Pressure Injury: Types and Causes
Pressure injury is also known as a pressure ulcer. It is caused by injury to the skin or the tissues beneath the skin (PancorboHidalgo 2006, p.94). The harm could be caused by medical errors or other gadgets. The injury is always the result of the skin or tissue being subjected to prolonged pressure, shear, or both. It may cause significant discomfort to the victim. There are two types of pressure injuries: preventable and unavoidable.
Treatment of Pressure Ulcers
Pressure ulcers that are avoidable can be treated by using preventive measures (Bluestein & Javaheri 2008, p.15). Pressure ulcers that are unavoidable are ones that do not respond to wound care plans. Unavoidable pressure injuries may occur as a result of lack of appropriate nutrition and fluids in victims, restricted movement by a person and when the person is in their late ages. Pressure injuries have various stages. Those caused by dermatitis of perianal (stage I pressure injury, Stage II Pressure Injury, Stage III Pressure Injury, Stage IV Pressure Injury, and those based on the level of damage to tissues (Medical Device-Related Pressure Injury, Deep Tissue Pressure Injury, and Mucosal Membrane Pressure Injury) (Maklebust & Sieggreen 2001, p.5)
Effects of Age and Body Positioning
As people age, the skin can experience changes that make it more vulnerable to pressure injury. Most old people, especially those bed-cared and those on wheelchairs, are less mobile. Body positioning is a major determinant of the pressure distribution in the body (Rothschild et al. 2000, p.2017). It is healthy to maintain a balanced pressure in the body through proper positioning of the body. Uneven pressure distribution in the body may cause ischemia and consequently result in damage of the tissues. Clinicians are therefore advised to carry out assessments on mobility to establish the risk to attracting pressure sores and after that recommend proper mitigative measures, such as administering preventive Medicare (Cherry & Moss 2011, p.16).
Current Research and Gaps
There are many studies on pressure injury. The studies have majored on various areas, but there is scanty of studies reflecting on the role of nurses in pressure ulcer prevention and management. Bhattacharya and Mishra (2015) discuss the current treatment alternatives such as reconstructive surgery, role of antibiotics, optimized dressings, debridement, and approaches of wound treatment. They also focus on the modern treatment alternatives such as benefits and setbacks in modern approaches, cell therapy, hyperbaric oxygen therapy and negative pressure wound therapy. However, the article does not discuss the role of nurses in pressure injury patient care (Bhattacharya and Mishra 2015, p.4). Clinicians and their role in pressure ulcer prevention management are so integrated that a discussion on one without the other is to "prescribe without test."
A clinical review titled "Mobility Limitation in the Older Patient" (Brown et al., 2012) asserted that periodic screening in the ambulatory setting is important in identifying aged people with high mobility risk. Tending to practical shortfalls and ecological hindrances with exercise and mobility devices can prompt enhanced capacity, security, and personal satisfaction for patients with mobility issues (Brown et al. 2012, p.1172). The assertions arouse a further inquiry into the pressure injury prevention and management that this paper fails to tackle.
The Australian Wound Management Association (2012) researched on pressure ulcers prevention and control in the Pan Pacific, Singapore, Hong Kong, New Zealand and Australia. They provided guidelines that are useful to the health practitioners in administering quality care to pressure injury patients. While the postulations of the guidelines remain viable and provide rich knowledge in pressure ulcer management, the study was carried out strictly in Australia, Singapore, and New Zealand. This leaves a gap for a similar study to be conducted in other countries to note the consistency of the findings and recommendations.
Roles of New Nurse Graduates
Pressure injury has emerged as a common disease among the old people and leads to fatal consequences if not properly managed. It is in this view that the nursing graduates must be prepared to play a vital role in managing the patients in their facilities (Lyder 2003, p.224).The following roles are expected of nursing graduates to improve management of pressure ulcers: adopting follow-up care and record the pressure injury in Electronic Health Records to facilitate easy monitoring of the progress of patients; help patients relieve pressure by helping them change position regularly; develop and implement an individualized continence management plan in partnership with the patient; use a reliable and valid nutrition screening tools to establish the nutritional requirement of patients at risk of getting pressure injury3; Include the patient in all treatment and management options following pressure injuries, skin tears or any other wounds and conduct pressure injury risk evaluation by using validated pressure ulcer risk assessment and carry out skin assessment based on visual inspection (Coyer et al. 2015, p.203).
Conclusion
The field of research on pressure injury is so wide and more investigations may be carried out to better the prevention and management of pressure sores. Growing usage of topical oxygen in wound treatment prompts a research on its effectiveness on pressure injury healing and closure. A further inquiry may be conducted on the impacts of pressure injury education programs on pressure injury prevention and management. Another suggested area of study that would be worth exploring is to investigate the significance of creating support groups for persons with pressure ulcers.
References
Bhattacharya, S. and Mishra, R.K., 2015. Pressure ulcers: Current understanding and newer modalities of treatment. Indian journal of plastic surgery: official publication of the Association of Plastic Surgeons of India, 48(1), p.4.
Australian Wound Management Association, 2012. Pan Pacific clinical practice guideline for the prevention and management of pressure injury. Osborne Park, WA: Cambridge Media, pp.1-124.
Brown, C.J. and Flood, K.L., 2013. Mobility limitation in the older patient: a clinical review. Jama, 310(11), pp.1168-1177.
Cherry, C. and Moss, J., 2011. Best practices for preventing hospital-acquired pressure injuries in surgical patients. ACORN: The Journal of Perioperative Nursing in Australia, 24(2), p.16.
Coyer, F., Gardner, A., Doubrovsky, A., Cole, R., Ryan, F.M., Allen, C. and McNamara, G., 2015. Reducing pressure injuries in critically ill patients by using a patient skin integrity care bundle (InSPiRE). American Journal of Critical Care, 24(3), pp.199-209.
Rothschild, J.M., Bates, D.W. and Leape, L.L., 2000. Preventable medical injuries in older patients. Archives of internal medicine, 160(18), pp.2717-2728.
Sundin, B.M., Hussein, M.A., Glasofer, S., El-Falaky, M.H., Abdel-Aleem, S.M., Sachse, R.E. and Klitzman, B., 2000. The role of allopurinol and deferoxamine in preventing pressure ulcers in pigs. Plastic and reconstructive surgery, 105(4), pp.1408-1421.
Lyder, C.H., 2003. Pressure ulcer prevention and management. Jama, 289(2), pp.223-226.
Maklebust, J. and Sieggreen, M., 2001. Pressure ulcers: Guidelines for prevention and management. Lippincott Williams & Wilkins.
Pancorbo‐Hidalgo, P.L., Garcia‐Fernandez, F.P., Lopez‐Medina, I.M. and Alvarez‐Nieto, C., 2006. Risk assessment scales for pressure ulcer prevention: a systematic review. Journal of advanced nursing, 54(1), pp.94-110.
Bluestein, D. and Javaheri, A., 2008. Pressure ulcers: prevention, evaluation, and management. American family physician, 78(10).
