DNP 815 A DPI Project Milestone: Pressure Ulcers Essay
DNP 815 A DPI Project Milestone: Pressure Ulcers Essay
DNP 815 A DPI Project Milestone: Pressure Ulcers Essay
Pressure ulcers are a common health issue among patients aged 65 years and above who have comorbidities and reside in long-term care facilities. According to the National Pressure Ulcer Advisory Panel (NPUAP), pressure ulcers affect approximately 11% of the elderly population residing in long-term care facilities (Borojeny et al., 2020). These ulcers can lead to a variety of complications, including infections, sepsis, and even death. Moreover, pressure ulcers can cause significant pain and discomfort to patients, leading to reduced quality of life. The literature supports the research topic, “Pressure ulcers among patients aged 65 years with comorbidities residing in a long care facility,” and emerges from the problem space. This research topic is aligned with various programs of study, including nursing, gerontology, and healthcare management. It is also feasible to complete within a doctoral program, including extension courses as needed.
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The research topic is focused on understanding the incidence and prevalence of pressure ulcers among patients aged 65 years and above who have comorbidities and reside in long-term care facilities. The research will also focus on identifying the risk factors that contribute to the development of pressure ulcers and evaluating the effectiveness of prevention and treatment programs. The literature review suggests that pressure ulcers are a common and significant health issue among elderly patients in long-term care facilities (Borojeny et al., 2020). Research indicates that patients with certain comorbidities, such as diabetes, malnutrition, and cardiovascular disease, are at increased risk of developing pressure ulcers. Moreover, studies have shown that the use of pressure ulcer prevention programs can be effective in reducing the incidence of pressure ulcers among elderly patients in long-term care facilities (Gunningberg et al., 2020).
The proposed research will use a mixed-methods approach to investigate the incidence and prevalence of pressure ulcers among elderly patients in long-term care facilities. The study will involve quantitative and qualitative data collection methods to understand the issue comprehensively. The quantitative aspect of the study will involve analyzing electronic health records to identify patients with pressure ulcers and assess the effectiveness of prevention programs. The qualitative aspect of the study will involve conducting interviews and focus groups with healthcare professionals and patients to gain insights into their experiences with pressure ulcers. The findings of this study will contribute to the existing literature on pressure ulcers among elderly patients in long-term care facilities. The study will provide insights into the risk factors that contribute to the development of pressure ulcers and evaluate the effectiveness of prevention and treatment programs. The findings of this study will be relevant to healthcare professionals, policymakers, and patients and their families. The study will provide valuable information on how to prevent pressure ulcers and improve the quality of life of elderly patients in long-term care facilities.
Literature Review
Background
Pressure ulcers, also known as bedsores, are a common problem among elderly patients with comorbidities residing in long-term care facilities. Pressure ulcers are defined as localized injuries to the skin and underlying tissue due to prolonged pressure, friction, or shear. They can develop quickly and progress rapidly, leading to pain, infection, and even death. The incidence of pressure ulcers among elderly patients in long-term care facilities is high, with estimates ranging from 7.5% to 50% depending on the population studied (Beeckman et al., 2019).
The literature on pressure ulcers is predominantly from the past five years, with an increasing focus on prevention and treatment strategies. Historically, pressure ulcers have been treated reactively, emphasizing wound care rather than prevention. However, recent research has shown that prevention is key to reducing the incidence of pressure ulcers among elderly patients with comorbidities residing in long-term care facilities (Gunningberg et al., 2020).
The problem of pressure ulcers among elderly patients with comorbidities residing in long-term care facilities is a critical issue that demands attention. These patients are at increased risk of developing pressure ulcers due to a combination of factors, including age, immobility, incontinence, malnutrition, and chronic medical conditions such as diabetes, dementia, and cardiovascular disease (Nussbaum et al., 2018). The consequences of pressure ulcers can be severe and long-lasting, including pain, infection, decreased mobility, and even death. Furthermore, the economic burden of pressure ulcers is substantial, with estimated costs ranging from $9.1 billion to $11.6 billion annually in the United States (Padula & Delarmente, 2019).
