Bedsores as a Problem facing Nursing Home Residents
The development of bedsores is a common public health issue that nursing home patients face. Pressure ulcers are estimated to affect 5% of patients admitted to nursing homes. The purpose of this study is to look into the occurrence of bedsores in nursing homes in the United States and elsewhere. The variables utilized in the study were age, gender, and the quality of healthcare. The study proposes solutions to this problem as well as techniques to prevent bedsores from developing. It gathered data on the prevalence of bedsores based on gender and age using secondary sources. A close relationship was developed between the nurses and the researcher to access the data of the resident's progress assessed through the Braden Scale tool. The data was also accessed from the United States Centre for Medicare and Medicaid Services and other United States valid database sites. Additionally, the study utilized primary sources through a direct collection of information by the use of questionnaires. The research found out that bedsores are prevalent in the nursing centers with approximately 2.5 million residents suffering from the pressure ulcers across the United States. This is, however, an improvement from the previous figures. This study concludes that the bedsores can be prevented by ensuring proper care is taken before and after delivering the patients to the nursing homes.
Keywords: bedsores, nursing home residents, treatment, and prevention.
Table of Contents
Abstract 2
Bedsores as a Problem facing Nursing Home Residents 4
Introduction 4
Evaluation of Resources 7
Methods 10
Presentation and Analysis of Data 12
Conclusion 15
Recommendations 16
References
18Bedsores as a Problem facing Nursing Home Residents
Introduction
Bedsores develop when an individual lies for a long time without turning (Mishra & Bhattacharya, 2015). This creates pressure on the skin leading to openings on its surface. If good nursing care is not provided, the openings develop into wounds adding into the complications of the patients (Nordqvist, 2017). The problem is common among the elderly due to their inability to turn themselves. As a result, they lie for long time using one side of their skins leading to the development of the bedsores. The problem is also a common occurrence among patients that are bed-ridden. These patients are either unconscious or have insufficient energy to turn their bodies. According to statistics from Decubitus Ulcer Victims (2013), the bedsores problem affects approximately 7.01% of all the patients admitted to the nursing homes. This makes it necessary to devise ways to curb the problem and reverse the nursing home residents' suffering as well as their imminent deaths.
The development of the pressure ulcers occurs in different stages that can be used to classify the patients to ensure customized health care. In the first stage of development, the blood vessels are pressurized leading to reduced blood supply to the surface of the skin. This leads to the natural death of the preventive layer of the skin (Mishra & Bhattacharya, 2015). As a result, the underlying tissues of the skin suffers an injury. It becomes red, swollen and possesses an increased sensitivity. At this stage, any pressure on the inflamed spot of the skin can lead to open wounds (Freeman, 2012). The residents should, therefore, be handled carefully to prevent the swollen spots from bursting and progressing to the next stage. If the nursing home resident continues to pressurize the swollen regions, they progress to the second stage where the skin breaks up forming an ulcer. They become wounds that affect the inner layers of the skin. The skin openings increase the risk of bacterial infection (Mishra & Bhattacharya, 2015). Bedsore continually gets deeper into the tissue beneath the skin. This leads to the formation of a crater-like ulceration with fatty tissues appearing (Joshi, 2012). The final stage of the bedsores may lead to damage since bedsore becomes deeper and reach the tendons and the bones (WebMD, 2015). They become extremely painful, and the patients may start producing a foul smell from the wound.
This study has different variables that influence the results obtained. The dependent variable of the study is the development of bedsores. The study also has other independent variables that include the age, gender as well as the quality of health care provided to the residents admitted to the different nursing home in the United States. According to a report published by the Pressure Ulcers; Prevention and Management body, 92% of all the cases of bedsores reported in Illinois affected the elderly in the society. This number is attributed to the fact that at a certain point, the mobility of the elderly is impaired making it difficult for them to change positions (Mishra & Bhattacharya, 2015). The few youths that were affected by the bedsores acquired them during hospital admissions. The report also states that more than 68% of all the bedsores recorded were acquired in the hospital set-up. This further compounds the problem for the nurses at the nursing homes since the majority of the residents are brought to their homes with existing bedsores (Bedbrook, 2013). There are research studies that classify gender as a risk factor in the development of the bedsores. There, however, lack specific association between the gender and development of the pressure ulcers (Margolis, Knauss, Bilker, & Baumgarten, 2003). A quantitative research done on the number of patients suffering from the bedsores in the United States showed that the majority of the patients were women. Several other research studies have documented similar results; females are more likely to acquire pressure ulcers than the men (Nightingale, 1860). The pressure ulcers can be prevented through proper health care. The Illinois Nursing Homes have developed programs aimed at improving the healthcare among the residents with the aim of reducing the cases of bedsores. The programs have reduced the prevalence of the ulcers by a remarkable 16% (Nordqvist, 2017). This is a representation of how the improvement of nursing health care can become a relief to the millions of residents in the nursing homes. Studies have shown that there lack emotional attachment in the nursing homes. Illinois came up with the regulations to ensure that the nurses provide proper health care (Margolis et al., 2003). This was after identifying this as the major problem in the institutions. This has worked as proved by the statistics above. It is, therefore, clear that the development of the bedsores is, in some instances, occasioned by the negligence of the nursing staffs. This study finds out how the healthcare providers can help not only the suffering patients but also prevent the fresh development of the ulcers.
