criticised due to its poor validity, particularly for the tool to underestimate the numbers at risk (Pancorbo Fernandez, 2006). Thestudies which I have critically evaluated have made it clear that observation and repositioning is key to pressure sore prevention. As identified by Guyatt et al, (2000) Nurses do not feel sufficiently competent to be able to appraise research findings because they lack the necessary understanding of information retrieval techniques, research design and data analysis and therefore it is important that Nurses are educated in pressure sore management, for clinical practice to be effective. This assignment has expressed the importance of evidence based practice for effective clinical practice,although contradictory findings from different sources and a lack of critical appraisal skills can make interpretation of evidence difficult. It has taught me the value of observation when caring for patients and made me become mindful of reading and evaluating research to learn and improve my clinical practice. I am aware that repositioning and skin integrity checks are a major pressure ulcer prevention and that risk factors such an nutrition also need to be monitored closely, I feel I will confidently use the knowledge I have obtained when in practice. This assignment has put into perspective the importance of identifying all factors when caring for a patient and aiming to prevent pressure sores. For future development I would like to do further research on methodology as I believe this will help me to evaluatethe studies in much more depth, especially seeing ascertain study methodological designs are likely to be more reliable compared to others. Conclusion In conclusion, this essay demonstrates an effective search strategy for research studies on ‘preventing pressure ulcers’ which have each been critically appraised. A reflection on the process of the research was carried out using Rolfe model of reflection (2001) highlighting learning outcomes as well as encouraging me to exploreimprovements for my future practice and search strategies.

A child & mom Essay

A child enters your classroom crying and screaming not wanting mom to leave. He has just been told, this morning, his daddy is leaving his mom and two brothers to live with another woman. What would you do? Why? To address this concern, what I can do is to approach the child with a smiling face and ask him a question in a soft voice about the cause of his crying. Based on the reading, it is necessary to communicate with a child which promotes an interest about his current situation (Maine Cooperative Extension, 2008). I can start with a simple â€Å"Hello† and ask him â€Å"May I please help you? † If the child will respond in a positive way, I can directly ask him why he is feeling bad even though I know the situation. I can come out of the classroom and accompany him to his mother outside so that the three of us can have a conversation and to let the child see that I am interested to accommodate him by having a scripted talk with his parent. One very good approach is to tell the child in front of his mother that all the kids inside the classroom are actually waiting for him to become their new friend. Having a conversation with him in front of his parent can boost his confidence with me since he will identify my presence with his mother that I am a person whom his she can trust upon his welfare. The aspect of saying to him that the whole class is waiting can entice the child that there are other people interested in him apart from his parents. Also, I could tell the child that each of the students in the class also had to cry loud during their first days in school but when they were able to meet their new friends, they had to tell their moms to leave because they know that parents cannot be involved in child’s play because they are too big which is something funny. This approach can help the child realize that he is not actually alone and that crying is a normal experience during the first day in school. Moreover, the comedic aspect of â€Å"parents playing with the class† can provide a deviation that it is actually funny and will not impose a shame effect on the part of the boy. When he calms down and after I have gained his trust, I will invite him inside the classroom and offer him a seat. I will not open up the issue about his family concerns since this may just complicate his feelings towards interacting with other people. It is much appropriate to have him forget his internal family problems at least inside class so that he can be more productive in learning. Scenario # 2 Your students keep getting up from their desks during journal writing time to sharpen their pencils. As they walk between the tables, they are constantly disrupting the other children who are working quietly on their journals. The students that finish first are also talking and laughing. The remaining students are having trouble concentrating on finishing their assignment. What should you do? Why? First of all, it would be effective to impose a technical resolution in a funny way of teaching them the appropriate behavior in doing their personal tasks. Since it is too embarrassing to pinpoint a single child who disrupts others when writing journals, I can first get the attention of the whole class and tell them that I have a funny story to tell. This will involve a make-up scenario on what disruptive walking can induce to other people. I will try to tell the story of a fictional previous student of mine while demonstrating them how it is problematic to disturb others while walking. I could create a scene where I will get a volunteer who will be writing on a table and then I will exaggerate my walk bumping my hips to the child’s table while making funny faces. Of course, I will intend to overdo the act so that it will be very obvious for them to see that the child volunteer will have hard time writing on his paper due to my actions. This funny scenario will induce laughing all over the classroom but will also let them realize that walking in a prim way between the tables is essential so that other students will not be disturbed. On the part of the noisy children who finish first, I could set up a simple guide that will separate them from those who are still working on their journals. I could allocate a small space at the back of the room complete with tables and chairs for a few students. Then I will tell them that it is sometimes very good to have non-verbal communication and it is more exciting to exchange thoughts by sending small notes even if the person you are talking to is right beside you. I could hand them small scratch papers in which they can write what they want to say to each other so that they will not need to talk verbally. The procedure can bring them excitement since they will need to write first on a piece of paper before they can send their messages to another person. This will not only minimize noise inside the class but will also enhance their writing and comprehension skills. Overall, the other students who are still working on their journals will be able to finish their work without any distractions. References Main Cooperative Extension. 2008. Winning Ways to Talk with Young Children. University of Maine. Retrieved February 6, 2008 from http://www. umext. maine. edu/onlinepubs/htmpubs/4077. htm.