The need to address the problem of pressure ulcers among elderly patients with comorbidities residing in long-term care facilities is clear. Prevention and treatment strategies must be implemented to reduce the incidence of pressure ulcers and improve patient outcomes. Direct education to staff on the implementation of a formal pressure ulcer prevention program is a potential solution that warrants further investigation. This research will examine whether direct education to staff on the implementation of a formal pressure ulcer prevention program compared to no formal program affects the rate of pressure ulcer incidence, identifies patients at risk for pressure ulcers, and improves skin care over a 30-day period. By addressing this critical problem, we can improve the quality of life for elderly patients with comorbidities residing in long-term care facilities and reduce the economic burden associated with pressure ulcers.
Theoretical Foundation
The conceptual framework for the proposed research on pressure ulcers among patients aged 65 years with comorbidities residing in a long-term care facility is based on the bio-psychosocial model of health. This model recognizes that health and illness are the results of the interplay of biological, psychological, and social factors. In the case of pressure ulcers, biological factors such as advanced age and comorbidities like diabetes and circulatory problems can increase the risk of developing pressure ulcers. Psychologically, the pain and discomfort associated with pressure ulcers can lead to negative emotions and behaviors, such as depression and reduced mobility, which in turn can exacerbate the problem. Finally, social factors such as the availability of resources and support from caregivers can also affect the development and treatment of pressure ulcers.
In addition to the bio-psychosocial model, the research will be guided by the Donabedian model of healthcare quality, which includes three components: structure, process, and outcomes. The structure component refers to the characteristics of the healthcare environment, such as the staffing levels and equipment available. The process component includes the actual delivery of care, such as the implementation of a pressure ulcer prevention program and the training of staff to carry out this program. The outcomes component refers to the actual results of the care, such as the incidence of pressure ulcers and the effectiveness of treatment.
The theoretical basis for the research will be drawn from nursing theories related to patient safety and quality of care. These theories emphasize the importance of patient-centered care, effective communication among healthcare providers, and evidence-based practice. By incorporating these theories into the research design, the study will provide a comprehensive understanding of the factors contributing to pressure ulcers in long-term care facilities and the most effective ways to prevent and treat them.
Review of Literature Topics
A review of the literature on the topic of pressure ulcers among patients aged 65 years with comorbidities residing in a long-term care facility will need to cover a range of relevant subtopics to demonstrate the breadth of knowledge. Some potential subtopics to include in the literature review are:
- Prevalence and incidence of pressure ulcers: The literature review should explore the prevalence and incidence of pressure ulcers in the target population. This will help to establish the need for the research and provide context for the study’s findings.
- Risk factors for pressure ulcers: The review should also cover the various risk factors for developing pressure ulcers, such as immobility, malnutrition, and incontinence. This information will help in identifying patients at risk for pressure ulcers and informing the development of prevention programs.
- Current practices for pressure ulcer prevention: The literature review should also examine the current practices for pressure ulcer prevention in long-term care facilities. This will help to identify gaps in current approaches and inform the development of a formal prevention program.
- Education and training for pressure ulcer prevention: The review should also explore the effectiveness of education and training for staff on pressure ulcer prevention. This information will help to determine the best approach for implementing a formal prevention program.
- Best practices for skin care: Finally, the review should cover best practices for skin care in the target population, including the use of specialized equipment and products. This information will help to inform the development of the prevention program and ensure that patients receive the best possible care.
By covering these subtopics, the literature review will demonstrate a broad understanding of the topic of pressure ulcers among patients aged 65 years with comorbidities residing in a long-term care facility. It will also help identify gaps in current knowledge and approaches, which can guide the development of the research question and design.
Problem Statement
The problem that this study aims to address is the high incidence of pressure ulcers among older adults with comorbidities who reside in long-term care facilities. Pressure ulcers, also known as bedsores or pressure injuries, are a significant health concern for this population, as they can lead to pain, discomfort, and serious complications such as infections and delayed wound healing. Moreover, pressure ulcer is often considered a preventable condition, and their incidence can be an indicator of the quality of care provided in long-term care facilities.
The literature review supports the need for this study, as it reveals a gap in knowledge regarding the effectiveness of pressure ulcer prevention programs in long-term care facilities, particularly among older adults with comorbidities. While several studies have investigated the risk factors and prevention strategies for pressure ulcers, few have focused specifically on this population and setting. Therefore, there is a need to investigate whether direct education to staff on the implementation of a formal pressure ulcer prevention program can reduce the incidence of pressure ulcers, identify patients at risk for pressure ulcers, and improve skin care among older adults with comorbidities in long-term care facilities.