The variables were measured and tested to ascertain their credibility. The data that was obtained from different sources was critically evaluated to ensure that the results are reliable (Mishra & Bhattacharya, 2015). It was then compared against the dependent variable (the development of the bedsores) to determine the prevalence of bedsores based on the age, gender and the quality of the health care offered.
This study evaluates the methods that can be used to eliminate the bedsore menace in the nursing homes. Additionally, the study brings out the statistics of the people suffering from bedsore with the aim of educating and informing the relevant bodies. It also recommends the ways that can be used, both in the hospital and nursing home setting, to alleviate the suffering of the patients (Joshi, 2012). This has been achieved by graphical analysis of the data obtained. The analysis is presented in an easy-to-understand format backed up with clear statistical graphs and charts. The bedsores development in patients has, in the recent past, attracted research from different institutions. The growing interest is attributed to the recent findings that the bedsores can be treated or their development prevented altogether. The healthcare bodies have, therefore, come up with regulations that are aimed at reducing bedsore's problem (Siddiqui, 2016). The regulations have achieved positive results in different areas of the United States with regions such as Chicago reporting a significant reduction of the cases (Ayello & Lyder, 2017). It is, however, not clear whether the nursing staff is complying with the regulations. There should be well-laid structures to ensure that all the nursing staffs from the nursing homes in the United States comply with the regulation since it is better to prevent than to cure (Nordqvist, 2017).
Evaluation of Resources
The resources used in this study were evaluated to ascertain their accuracy, currency, authority, reliability, purpose, and relevance (Ayello & Lyder, 2017). The topic of the prevention and management of the bedsores in the nursing homes is of keen interest in the research world. The topic developed a large interest in the public health sector after the realization of a possible cure as well as the ability to prevent their occurrence (Joshi, 2012). A report published in the Indian Journal of Plastic Surgery indicates that the bedsores can be cured through the reversal of the factors that lead to their development (Mishra & Bhattacharya, 2015). The primary factor that the report addresses are the immobility that occurs as a result of old-age or a patient being bed-ridden for long periods. It further indicated that the people on wheelchairs were among those at high risk of developing bedsores (Siddiqui, 2016). This issue drew the attention of the human rights activists who challenged the relevant bodies to research on various mechanisms that can be used to avert the situation (Margolis et al., 2003). According to Florence Nightingale (1860), the development of the bedsores is not as a result of the disease but rather the carelessness of the nursing stuff. These reports contributed significantly to the increase in the research on the bedsores as a preventable problem in the nursing (Bedbrook, 2013). It also played a role in pressurizing the nursing care to embrace humanity and develop an attachment to the patient to enhance the care. All the current research reports that have been conducted suggested to the possibility of reducing and preventing the cases of pressure ulcers by improving the healthcare setting in the nursing homes (Mishra & Bhattacharya, 2015).
