...Pressure ulcers usually occur on bony areas of the body, such as the tailbone, back, buttocks, back of the head, elbows, heels, hips, and shoulders. The patients that are high risk for pressure ulcers are the patients that are unable to ambulate. According to Defloor and Grypdonck, the first pressure ulcer assessment was designed and tested in 1962, which was the Norton Scale. According to this scale, each item is scored on a four-point scale, where the minimum score is a 5 and the maximum score is a 20. This scale has been tested in particularly older patients. Since the 1980s more scales have developed and at least 38 alternative risk assessment scales have been described in the literature. The most frequently used scale in research is the Braden scale. This scale consists of six items which are activity, sensory perception, moisture, mobility, shear and nutritional status. The scores on this scale vary between 6 and 23 where the original cut-off point is 16. Defloor and Grypdonck researched the American National Pressure Ulcer Advisory Panel, where they found that the ideal at risk assessment tool should have a high specificity, be easy to use, have a high sensitivity and have agood predictive value. Sensitivity is the proportion of those with the condition who have a positive test (Defloor 2005). On the contrary, specificity is the extent to which the absence of a characteristic is correctly classified or...
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...patients. In spit of the institution of Clinical practice regulations and innovation in medical science; the occurrence in hospitalized patients, of pressure sores continues to rise. At presence, concord is missing on the risk aspects for pressure sores in critical care patients, and there are no risk measurement scale particularly for pressure sores in these patients is existing. Objective To decide the major risk elements that projective of pressure sore in adult critically ill persons. At present Braden scale is the most common method of risk assessment for pressure ulcers. Braden scale is covering only six components, which are sensory acuity, moisture, nutrition, activity, mobility, and friction/shear. Potential grade from 6-23; lower numbers reveal high risk. Numbers of 15-18 shows mild risk; average risk were 13-14; scores of ten to twelve denotes more danger; and scores of 9 or less means extreme danger.. Other elements which are not included in the Braden Scale, cause raise the level of risk for pressure ulcers in patients, which is why it is very important to determinants in patients who are in Intensive care unit. Facts indicate that these elements could be projective of bed-sores in critically ill person. Those are being old , low pressure, lengthy stay, acuteness of illness co morbid circumstances, sepsis, diabetes , vascular disease and iatrogenic elements, like use of vasopressin. Even though study shown most of the elements relatively...
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...dollars each year in the United States (AHRQ, 2011). One of the foundation study conducted to address this challenge was by Dr. Nancy Bergstrom in collaboration with Dr. Barbara Braden to develop and test the effectiveness of use of Braden Scale for assessing risk of pressure sores. In their study, the tool was tested in a multisite clinical trial involving hospitals, Veterans Administration (VA) medical centers and skilled nursing facilities. The study concluded Braden Scale as an effective tool in determining risk of pressure sores in patients (NNIR, n.d). This research has served as a milestone in identifying and preventing pressure sores in high risk patient population. The Braden Scale is among the most widely used tools used for predicting the risk of development of pressure sores. It assesses patient risk in six areas i.e. sensory perception, skin moisture, activity, mobility, nutrition and friction/ shear. The Braden Scale gives an item score in each subgroup ranging from one (highly impaired) to three/four (no impairment).Summing score of each subgroup yields a total overall risk for pressure ulcers ranging from 6-23 (Stotts, & Gunningberg, 2007). The lower the score on the scale the higher is the risk of developing pressure sores. Based on the findings of the Braden scale strategies could be employed to prevent the development of pressure sores in high risk patients. References Agency for Healthcare Research and Quality [AHRQ], (2011). 1...
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...Evidence Based Nursing Practice: Pressure Ulcers Jane Smith Research and Scholarship for Evidence-Based Practice March 10, 2010 Evidence-Based Nursing Practice: Pressure Ulcers The primary goals for conducting nursing research are to generate new knowledge to promote positive outcomes for patients, enhance quality and cost-effectiveness of care, improve the healthcare delivery system, and validate the credibility of the nursing profession through evidence-based practice (Schmidt & Brown, 2012). The purpose of this paper is to explore the practice-related problem of pressure ulcers and the importance of the problem in the nursing profession. Practice Setting Problem Pressure ulcers are a serious concern in caring for adults in all types of settings (Stotts & Gunningberg, 2007). I have personally observed and cared for numerous patients with debilitating, painful decubitus wounds to their bodies both in long-term care and acute care settings. I will never forget a patient that I took care of at a long-term care facility; even after pain medications she would plead that she would rather die than have me change her pressure ulcer dressing. It is heartbreaking to know that the majority of these pressure ulcers could have been prevented had the correct measures taken place. It is essential for all healthcare providers to examine and explore the evidence based guidelines and information regarding pressure ulcers...