Sample and Location
The sample for the study would be patients aged 65 years and older with comorbidities residing in a long-term care facility. The needed sample size would be 100 patients. A power analysis should be conducted to determine the appropriate sample size. Generally, a larger sample size is preferred to increase the generalizability and reliability of the study results. The location for the study would be a long-term care facility in Minnesota that meet the inclusion criteria for the study. The selection of the location depended on factors such as the availability of eligible patients, the willingness of the facility to participate, and ease of access to the facility for the research team. It is important to select a location that is representative of the target population to increase the external validity of the study results.
Research Questions
- What is the prevalence of pressure ulcers among patients aged 65 years with comorbidities residing in a long-term care facility?
- How effective is direct education to staff on the implementation of a formal pressure ulcer prevention program compared to no formal program in reducing the rate of pressure ulcer incidence among this population?
- What are the risk factors associated with the development of pressure ulcers in this population?
- How does a formal pressure ulcer prevention program impact identifying patients at risk for pressure ulcers?
- How does a formal pressure ulcer prevention program improve skin care among this population?
Phenomenon
The phenomenon to be better understood in this study is the incidence and prevention of pressure ulcers among older adults with comorbidities residing in long-term care facilities. Pressure ulcers, also known as bedsores or pressure sores, are a common problem among older adults with limited mobility, such as those residing in long-term care facilities. These individuals are at an increased risk of developing pressure ulcers due to factors such as decreased mobility, poor nutrition, and underlying medical conditions.
The study aims to better understand the factors that contribute to the incidence of pressure ulcers in this population and identify effective prevention strategies. This includes investigating the role of staff education and the implementation of formal pressure ulcer prevention programs in long-term care facilities. By better understanding these factors, the study aims to improve the quality of care for older adults in long-term care facilities and reduce the incidence of pressure ulcers.
Methodology and Design Top of Form
The selected methodology for this study is a quasi-experimental design. Specifically, a non-randomized pretest-posttest design will be used to evaluate the impact of direct education to staff on the implementation of a formal pressure ulcer prevention program in a long-term care facility. The study will be conducted in a single long-term care facility with a population of adults over the age of 65 years with comorbidities.
The pretest will involve collecting baseline data on the incidence of pressure ulcers in the facility, identifying patients at risk for pressure ulcers, and evaluating the current skin care practices. After the pretest, the staff will receive direct education on the implementation of a formal pressure ulcer prevention program. The education will include information on risk assessment, pressure ulcer prevention interventions, and proper skin care practices. The posttest will be conducted 30 days after the implementation of the program to evaluate its impact on the incidence of pressure ulcers, identification of patients at risk, and skin care practices.
Quantitative data will be collected through electronic health records and analyzed using statistical software. The sample size for this study will be determined based on the number of patients in the long-term care facility during the study period. The sample will consist of adults over the age of 65 years with comorbidities residing in the long-term care facility.
Purpose Statement
The purpose of this study is to evaluate the effectiveness of a pressure ulcer prevention program among adults over the age of 65 with comorbidities residing in a long-term care facility through the implementation of direct education to staff, using a quantitative, pretest-posttest design, with a target population of 100 participants in a single long care facility in the United States.
Data Collection
The primary instruments for data collection in this study will include a standardized pressure ulcer assessment tool, direct observations of skin care practices, and interviews with staff members involved in the implementation of the pressure ulcer prevention program. The standardized tool will be used to assess the incidence of pressure ulcers among the study population over the 30-day period. Direct observations of skin care practices will be used to identify areas for improvement in the implementation of the prevention program. Interviews with staff members will provide insight into their perceptions of the program’s effectiveness and any barriers to its implementation. Additional sources of data will include medical records and facility documentation related to pressure ulcer prevention and management.
Data Analysis
The specific data analysis approaches to be used in this study include descriptive statistics to summarize data, inferential statistics to examine relationships between variables, and logistic regression analysis to identify factors associated with the incidence of pressure ulcers. Qualitative data will be analyzed using content analysis to identify themes and patterns. Statistical software such as SPSS and NVivo will be used to facilitate data analysis.
Conclusion
The problem of pressure ulcers among elderly patients with comorbidities residing in long-term care facilities is a serious issue that requires attention. Through a comprehensive review of the literature, this research has identified the need for a formal pressure ulcer prevention program to reduce the incidence of pressure ulcers and improve skin care. The selected methodology and research design will address the problem statement and research questions by providing a quantitative analysis of the impact of direct education to staff on the implementation of a formal pressure ulcer prevention program. The study will take place in a long-term care facility with a sample size of 100 patients over the age of 65 years with comorbidities.