According to the Centre for Disease Control, there are an estimated one million cases of bedsores every year in the United States (Bedbrook, 2013). The report further indicates that most of the pressure ulcers progress to the second stage of development which exposes the inner surfaces of the skin to infection. It observes that it is because of negligence that the pressure ulcers progress to become deep wounds. With proper nursing care, the wounds can be treated by ensuring excellent hygiene to prevent bacterial infections which contribute largely to the wounds becoming chronic (Joshi, 2012). The transition of the wounds from the acute type to the chronic type is caused by anaerobic bacteria. These type of bacteria are notorious in advancing the tissue destruction on the skin. They significantly reduce the supply of oxygen on the tissues leading to the natural death of the cells (Mishra & Bhattacharya, 2015). The bacteria should be prevented from infecting the wounds through the maintenance of proper hygiene. On the skin surface, there exist heavy presence of aerobes mainly Staphylococcus spp and the Streptococcus spp (Nordqvist, 2017). These bacteria first invade the ulcers at the second stage. This is immediately after the opening on the skin surface (Mishra & Bhattacharya, 2015). If they are not eliminated by the typical application of antibiotics, they consume the available oxygen from the wound giving a chance for the anaerobes to colonize. The colonization of the ulcers by the anaerobic bacteria is dangerous, the blood supply of the wound is reduced making it difficult for the tissues to get nutrients necessary for regeneration (Nordqvist, 2017). Additionally, the anaerobic bacteria may develop resistance to the antibiotics being applied making the wound to progress to a chronic wound automatically. According to the statistics from the United States Bureau of Statistics, approximately 33.3% of all the cases of the bedsores in the United States progresses to the third stage of development (Siddiqui, 2016). At this point, the ulcers start to produce puss, and its management becomes difficult. The residents become repulsive due to the foul smell that originates from the wounds. As a result, there exist a heightened risk of negligence of the patients by the nursing staff. A study carried out by Margolis et al. (2003) using a sample of 32 patients suffering from different levels of bedsores strengthens the argument that it is vital to ensure that all these microbes that have the potential of invading the pressure ulcers. This is the surest way of managing the pressure wounds. The hygiene factors cut across all their sphere of life but particularly suggest sterilization of all the nursing equipment in the nursing homes, the bedding, the surrounding environment as well as the food that the resident patients consume on a daily basis (Mishra & Bhattacharya, 2015). While cleaning the ulcers, the nurses should always use antiseptics to ensure that the area is well protected from harmful microbes. The antiseptics used should be checked for proper concentrations (WebMD, 2015). This is because when they are too concentrated, they tend to damage the tissue leading to the worsening of the wound status. On the contrary, when the antiseptics are too diluted, it fails to protect the wound. After the cleaning, the pressure ulcers should be dressed gently using clean materials (Freeman, 2012). The dressing of the wound is crucial since it protects the ulcers from dirt as well as an unnecessary touch by contaminated surfaces. It is also suggested that the patients should use materials that have the potential of reducing the pressure including foam wedges, cautions as well as pillows.
It is also the obligation of the nursing care staffs to ensure that the residents in their nursing homes get fair and balanced meals. According to a report Roslyn Tarrant, the wound healing process requires a lot of nutrients (Bedbrook, 2013). Some of the nutrients required may have to be supplemented due to their inadequacy in the usual meals. The elderly has been adversely affected by this factor. According to data in the United States Health Statistics website, the majority of the elderly past 70 years are neglected or mistreated by the people around them (Margolis et al., 2003). They suffer hunger which leads to malnutrition and reduced movements. The reduced movements increase the risk of developing the pressure ulcers. When the ulcers develop, they quickly progress to the chronic phase due to low immunity coupled with the lack of committed nursing people. Deficiency of nutrients such as the zinc, ascorbic acid, and proteins lead to delayed wound healing (WebMD, 2015).
Based on all the research reports documented, the bedsores can be reversed or prevented. This can be achieved through excellent healthcare and proper diet (Ayello & Lyder, 2017). A report by the Agency for Health Care Policy and Research recommends that the patients with any degree of bedsores should regularly be turned to prevent the progression of the ulcers to chronic level (Freeman, 2012). Additionally, the elderly and the bed-ridden should be turned after every two hours and be laid on materials that absorb any shock. They should also be fed a diet rich in vitamin C, proteins as well as zinc (Joshi, 2012).
Methods
This study is aimed at exploring the independent variables that influence the development of the pressure ulcers. The study concentrated on three variables including the gender, age and the availability of quality healthcare services in different nursing homes (Nordqvist, 2017). The study region is the United States where a random sample of the nursing home was selected and utilized in the study. The primary data was collected through the filling in of well-designed questionnaires. The questions were designed to find out the following from the nursing staffs;
How many cases of bedsores do you report annually? Out of the number, how many of the cases progresses to the second, third and final stages in that order? Do you receive cases of deaths resulting from chronic bedsores?
How often do you turn the residents in your nursing home? Which diet do you give to the patients under your care?
Which is the most common age affected by the bedsores? Do you observe any gender disparity in the patterns of bedsores development?
The questionnaires were then distributed to selected nursing homes to find out the information needed. The use of primary data is ideal because it gives first-hand and current information on the topic of interest (Mishra & Bhattacharya, 2015). Additionally, it is possible to devise the mechanism of the data collection to suit your particular purpose. This makes the method the most preferred in the collection of the data. The use of secondary resources should only be used when the environment does not favor the direct collection of data (Mishra & Bhattacharya, 2015).