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...appropriate referrals and resources. Nursing-Sensitive Indicators A CNA is called into the patients’ room to assist the patient to the bathroom, when the patient’s daughter notices and points out a red, depressed area over the patient’s lower spine and the CNA tells the daughter that the red area should go away on its own. The nursing sensitive indicator of pressure ulcer should be used in this case. The CNA needs to be educated in identifying what the preventative steps for avoiding pressure ulcers are by using the Braden Scale which should of been implemented upon this patient being admitted (Fosco, 2012). When the scale is used it can trigger the appropriate interventions before a pressure ulcer forms or gets worse, for example the CNA can pass on to other care team members if this pressure ulcer was prior to admission or formed during the patients hospital stay (Fosco, 2012). Educating all first line care team staff members of the Braden Scale is important because care team members can communicate with each other and initiate the appropriate interventions to help avoid pressure ulcers or any further damage to the patient (Stotts & Gunningberg, 2007). Some possible examples of interventions for this case is to incorporate a posted turn schedule for other care providers to...
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...A written assignment that evaluates comprehensive approaches to nursing assessment for an older person with multiple health problems. The account should reflect on how the multidisciplinary team and other agencies including the family, may contribute to these assessment approaches. Particular attention should be paid to national policies in this area and evidence of best practice. The patient that will be discussed within this assignment is a 70 year old male admitted to hospital following a stroke. Pressure ulcer risk assessments and nutritional risk assessments will be discussed within this assignment looking at how they are used in the assessment of an older people with multiple health problems. A stroke occurs when there has been a disturbance or cut off of blood flow within the brain, this disturbance damages or destroys brain cells preventing these cells from doing their job. Damage to the brain causes problems with bodily functions and can also affect mental processes (Stroke Association, 2010). A stroke can cause sudden weakness or paralysis which often only affects one side of the body and is one of the most common symptoms of a stroke. It can also cause swallowing difficulties (dysphagia), speech and language (dysphasia) can be affected also, patient may have difficulty in understanding and basic things such as reading and writing following stroke. Problems with eyesight, perception and interpretation, mental processes, bladder and bowels, mood swings, sensation and...
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...“Have you considered asking her for it?” “A million times,” Stone sighed. “But how do I explain my knowledge of her having it. I can’t very well tell her that I’m capable of searching a person’s mind to see what secrets they hold. And compromising that, Amir has resurfaced and has been stalking her.” “Amir!” For a few reasons, Braden was alarmed. For one, he carried a strong grudge for Stone. For another, his sudden appearance coincided with the attack on The Chimera had him wondering if he orchestrated it. And last, as a skilled predator, he stalked for one or two reason, either he wanted to kill you or he wanted something from you. Seeing that Sibela isn’t dead, he wanted something from her, which awakened a secret that he hadn’t thought about for years, and prayed that wasn’t the case....
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...dangers of pressure sores that a patient faces is called the Braden Scale. After assessment, the victim is categorized depending on six aspects: capability of physical activity, hydration and nutrition status, capacity to alter position, the ability to respond after sensing discomfort related to pressure, shearing or exposure of the skin to friction during locomotion, and skin exposure to moisture. If the overall score is lower it means the risk of pressure sore is higher (Changing Practice, Changing Lives: 10 Landmark Nursing Research Studies, n.d). Prior to this Change, Skin assessment was based on non- formalized risk assessment which varies with each clinical practice. 2. Discuss why the current nursing practice needs to be changed Using non-formalized risk assessment in Predicting pressure ulcer resulted in non-uniformity and personal clinical judgement which varies from one person to another. Using Clinical judgement is more effective where the staffs are experienced and their experience assist in appropriate predictability, but with novice staff, the use of clinical judgment is inappropriate. In a multisite trial, Braden scale was tested by clinics bringing together skilled nursing facilities, Veterans Administration or VA medical centers and hospitals providing tertiary care. Of those who took part, none had experienced pressure sores earlier. Nurses evaluated those who took part in the trial with the Braden scale during a period covering One to four weeks for every...