The data will be collected through direct observation and documentation, and the analysis will be performed using statistical methods such as descriptive statistics and chi-square tests. The findings of this research will contribute to the existing literature on pressure ulcer prevention and provide evidence-based recommendations for the implementation of formal prevention programs in long-term care facilities. The results will also provide valuable insights into the role of staff education in reducing the incidence of pressure ulcers and improving skin care in elderly patients with comorbidities. This study has the potential to improve the quality of care for elderly patients residing in long-term care facilities and help prevent the development of pressure ulcers, a serious and preventable health issue.
References
Beeckman S., De Meyer, D., Verhaeghe, S., & Van Hecke, A. (2019). Knowledge of nurses and nursing assistants about pressure ulcer prevention: A survey in 16 Belgian hospitals using the PUKAT 2.0 tool. Journal of Tissue Viability, 28(2), 59-69. https://doi.org/10.1016/j.jtv.2019.03.002
Borojeny, L. A., Albatineh, A. N., Dehkordi, A. H., & Gheshlagh, R. G. (2020). The incidence of pressure ulcers and its associations in different wards of the hospital: a systematic review and meta-analysis. International Journal of Preventive Medicine, 11. https://doi.org/10.4103%2Fijpvm.IJPVM_182_19
Gunningberg, L., Sving, E., Fredriksson, L., Mamhidir, A. G., & Högman, M. (2020). A multifaceted intervention for evidence-based pressure ulcer prevention: A 3-year follow-up. JBI Evidence Implementation, 18(4), 391-400. https://doi.org/10.1097/XEB.0000000000000239
Nussbaum, S. R., Carter, M. J., Fife, C. E., DaVanzo, J., Haught, R., Nusgart, M., & Cartwright, D. (2018). An economic evaluation of the impact, cost, and medicare policy implications of chronic nonhealing wounds. Value in Health, 21(1), 27-32. https://doi.org/10.1016/j.jval.2017.07.007
Padula, W. V., & Delarmente, B. A. (2019). The national cost of hospital‐acquired pressure injuries in the United States. International Wound Journal, 16(3), 634-640. https://doi.org/10.1111/iwj.13071
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The Direct Practice Improvement (DPI) Project incorporates 10 key or strategic points that need to be clear, simple, correct, and aligned to ensure the project is doable, valuable, and credible. These points, which provide a guide or vision for the project, are present in almost any research. These 10 points are defined and instructions for completion of the DPI Project Milestone: Outline of 10 Strategic Points .
General Requirements:
Use the following information to ensure successful completion of the assignment:
Use the “10 Strategic Points” document
While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines.
This assignment uses a rubric. Review the rubric prior to the beginning to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Directions:
Use 10 Strategic Points.”
Complete the table.
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DPI Project Milestone : Outline of 10 Strategic Points – Rubric
Collapse All
Title of DPI Project 5 points
Criteria Description
Title includes the intervention and is no more than 12 words in length.
- Target 5 points
Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.
- Acceptable 4.6 points
Component is comprehensively addressed, but some detail is needed for clarity. No gaps are present that leave the reader with questions.
- Approaching 4.4 points
Component is present and adequate. Small gaps are present that leave the reader with questions.
- Insufficient 4 points
NA
- Unsatisfactory 0 points
Item is not present, or all components are not present. Large gaps are present in
Background 20 points
Criteria Description
Background to Chosen Evidence-Based Intervention; Theoretical Foundations; Synthesis of Primary Literature; Practice Change Recommendation: Validation of the Chosen Evidence-Based Intervention; Summary of Findings
- Target 20 points
Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.
- Acceptable 18.4 points
Component is comprehensively addressed, but some detail is needed for clarity. No gaps are present that leave the reader with questions.
- Approaching 17.6 points
Component is present and adequate. Small gaps are present that leave the reader with questions.
- Insufficient 16 points
NA
Problem Statement 5 points
Criteria Description
Problem statement presented using the templated statement.
- Target 5 points
Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.
- Acceptable 4.6 points
Component is comprehensively addressed, but some detail is needed for clarity. No gaps are present that leave the reader with questions.
- Approaching 4.4 points
Component is present and adequate. Small gaps are present that leave the reader with questions.