This study also utilized secondary resources from various valid and reliable sources. The sources provided relevant data that helped in the analysis of the results (Joshi, 2012). This is because it helped in the comparison of the current and the past situations as well as in the explaining of the disparity that existed. The data that was primarily used was obtained from the United States Center for Medicare and Medicaid Services (CMS) and the population data of the United States as presented by the United States Bureau of the Census (WebMD, 2015). The study analyzed every material used through the following criterion; all the resources that were applied to this study are current. This was meant to ensure that the study makes recommendations that are not only up-to-date but are also easy to implement (Margolis et al., 2003). It is also vital to ensure that the resources used are reliable. This was realized by ensuring that all the articles that were quoted in the study are authoritative. This is because the author/ the researchers that were involved in the documentation are experts in the nursing home care thus possess enormous expertise on the field (Joshi, 2012). The importance of the accuracy of any resource used for research study cannot be overemphasized. This study achieved a high level of accuracy by combining both the primary and secondary data collection method. This is vital because it allowed for detection of any abnormalities in the data.
Through the entire process of the data collection and research processes, the ethical consideration was highly upheld (Bedbrook, 2013). All the respondents filled the questionnaires willingly and were not coerced in any way to participate. Additionally, the confidentiality of the data was maintained, and no sensitive details of the respondents have been disclosed anywhere in this report. All the patients that were involved in this study consented to it. The data provided has been exclusively used for the compilation of this report. The use of secondary resources has also been very instrumental in the documentation of the findings (Nordqvist, 2017). All the reports, journals, websites, books or any other resource used in this report has been accordingly cited. No resource has been used from restricted sites, and the use of the resources has been permitted by the authors of the resources.
Presentation and Analysis of Data
The results of the research study are classified into three;
The results showing the relationship between the age and the development of bedsores
The results showing how gender and bedsores are related
The results are showing the relationship of quality healthcare and the chances of development of bedsores.
According to the findings of the research, all the nursing home registered a higher number of the elderly than the youths. Only 31 of the total respondents (1122) were below the age of 35 years. This represents 2.8% of the total respondents. The majority of the respondents were above the 65 years. There was a total of 846 respondents under this age group representing 75.6% of the total respondents. This data is represented below;
The data evidently shows that the prevalence of the bedsores is higher in the elderly than it is among the young people. Other secondary sources give similar report as the findings. For example, the data at the United States Bureau of Statistics puts the percentage figure of the elderly at approximately 72% of the total affected individuals (Mishra & Bhattacharya, 2015).
The gender of the respondents is another research question that was investigated. The total respondents remained 1122, out of which 656 were female, and the remaining were male. The figures represented 58.5% female and 41.5% male. This is clearly showed in the bar graph below;
The research findings indicate that the bedsores are mainly developed among the women represented by approximately 58% of the total respondents. The chronic cases of the pressure ulcers were more prevalent in women. A lot of studies have been done, but none has conclusively explained the findings. Nevertheless, most of the research studies have found out that the bedsores are more common among women than they are in the men (Joshi, 2012). Among the studies that have come up with similar results include a research documented in the Indian Journal of Plastic Surgery indicating that more than 52% of the respondents in the study were female (Mishra & Bhattacharya, 2015).
Provision of quality health care is vital for the prevention of the development of bedsores (Kelvin, 2017). This can be achieved by reducing the pressure on the skin through changing the patients’ position regularly (Bedbrook, 2013). Additionally, the nursing professionals at the nursing homes have a pivotal role in ensuring that the residents are given properly balanced diet. This is essential for any recovery of the bedsores to take place. This research sought to find out how the quality healthcare plays a fundamental role in the recovery process of pressure ulcers (Mishra & Bhattacharya, 2015). To achieve this objective, 22 selected patients were used as the study sample. They were subjected to regular cleaning of the wounds, application of the antibiotics, turning of their bodies after every two hours, a show of compassion, and provision of a balanced diet and mineral salts supplements. After one month, they were observed to determine their progress. Interestingly, the wounds started to redden which was a clear show that the proliferation had taken place. At that juncture, there was sufficient supply of nutrients which means that the wounds were receiving oxygen and nutrients necessary for tissue regeneration and the overall healing process.
Conclusion
This study has carefully explored the most fundamental variables that are associated with the development of pressure ulcers. The variables that have been investigated and results reported in this report include; age, gender, and health care quality. The hypothesis of this study is that the prevalence of the bedsores is determined by factors that can be regulated to reduce the number of bedsore cases reported annually. The research has proved that this is indeed true.
