Pressure ulcers or decubitus ulcers are a major problem in field of medical practice. The potency of different types of mattresses and pads in the elimination are very important at the mercy of offer with but is badly studied.
In this newspaper, evidence structured practice would be the foundation in the management and change process. It is an important in medical field, nursing action requires updated information which must be placed into practice for the reason that sense nurses need to question the grade of the studies and reliability of findings so that it is important to build up critical skills, critique is often viewed as first step in learning research process. Evidence-based practice entails a combination of several disciplines, including aspects of multidisciplinary sciences to market the restoration and maintenance of health inside our clients (Davies, 2005). Much books has been published on this theme in recent years, an evolving subject matter and idea for specific techniques that promote far better, safer and more efficient ways of nurturing (Drenkard & Cohen, 2004). Regarding to Kleinman (2004), healthcare professionals are striving constantly to boost and develop the expectations of care. Achieving the challenges require health care providers to be effective leaders who foster a culture and develop partnerships that embraces advancement (Salsberg, 2008).
In this paper, the writer change the study question to pressure relieving mattresses and cushion in the relieving of pressure ulcer to provide more specific views and some practical discussions concerning the cushion and mattresses choice that is most beneficial for each patient. The pressure ulcer reduction is vital for both the mental health and physical wellbeing of the patient and it will avoid any hold off in the treatment process and programs. The cutaneous and subcutaneous tissue cover on the bone prominence area is very important for those patients who are bedridden or sitting in a wheelchair all day long (Biondo & Haber, 2006).
Moreover, quality of life factors are essential considerations for patients especially those with pressure ulcer problems because such condition impacts important bodily processes. The significant effect of pressure ulcer on the grade of life of the patient functions as the impetus for this paper which seeks to examine changes in quality of good care after the care and attention provider, has been through change (Brancato, 2006).
Summary and Critiques of Existing Literatures
A clinical analysis conducted by Mukai et al (2010) entitled Physiological and care monitoring of anti-decubitus mattress patients presented a smartly designed an ultrasonic physiological and monitoring system for attention that is designed and developed physiological monitoring especially for the variables of anti-decubitus (anti-bedsore) in a healthcare facility beds used by the patients. Furthermore, they discussed that the bed's mattresses and cushions are designed to prevent the pressure on the patient's body surface especially those immobilized patients. Quantitative kind of research method was utilized in the analysis and final result was statistically provided. The abstract provides general view and catches reader's attention quickly. It is concise in wording and the purpose of the study was clearly talked about. The abstract also uncovers strong statistical need for anti-decubitus mattresses and significantly described the assumptions. Although abstract encompasses the reason as well as major findings of the study, some features and information like test size, approach to sampling, place of study were absent. A good example of abstract contains short information of article representing all the fundamental details like purpose of the analysis, design setting, sample size, sampling method, major results and realization.
The second article by Melnyk (2005) revealed a data and books review regarding the idea that mattresses with that shortage conventional springs and low-repulsion mattresses can transform the body motions of the individual and can cause ulcer pressure. Data provided that comfortable bed mattresses and pads indicate improvements comparative patient condition. The conceptual idea pulls mainly from the resource-based view of the researcher which have valuable, scarce, inimitable, and non-substitutable resources created and suffered competitive advantage. Earlier study was also included. The writer also talked about about another review using hydro fibre dressings which more beneficial but there is no proof their cost efficiency. With the synthesis of previous studies, facts about the theory that beds with that lack typical springs and low-repulsion mattresses can alter the body activities of the patient and can cause ulcer pressure must be turned out thus author evidently stated the purpose of the study. While using the critical review of these literatures, the writer reveals some dominant features of the present practices in the field. Even though the purpose of the analysis was clearly stated, there was a total inadequacy of back ground information. It might be beneficial if writer adds his own private experience or observations in the introductory part to aid the explanation for the study. The benefits of any article should established a scene which identifies the study problem thus providing rationale for the task.
The third article by Wolsley and Hill (2000) talked about the systematic review interface pressure dimension in creating a standard protocol for the examination of support surfaces of the patient. It is being found in the assessment or analysis of pressure alleviating devices to avoid pressure sores. They presented a review of the literature showing the very best devices to relieve pressure sore for patient care and attention, as well as from the decision making in selecting devices including pads and mattresses. This newspaper admitted that there surely is an existing distance in research in this type of filed that need to be evaluated with patients in a medical center setting. Their results suggested an improvement in the utilization better devices/ materials for probing the effectiveness of different support floors clinically.