- Insufficient 4 points
- NA
- Unsatisfactory 0 points
Item is not present, or all components are not present. Large gaps are present in
PICOT-D Converted to Evidence-Based Questions 5 points Criteria Description
PICOT-D question presented. Evidence-based question converted from PICOT-D using
templated statement.
- Target 5 points
Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions
- Acceptable 4.6 points
Component is comprehensively addressed, but some detail is needed for clarity. No gaps are present that leave the reader with questions.
- Approaching 4.4 points
Component is present and adequate. Small gaps are present that leave the reader with questions.
- Insufficient 4 points
NA
- Unsatisfactory 0 points
Sample, Setting, Location, and Inclusion, and Exclusion Criteria 10 points
Criteria Description
Sample, Setting, Location, and Inclusion, and Exclusion Criteria
- Target 10 points
Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.
- Acceptable 9.2 points
Component is comprehensively addressed, but some detail is needed for clarity. No gaps are present that leave the reader with questions.
- Approaching 8.8 points
Component is present and adequate. Small gaps are present that leave the reader with questions.
- Insufficient 8 points
NA
- Unsatisfactory 0 points
De ne Variables 5 points
Criteria Description
Describes independent and dependent variables
- Target 5 points
Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.
- Acceptable 4.6 points
Component is comprehensively addressed, but some detail is needed for clarity. No gaps are present that leave the reader with questions
- Approaching 4.4 points
Component is present and adequate. Small gaps are present that leave the reader with questions.
- Insufficient 4 points
NA
- Unsatisfactory 0 points
Item is not present, or all components are not present. Large gaps are present in
DPI Project Design 10 points
Criteria Description
Explain the difference between research and quality improvement. Literature cited to support explanation.
- Target 10 points
Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.
- Acceptable 9.2 points
Component is comprehensively addressed, but some detail is needed for clarity. No gaps are present that leave the reader with questions.
- Approaching 8.8 points
Component is present and adequate. Small gaps are present that leave the reader with questions.
- Insufficient 8 points
NA
Purpose Statement 5 points
Criteria Description
Purpose statement presented uses the templated statement.
- Target 5 points
Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.
- Acceptable 4.6 points
Component is comprehensively addressed, but some detail is needed for clarity. No gaps are present that leave the reader with questions.
- Approaching 4.4 points
Component is present and adequate. Small gaps are present that leave the reader with questions.
- Insufficient 4 points
NA
- Unsatisfactory 0 points
Item is not present, or all components are not present. Large gaps are present in
Data Collection Approach 10 points
Criteria Description
Demographic information of participants, primary instruments, reliability and validity of instruments, process used to collect data, potential ethical issues, and adherence to principles in the Belmont Report.
- Target 10 points
Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.
- Acceptable 9.2 points
Component is comprehensively addressed, but some detail is needed for clarity. No gaps are present that leave the reader with questions.
- Approaching 8.8 points
Component is present and adequate. Small gaps are present that leave the reader with questions.
- Insufficient 8 points
NA
Data Analysis Approach 10 points
Criteria Description
Analysis of participant demographic information. Type of data analysis used. Statistical test used. Potential bias and mitigation of data.
- Target 10 points
Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions.
- Acceptable 9.2 points
Component is comprehensively addressed, but some detail is needed for clarity. No gaps are present that leave the reader with questions.
- Approaching 8.8 points
Component is present and adequate. Small gaps are present that leave the reader with questions.
- Insufficient 8 points
NA
- Unsatisfactory 0 points
References 5 points
Criteria Description
References are listed and complete.
- Target 5 points
References are listed and complete.
- Acceptable 4.6 points
NA
- Approaching 4.4 points
NA
- Insufficient 4 points
nA
Unsatisfactory 0 points
References are omitted or incomplete.
Paper Format 5 points
Criteria Description
References are listed and complete.
- Target 5 points
All format elements are correct.
- Acceptable 4.6 points
NA
- Approaching 4.4 points
Template is used, and formatting is correct, although some minor errors may be present.
- Insufficient 4 points
NA
- Unsatisfactory 0 points
Template is used, but some elements are missing or mistaken; lack of control with
Documentation of Sources 5 points
Criteria Description
Citations, footnotes, references, bibliography, etc., as appropriate to assignment and style.
Target 5 points
Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.
- Acceptable 4.6 points
NA
- Approaching 4.4 points
Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.
- Insufficient 4 points
NA
- Unsatisfactory 0 points
Total 100 points