Entertainment V. Addiction Essay

There is a definitive and quite distinct difference between wholesome, quality entertainment and addiction. In the novel Fahrenheit 451, Ray Bradbury very clearly states the variation among the two. Through his examples and characters in his story about a very realistic society, he expresses his opinions and almost foresees something quite relevant to society today. However, there will always be those select few who will recognize the worthlessness of mindless propaganda that seems to infect the minds of humankind. Television takes a prominent role in the script of everyday life. Additionally, it takes an even larger role in the lives of the citizens of Bradbury’s metropolis. Actually, it is more of a brain cell cemetery. For example, Mildred, the main character’s (Montag’s) wife, is constantly bombarded with television and radio programs. In fact, three walls in the parlor of the couple’s home have been converted into giant television screens! For Mildred, however, this is not good enough. She whines that having a fourth wall installed would make her happy, and that she couldn’t possibly be happy without it. Her argument is that the installation would only be $2,000 and that in order to earn this money they could just â€Å"do without a few things†. This could be considered addictive, taking into account that she is willing to give up part of the way that she lives in order to further intoxicate her mind and make her even number to the world around her . And as a result of this constant flow of trivial nonsense into her system, she is made to feel as though she is thinking for herself, acting for herself, and having a wonderful time. During the time that Ray Bradbury had written this book, television was a brand new invention. It was not too terribly popular yet, but he thought that it posed a problem. In Ray’s mind, people would be consumed by irrelevant and insignificant programs, which may become habit-forming as time progressed. He wrote of enormous televisions, which we can relate to modern-day flat screens. Bradbury foretold of people becoming reliant on technology, and not being able to ponder life and all of its questions†¦ to just stop and smell the roses! This is all very relatable to modern society,  and it is easy to see where it fits into everyday life. Clarisse, a seventeen year old girl in Fahrenheit 451, is able to show Montag that life does not have to be lived in such a way as to think that being unaware of the world is a good thing. She is able to show him that there are ways to enjoy one’s self without needing anything but an open mind. Clarisse is one of those genuine people who are able to think for themselves, who asks the â€Å"why† instead of the â€Å"how† of things. Furthermore, the intellectuals that Montag meets also have that same zest for life. They are able to understand the importance and necessity of the thoughts of others in the past. These intellectuals realize that a better understanding and perception of life can come from theminds of others. Faber, an exceptionally odd character, is also one of those remarkable people. He is able to realize that true entertainment comes from enjoying life and exploring its mysteries. He is able to find joy in free-thinking and learning in a way that is completely separate from the superficial way of his society. Montag also slowly comes to this great discovery throughout the book. It starts with him just being curious. But isn’t that all it takes to do something great, a spark of curiosity? In conclusion, Mr. Bradbury’s position is clear as crystal in his novel Fahrenheit 451. Entertainment consists of inspiring and enlightening ideas and activities, while addiction can come easily and swiftly from those things that will deaden the mind and will bring nothing of value into the thoughts of mankind. And even though they can be rare, those who are able to look past those things and find the worthwhile substance in life will gain more out of life by being able to look at the world in new ways.

Essay on The Black Panther Party for Self Defense

The Black Panther Party for Self Defense was the most significant activist group during the Civil Rights Movement Era. It was founded in Oakland, California by Huey P. Newton and Bobby Seale in October of 1966. The Black Panthers Party was founded to fight for and protect the rights of African Americans. Believing that the approach Martin Luther King Jr. was expressing would take too long, the approach Black Panther Party took was more along the lines of Malcolm X more aggressive theories rather than Martin Luther King Jr.’s more peaceful strategy. Although it gained a lot of support quickly it was ineffective in its main agenda’s due to, government actions against them, disorganization within the BPP, and the loss and shortcomings of its†¦show more content†¦4. We want decent housing, fit for shelter of human beings. . 5. We want education for our people that exposes the true nature of this decadent American society. We want education that teaches us our true history and our role in present-day society. 6. We want all Black men to be exempt from military service. 7. We want an immediate end to police brutality and murder of Black people. 8. We want freedom for all Black men held in federal state, county and city prisons and jails. 9. We want all Black people when brought to trial to be tried in court by a jury of their peer group or people from their Black communities, as defined by the constitution of the United States. 10. We want land, bread, housing, education, clothing, justice and peace. And as our major political objective, a United Nations-supervised plebiscite to be held throughout the Black colony in which only Black colonial subjects will be allowed to participate, for the purpose of determining the will of Black people as to their national destiny. Many people believe that the Emancipation Proclamation freed slaves in America, this is only partially true. 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It was an organization that was founded by Huey Percy Newton and Bobby Seale in 1966. Not only that, but it was also the largest revolutionary organization that had ever existed. Their purpose was to protect fellow African-American residents from mistreatment from the authorities. During the 1960s, racial injust had spreaded throughout