The fourth article displaying professional medical evidences of two cushions effectiveness in the heel pressure ulcers reduction by Heyneman et al (2010) directed in determining the effectiveness of two pads in the heel pressure ulcers avoidance especially in a geriatric people. In this study, the researchers implemented two various cushions in avoiding heel pressure ulcers called as a bedwide, wedge-shaped, a typical cushion and viscoelastic foam cushioning. All the 162 participating patients were repositioned every 4 hours lying over a viscoelastic foam bed. The consequence of the analysis shows significant evidences a bedwide, wedge-shaped and the viscoelastic foam cushioning lower the chance of any heel pressure ulcer development weighed against the traditional use of an pillow.
The previous article by Grioni et al (1996) present some evidences and earlier literatures about the selection of anti-decubitus cushion seating for patients to relieve the pressure sores. In this article, they pointed out that anti-pressure cushioning choices have two significant requisites; first of all, there's a need for the correct patient analysis and a whole understanding of the products properties available. The prescription of the cushions discussed in this paper is not really a simple task for the reason that the clinical and physical needs of the individual must be taken into consideration. Overall, the research approach is appropriate to the type of the analysis. The explanation of quantitative research method and experimental design in the literatueres which used to learn the relationship between the parameters are explicit. The adjustable clearly determined anti-decubitus cushion bed linens and traditional beds as independent parameters (or cause), bed sore/ ulcers as dependent variable (or effect). This research is used to discover from existing literatures the relationship between parameters as well as earlier studies about the selection of anti-decubitus cushion car seats for patients to relieve the pressure sores. Objectives were mentioned in the tables.
In these articles evidences that pressure ulcer elimination and recovery is a complex process that may be complicated by a certain factors. Although with right and appropriate care, some wounds failed to heal within an appropriate fashion and may are more chronic. From different studies and studies reported in literature effective utilization of effective cushion and mattress materials for the reduction and healing is important. This will help patients with complicated and non- healing chronic ulcers. Clinical Evidences from these articles and past studies can be used in the change process in specialized medical settings.
Proposed Change Method and Assessment of Rationale
Conceptual model for translating data into professional medical practice by Kurt Lewin will be utilized to market change process. This model accepted that translation of research into practice takes a sound grounding in change theory, key points of research utilization, and use of standardized nomenclature. The model gets the following six stages: Unfreeze, Change and Freeze (Marquis and Huston, 2008).
The level 1 of Kurt Lewin's Change model is the unfreezing. This calls for process of understanding that there is a necessary need for a change. The process involved preparation of a situation in which there's a need for an alteration (Marquis and Huston, 2008). Within this level, orientation to a new set of professional medical evidenced-based understanding of the pressure alleviating mattresses and cushion in the relieving of pressure ulcer including a written orientation packet prepares clinical practitioner to own general skills would have to be competent in caring patients in a scientific setting. They need to possess good analysis skills and have good information and judgment skills in order to foresee or interpret the needs of your client in health care practice (Hewson M G. 2000). The particular clinical preparation for health service provider is very essential to learn actual scientific practice and the orientation in new protocols and insurance policies in controlling patients' needs, this technique of learning is termed as evidenced-based practice education (Davies 1999, p. 109). In finding your way through change process, the talk of each process of pressure ulcers management interventions includes necessary backdrop information, with carefully chosen photos of real mattresses and cushions with technically precise illustrations; they can grasp the topics and improve the imagination when accomplishing the mandatory skills used. Instructions are also provided in format when the skill is one which is employed with patients so when the process is appropriate to the skill. This emphasis reinforces the preparation to an arranged process is pertinent to practice to guarantee the patient's safeness and rehabilitation.
The second stage is called Change or transition in which there is a need for a movements to accomplish changes. Within this level training is a part of the process. Ownership of knowledge and competency in accomplishing skills and interventions which may be acquired in real or hands on trainings is vital in this level (Marquis and Huston, 2008). It involves a combination of many disciplines, including areas of multidisciplinary sciences to market the recovery and maintenance of health inside our clients (Davies, 1999). The obstacles in this stage includes difficulty gaining support economically for the programs and trainings that ensure the effectiveness of skills, practice, authority and integration of the program with existing practice of good care through trainings and training seminars and ecological momentum through the switch of culture. These problems are not limited by those who implement the change (Young, 2004). Some of the activities applied in a clinical setting will be the provision of the most current information easy for your client and co-professionals using the collaborative methodology. During the coaching session and real learning practice we've given clear explanations of the pathophysiological condition and procedures of human condition and injury. It combines information as essential component of specialized medical practice and evidenced structured practice. These activities stresses the role of nurses as essential person in health care team, working alongside one another to achieve highest possible recovery for every patient. By means of prioritizing diagnoses and interventions specific to altered responses to diseases and disease conditions, we provide them quality care. Providing case studies for every case so that we can envision your client as a person needing and necessitating care and find knowledge about the specific circumstance is also a factor. We are able to also foster critical wondering and decision making which very important for each and every health care professional in specialized medical practice. They are abilities and skills I have acquired in conditions of patient management specifically wound treatment (Closs, 2004).
