Research proposal on prevention of pressure sores
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Pressure sores, resulting from constant pressure on prominent weight-bearing parts of the horizontal body, are a constant worry. Nursing staff turn the paralyzed person every two hours day and night to change the pressure on the skin in an effort to prevent these sores. Physiotherapists position the person in order to prevent overstretching of undamaged muscles and to avert contractures. The person must be encouraged to cough and to expectorate mucus from the lungs, essential early activities (McKenna 1997). Loss of sensation means that the mere act of sitting in a wheelchair or lying in a bed becomes a hazardous activity. The paralyzed person is not able to move his or her body as other people do, even at rest, and because he or she cannot feel that damage is occurring, a pressure sore can develop very quickly. For this reason, soft pants of the tracksuit variety are most often chosen to avoid the possibility of inadvertently sitting on creased trousers, thick seams, studs or any of the other design details of fashion clothing. Similarly, feet that have lost movement and sensation are susceptible to knocking and burning as well as to circulatory disturbances such as chilblains. Choice of footwear is curtailed by the need to protect the feet from these dangers. Apart from these restrictions, many of the men and women in this study are unable to bend down to put shoes on their feet, much less to tie the laces. Pressure sores are most likely to develop on areas of the body where the bones are closest to the surface of the flesh. The first sign will be a reddening of the skin, and if caught at this stage and pressure on the spot is relieved, all may be well (Seymour 1998). This paper is a proposal to create a study on prevention of pressure sores, specifically in a critical care unit.
Aims and objectives
- Understand the occurrence of pressures sores in individuals.
- Analyze the effect of pressure sores on individuals.
- Determine the care given to individuals in critical care unit.
- Know how pressure sores can be prevented on critical care units.
The critical care unit has become increasingly complex and highly technical. Nurses have rapidly become the major treatment modality in the critical care unit because of skill, competence in judgment, and round-the-clock presence. The economics of medical futility needs to be seriously addressed, since intensivists will be called upon more often to justify their medical decisions for continuing life support for severely or terminally ill patients. This is especially true as critical care units have not been expanding and limited facilities for patients on life-support exist in the acute or less costly post-acute settings. Providers will need to be encouraged to explore cost-effective medical decisions since these protocols may be in conflict with their compliance to the Hippocratic oath, as well as with potential threats of litigation in the event that the aggressive treatment has a remote chance of improving the health status of the patient, or at least do no harm (Zalumas 2003). Team management of patients can also reduce length of stay in the critical care unit. Researchers have shown that, by implementing a multidisciplinary team that manages hopelessly ill critical care unit patients, critical care unit length of stay and costs can be decreased up to 50 percent. Further, those patients in a state of relative clinical stability could benefit from removal from the critical care unit to an environment that is less intensive and invasive while being monitored by a multidisciplinary rehabilitation team that crafts an individualized treatment protocol for each patient. This approach can address the discharge planning problem often seen with frail or elderly patients. A major problem in discharge planning is the coordination of post-acute services in home or in other less costly long-term care facilities. While home health services and long-term care facility costs are one-tenth and one-third of critical care unit costs, respectively, placement issues cause prolonged stays in the acute care setting. Care teams can also successfully coordinate care in chronic mechanical ventilation step-down units in the acute care setting for patients who do not have the option physically or geographically to go to other less intense facilities. These arrangements have had success since focused rehabilitation can take place in such a dedicated care unit rather than in a busy general critical care unit (Davis 2001).
The proposed study will use a mix of qualitative and quantitative method to allow for better understanding of the performance based post occupancy evaluation of institutional buildings. Use of a mixed-method approach can make the results more presentable to a hostile audience or in using quantitative work to back up qualitative work. This can be useful where there are concerns about getting a qualitative proposal past a quantitative panel, or getting results of largely qualitative work published in a more traditionally quantitative journal. From the standpoint of those who choose quantitative methods using qualitative methods means debasing psychology as a science. From the standpoint of those using predominantly qualitative methods those who adhere to the quantitative camp devaluate the human being which should be at the centre of psychology as a discipline (Darlington & Scott 2002).
Darlington, Y & Scott, D 2002, Qualitative research in practice:
Stories from the field, Allen & Unwin, Crows Nest, N.S.W.
Davis, JB (eds.) 2001, The social economics of health care,
McKenna, H 1997, Nursing theories and models, Routledge, London.
Seymour, W 1998, Remaking the body: Rehabilitation and change,
Zalumas, J 2003, Caring in crisis: An oral history of critical
care nursing, University of Pennsylvania Press, Philadelphia.