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...Professor Pamela A. Braden Division of Business & Economics Lecture: Theory Z Participative Management Styles: Theory Z - William Ouchi During the 1970s, when Japanese-style management was all the rage, William Ouchi, took the Theory X, Theory Y concept one step further: Theory Z. This is the participative model. Ouchi was born and educated in America, but was of Japanese descent. He visited Japan and studied their success with team and participative management and developed this theory. Assumptions about: Workers' motivation. Theory X The Theory X manager assumes that the only motivation that works for employees is $$money$$. Theory Y The Theory Y manager assumes that employees are motivated by their needs to fulfill their social, esteem, selfactualization, and security. The Theory Y manager believes that employees see work as a natural activity and will seek out opportunities to have increased responsibility and understanding of their tasks. The Theory Y manager believes that workers will respond best to favorable working conditions that do not pose threats or strong control. Theory Z The Theory Z manager assumes that employees are motivated by a strong sense of commitment to be a part of something worthwhile -- the self-actualization need. The Theory Z manager believes that employees will not only seek out opportunities for responsibility, in fact, they crave opportunities to advance and learn more about the company. The Theory Z manager believes that employees...
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...Prevention Grand Canyon University NRS 430V Professional Dynamics 22 October 2010 Prevention As a nurse, we have to be accountable to meet standards with our clients. We meet some of these standards on a daily basis without even thinking about them. Between patients, we automatically wash our hands without giving it a second thought. We don on a pair of gloves when we do IV therapy or IM shots. “Accountability for professional nursing revolves around interventions, outcomes, and costs.” (Hood, 2010) Prevention is the key to interventions, outcomes, and cost. People associate pressure ulcers with long term care. They can occur during a long surgery. As nurses we need to be sure that we are doing our part to prevent them no matter what the setting. If the patient has poor nutrion status or certain other qualifiers their chances for receiving a pressure ulcer increase significantly. With keeping this in mind we need to ensure that we do what we can to prevent pressure ulcers. Even in acute care pressure ulcers occur. They can happen in as little as an eight hour shift. With different health conditions making it easier for someone to acquire a pressure ulcer. The risk of acquiring one in acute care is a stagering “2.7 percent to 29.5 percent” (AHCPR Supported Clinical Practice Guidelines). As a nurse we have a responsibility to our patients to give them the best care available. With that we have to prevent harm from our clients. As nurses we need to be...
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...the nation could be as high as $11 billion/year (Lynch & Vickery, 2010). Initial identification of at risk patients has been one of the keys to successfully reducing stage 3 and 4 reported pressure ulcers. The Braden scale for predicting pressure sore risk is a universally accepted tool used to help nurses identify patients who are at risk of developing pressure ulcers. The scale evaluates each patient in the following six areas exposure to moisture, sensory perception, activity, and ability to change positions, nutrition, and exposure to shear (Rosenfeld, 2010). The identification of unit specific champions is a key strategy for the continued reduction of the prevalence of pressure ulcers. These leaders on the units serve as the educators for the remaining staff on the unit. These champions would be part of a multidisciplinary team, which reviews all new research, assistive devices, and evidence-based practice concerning the treatment and prevention of pressure ulcers. The multidisciplinary team would focus on key points the help take aggressive action against pressure ulcer prevention, some of the key points are education, documentation, setting benchmarks , and walk rounds. Education would focus on proper assessment, staging and accurate completion of the Braden scale. Consistent and thorough education would be provided to the patient and family. Documentation would be uniform and reduced to a...
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...Running head: SACRUM PRESSURE ULCER REDUCE WITH FOAM DRESSING Sacrum Pressure Ulcer Reduce With Strict Use of Foam Dressing Chamberlain School of Nursing Penni-Lynn Rolen NR 451 Capstone Course Sacrum Pressure Ulcer Reduce With Strict Use of Foam Dressing Despite advancement of technology, pressure ulcer continues to be a primordial in the health care system. Prevention of pressure ulcer remains an important issue in the health care facility. The critically ill ICU patient is the main target of this disease. Prevention remains the key for this problem. Some facility have standard policy for the eradication of pressure ulcer However the question is will the sacrum pressure ulcer formation be reduced in adult critically ill clients in the ICU by implementation of strict use of foam dressing? Reviews of evidenced base article, and foam dressing trail will turn on the light. Contribution to the Future of Healthcare According to recent literature and research, pressure ulcer remains one of the problems confronted by hospitals and other health care facilities around the countries. Intensive care patients are the largest group of patients who end up with pressure ulcer during their stay in hospitals. Taking care of patients with pressure ulcer consume a large part of hospitals budget. Prevention of pressure ulcer is not only the job of bedside nurses, but also the responsibilities of nurse educators as well as administrators. Prevention of pressure ulcer will contribute...