Teaching lessons and conversations in this stage is vital because you can boost your learning through learning derived from the application of concepts and theories. You can actually discuss and clarify some information and clinical practices during these sessions. Helping each other in achieving proper knowledge and competency in nursing practice is also innate with this kind of community forums. The discussion of each skills in practicing effective anti-ulcer management begins with a synopsis of pathophysiology followed by the manifestation and issues is very effective in particular when it has been connect with the genuine experience in controlling wound good care patients. Targets diversity and illustrate the contributing factors are also a necessary to create basic knowledge and software of nursing theories and principle (Brancato, 2006).
The last level is termed as freezing. This stage is approximately the establishment of steadiness after the necessary changes have been made. Organizations must initiate the stableness development of an efficient use of mattresses and cushions to alleviate or prevent the pressure ulcers. This change process must raise the knowledge, skills and competency of nurses and other doctor and allow them to understand the importance of the new tasks (Marquis and Huston, 2008). The change must help them in other move by assisting other associates in understanding effective methods of care in the professional medical setting up constantly. This level will produce knowledge and competitiveness among the list of people involved in the change process. Knowledge and competitiveness is a product of experience and effective learning process which is vital in actual scientific practice of nursing job. It is essentially predicated on innate potentials and motivations afforded by the familiarity of an learning environment. The richness or strength of the inculcation of knowledge, positive ideals and skills of a person is not simply based on the innate capacity of one to evaluate, think, reason and interact in a learning situation. It similarly depends on the grade of the change and experiences that are either tied to the individual's capability and will to choose or with what is suitable to her which is quickly accessible in the surroundings. This will likely determine the road of being effective and qualified nursing specialist (Davies, 1999).
This level provided and managed theoretical and specialized medical competence of the practice (Hagger & McIntyre, 2000). Medical professionals need to get ready the next era of nurses to provide competent and quality treatment to patients. To get an effective doctor, this kind of health care management provided me with specific appraisal ability of your respective self competency and enhanced my education based on routines and trainings used recently during undergraduate, graduate studies, workshops, trainings, carrying on education, and preparation for teaching training seminars or modules including the written and on site orientation (Lichtman et al. , 2003).
The rationale for the use of this model and the evaluation of the cases brought up in this review is geared toward a familiar setting up where nurses and other health care provider will have a healthcare facility resources knowledge needed to put into action successful change process in neuro-scientific decubitus ulcer prevention. Once the period of change concludes, they'll be able to concentrate on specific needs invoking patient care and attention process (Lichtman et al. , 2003). They will become more self-confident in her pedagogical approaches for sharing skills, experience, and knowledge, instruction, and assisting other associates in their learning which are essential elements of effective caring process (Freiburger, 2002). These behaviours aren't automatic or innate to individuals; all can be learned through education and methods of the job. The outcome will be measured through examination methods and tool to be utilized in order to judge the efficiency and the result of the study. The assessment plan will be executed and evaluated based on the objectives and goals of the procedure and care. The outcome will be analyzed to identify if the target was met at the end of patient good care.
Conclusions
According to Kozier & Erb (2008) wound reduction and management is an example of specialized medical skills education which identifies formal examination made to enhance the skills or understanding of nursing educators or practitioners. Through this new knowledge and skills about pressure alleviating mattresses and pillow in the relieving of pressure ulcer, the capability to learn actual specialized medical practice and the orientation in hospital protocols and plans in managing patients' needs will be performed. Recent studies have reported spaces between medical practice and researches (Brancato 2006) and discovered different obstacles that avoid the proof to clinical practice to translate into clinical configurations (Oleguo, 2005). These issues in applying evidence-based practice such as effective used of pillow and mattresses to prevent pressure ulcer in professional medical settings have been steady across researches. One challenge is that, in the technology and development of new medical and nursing knowledge, the amount of resistance of profession has often been offered with the new ways of practice (Young, 2004).
The study shows that much recent practices are based frequently on custom, experience and intuition, somewhat than validation of technology. Furthermore, the growing amounts of studies and researches designed to develop and improve practice at the personnel nurse level cannot make nurses improve their skills, research knowledge and understanding. They frequently lack nurse's formal training such as medical queries (Oleguo, 2005).