The results have shown that the quality of healthcare directly influences the rate of healing of the bedsores or even prevent the occurrence of the pressure ulcers altogether. According to the results, all the 22 patients that were subjected to excellent healthcare showed a high level of recovery compared to the other patients. Reports published in various journals including PubMed Journal has indicated that the patients' recovery can be accelerated by ensuring proper hygiene, compassion to the patients as well as the provision of a balanced diet. These factors prevent the infection of the wound by the bacteria and ensure the proliferation of the wound thus enhancing the healing process. This is a clear proof that indeed the development and management of the bedsores can be enhanced by combined efforts from all the concerned quarters.
The study also finds out that the age of any individual is a risk factor. 75% of all the respondents that suffered from bedsores were above 65 years. This is attributed to the fact that the mobility of any individual significantly reduces with the increase in age. Additionally, reports are indicating that the elderly are most often neglected by the family members. This negligence occasion malnutrition which weakens the elderly and results in malnutrition. Their ability to fight infections is impaired. This fact coupled with the immobility leads to increase the risk of the development of the bedsores. Numerous studies have found out that the elderly are more prone to the bedsores than the young individuals.
Another of the findings of the study is the gender factor. The results indicate that an individual's gender is a risk factor for the development of bedsores. In the study, 58.5% of all the respondents involved in the study were females. This shows that the men are relatively safer when compared to the women. Interestingly, the women also showed that the women developed the pressure ulcers that were 20% more likely to develop to the last stage than the male. Almost 80% all the cases of the chronic pressure ulcers were in the female. Various studies carried out by reputable institutions has also indicated a slight inclination of bedsore development towards women. It is, however, unclear what causes this variation. There exist little information regarding the topic, and no research report has clarified the matter.
Recommendations
The study was carefully executed and the results analyzed professionally. However, there existed various shortcomings during the research phase of the study. The study did not obtain the data from a large dataset. This was occasioned by time limitation as well as the high-cost implication of the process. The study heavily utilized the secondary sources to cover up for the deficiency of the primary sources. This involved the adoption of relevant details such as the statistics from other reliable sources. Additionally, the study would have incorporated more variables save for the fact that that would be time-consuming and may have led to shallow data collection and research. As such, this study concentrated on the most relevant variables that would fit into the research question. The age, gender and healthcare quality were determined as the most vital variables that required further research.
In future, scientists and the nursing fraternity should explore the scientific reasons that make women more susceptible to the development of bedsores. This is because, in as much as it is evident that women are more prone to the pressure ulcers, there lack documented and final report to explain it. Research should also be performed to include a bigger sample and more variables.
Genetic studies should also be carried to determine why the development of bedsores is more common among the females. It should be specified whether the genetic composition of the male has genes that are resistant to the development of the bedsores. Other factors that could be linked to the higher probability to developing bedsores among women should be investigated. These could be lifestyle, the nature of work, and dietary requirements.
References
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Bedbrook, G. M. (2013). The care and management of spinal cord injuries. Springer Publishers.
Decubitus Ulcer Victims. (2013). Pressure sore statistics (decubitus ulcer stats). Retrieved on June 21, 2017 from: http://decubitusulcervictims.com/pressure-sore-statistics
Freeman, B. S. (2012). The treatment of bedsores in paraplegic patients. Surgery, 21(5), 668-674.
Joshi, S. K. (2012). Safety management in hospitals. Oxford University Press.
Margolis, D., Knauss, J., Bilker, W., & Baumgarten, M. (2003). Medical conditions as risk factors for pressure ulcers in an outpatient setting. Age and Ageing, 32(3), 259-264.
Mishra, R. K., & Bhattacharya, S. (2015). Pressure ulcers: Current understanding and newer modalities of treatment. Indian Journal of Plastic Surgery, 48(1), 4-16.
Nightingale, F. (1860). Notes on nursing: What it is, and what it is not. Oxford University Press.
Nordqvist, C. (2017). Pressure sores: Causes, treatment, and prevention. Retrieved on June 19, 2017 from: http://www.medicalnewstoday.com/articles/173972.php
Siddiqui, A. (2016). International pressure ulcer guidelines. Retrieved on June 19, 2017 from: http://www.npuap.org/wp-content/uploads/2012/03/NPUAP@-CMS-2015_v1.pdf
WebMD. (2015, May 18). Stages of pressure sores. Retrieved on June 20, 2017 from: http://www.webmd.com/skin-problems-and-treatments/four-stages-of-pressure-sores