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...Evidence Based Practice & Pressure Ulcers Matthew Slawter Chamberlain College of Nursing NR451 RN Capstone Course November 2014 Evidence Based Practice & Pressure Ulcers Evidence based practice (EBP) gives nurses a method to use critical appraised data and scientific evidence that is proven to confirm the delivery of quality health care to a patient population. Pressure ulcer prevention continues to be a major and growing concern among todays patients and healthcare providers. This problem is a concern because prevention of pressure ulcers can be accomplished through good skincare techniques and increased education of nurses. The field of nursing along with the healthcare industry can benefit from simply decreased the occurrence of pressure ulcers. The general purpose of this proposal is to determine if the value nurses place on skincare and pressure ulcer prevention can decrease the incidence pressure ulcers. Change Model Overview The John Hopkins Nursing Evidence-Based Practice Process is simply related to the complex challenges organizations and nurses face with the implementation of evidence-based practice and translation. Furthermore, this process provides guidelines for managing the process, structure, and evidence translation among various healthcare settings and outcomes of EBP projects. Nurses should use this process as a guide to facilitate change as it suggest leadership and planning for EBP measurement, identification, evaluation and monitoring...
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...Congress for Cultural Freedom contracted his museum and organized some of the most important and influential art shows of this time. There were many other people connected to the CIA that were associated with this museum. William Paley, “a founding father of the CIA”, participated a member of the museum’s International Program (Saunders). Tom Braden, “first chief of the CIA’s International Organizations Division, was the executive secretary of the museum” as well (Saunders). The IOD was a division of the CIA that worked to unite all fine arts to prove that “the United States was devoted to freedom of expression and to intellectual achievement” (Saunders). This division was important because it was the exact opposite of what was happening in the Soviet Union, where one was told “what [to] write, and what [to] say, and what [to] do, and what [to] paint” (Saunders). The IOD was considered to be “the most important division that the agency had” and the “enormous role” it played in the Cold War cannot be denied (Saunders). The Congress did not necessarily agree with some of the things that the CIA did which is why most of it was done in secret. Braden confirmed that the IOD did perform its duties secretly due to “the public hostility to the avant-garde” (Saunders). While the popularity and success of abstract expressionism was manipulated by the CIA, the strategy did wind up to be beneficial. The CIA did, in fact, use this type of art as a weapon against the Soviets and its effectiveness...
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...He is an 82-year-old African American who is disoriented to place and time. He lives with his daughter Claudia in her home. Claudia and her two brothers visit Mr. Gordon daily since he has been hospitalized. Mr. Gordon has not been eating well since the surgery and has lost 3 pounds. Mr. Gordon has type 2 diabetes and is on oral antihyperglycemic medication. Before he came to the hospital, Mr. Gordon was able to only ambulate for short distances. He has orders to get up in a chair twice a day. Joan, a student nurse, is caring for Mr. Gordon this morning. She has reviewed his medical record and is now ready to start caring for him. 1. Joan assesses Mr. Gordon using the Braden Scale and determines that his score is 12. What does this score indicate about Mr. Gordon’s pressure ulcer risk? Explain what the Braden score is. * Mr. Gordon has a high risk of developing a pressure ulcer because his score is a 12 on the Branden Scale. The lower the score on the Branden Scale (6-23) the higher the risk of developing a pressure ulcer. The Branden Scale is used to determine any limitations with a patient’s sensory perception, activity, nutrition, moisture, and mobility. 2. Joan is assessing Mr. Gordon’s skin and notices that he has a 3 cm blister and a shallow crater on his buttock. Mr. Gordon winces when Joan palpates the area. How should Joan stage this area and Why? A. Stage I pressure ulcer B. Stage II pressure ulcer – A stage II pressure ulcer includes having blistering, shallow...
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