Good Research Paper About Skin Assessment To Prevent Pressure Ulcer

Section A

Discuss why the present process or procedure needs to be changed based on the evidence you have gathered
Pressure ulcers continue to remain a major health concern with approximately 3 million being affected by the problem, notably, the elderly people (Lyder, et al., 2012). Development of pressure ulcers especially for patients who have undergone surgery significantly increase the health care costs due to prolonged stays in hospitals. Nonetheless, pressure ulcers are preventable if at proper clinical procedures are put in place. This is through relying on evidence-based research, with the sole purpose of improving the currently existing prevention techniques or perhaps replacing them with more feasible and effective techniques.
In my current practice setting, assessment of the surgical site only and the use of pressure-reducing mattresses have conventionally been used. For patients undergoing surgical operations, assessment of the skin is only limited to the surgical site, whereby antiseptic procedures are done on the surgical site during the pre and post-operation periods. On the other hand, after moving out of the surgical room, patients are put on pressure-reducing mattresses during their stay in the hospital. This practice also extends to non-surgical patients, especially, the elderly who present a high degree of risk of developing the pressure ulcers.
However, development or severity of pressure ulcers within the setting has appreciably remained high; leading to high hospital costs and long stays within the hospital. This implies that there is the need to address this issue urgently in order to improve the quality of care provided to patients and subsequently improve on the patient outcomes. Nursing is an ever-evolving discipline and is informed by evidence and research. It is evident that the current standard is not effective enough to prevent pressure ulcers and as such underscores the importance of using this evidence to develop more appropriate and evidence-based procedures (Berlowitz et al., 2011). It is the role of the nurse to advocate for quality care through identifying weaknesses in the existing protocols or procedures and subsequently working on them with a bid to improve the patient outcomes and satisfaction (McGuinness et al., 2012). It is apparent that the current statistics on the incidence of pressure ulcers within the setting show that the method that is already in place is not adequate.
Explain who determined the basis for the current process or procedure in your practice setting, rationale and role of decision makers
The current standard was developed by a multidisciplinary team working within the surgical unit. This involved nurses working within the surgical unit and the surgeons. The need to abide to this protocol was aimed at saving costs and time. As one of the nurse managers involved in the development of the protocol, elucidated, many patients who come into the surgical unit are referred from the emergency wing and present conditions that require immediate action by the physicians. As such, there was the need to develop a standard that saves time and reduces costs. Assessment of the surgical unit only consumes less time and requires fewer resources. On the other hand, the use of pressure-reducing mattresses was considerably cheaper and requires minimal attention from nurses. As much as the protocol was purely cemented on the best interest of the patient, that is, saving time and reducing the cost of care, the standard significantly contributes to the increase of pressure ulcers for patients (Sullivan and Schoelles, 2013). It is the rule of the thumb that not even cost or time should come first to quality care. Convincingly, the current standard seemingly places cost of care and time-saving a priority to achievement of the best patient outcomes.

Recommend a change in practice change for the process or procedure you selected

As much as the care process is supposed or expected to be standardized at all times, there comes a time when the procedure should be disbanded or at least modified to improve the care process. The change however is pegged on a due process that involves research and applicable evidence designed to allow a change to those procedures that are considered to improve the care process. This consideration is however based on valid and credible research findings that should at least show that the existing strategy does not achieve the objectives it was meant and that the ne methodology is essentially more suitable to the defined care process in improving care (Appelbaum et al., 2012). The process of accessing the surgical site concurrent with the use of pressure-reducing mattresses while omitting the skins assessment procedure has always been the norm in the institution. As far as pressure ulcers illness is concerned, patients who undergo surgery and who may be hospitalized for several days after surgery are at risk of acquiring pressure ulcers. The continuous hospitalization causes irritation and bruising on the skin and with such bruises the skin condition may extend to underlying tissues and cause further harm to the patient (Lyder, et al., 2012). Such complications are as a result of the failure by the pre-op and post-op teams to conduct a thorough assessment of the patient’s skin to ascertain what precautions may be required during hospitalization after surgery.

Explain the clinical implications your recommended change might have on patients, based on the relevant and credible sources you listed

The integration of skin assessment in the pre-op and post-op procedures will play a significant role in helping patients gain faster recovery while also avoiding the possible chances of prolonged stay due to hospital acquired illnesses such as pressure ulcers. Thus, with the increasing cases of pressure ulcers in patients who have undergone surgery, it is important that the skins assessment procedure is incorporated in the pre-op and post-op process to enable nurses in particular determine the best approach to take in ensuring that during the hospitalization period patients receive individualized care especially in bed positioning to avert possible chances of acquiring pressure ulcers.
Pressure ulcers especially for hospitalized patient who have undergone surgery should be prevented as much as possible especially considering the surgical site location since this is where the bruising and injury of tissues may begin. In a far more abstract view, the assessment of the skin could provide a clue to other skin problems that patient may have and which may be considered as predisposing factors to pressure ulcers such as previous injuries on the skin. This assessment will help the clinical tem to develop the best bed positioning tactics, need for regularly change of bed positioning and how pressure-reducing mattresses may help in averting the development of pressure ulcers (Appelbaum et al., 2012). Furthermore, with the integration of skin assessment in the care process, the high rates of mortality and morbidity caused by pressure ulcers for hospitalized patients will gradually go down.
Explain the clinical implications your recommended change might have on the practice setting, based on the relevant and credible sources you listed
In an extended view, the integration of skin assessment will lower the healthcare costs for the concerned institution owing to the short period of stay in hospital. Hospital acquired illnesses costs account for more than $1.6 billion annually which could be saved to improve the other pressing issues in the care sector. Further, the reduced hospital stay would avert the apparent nurse shortage cases in healthcare institutions since if at least 40% to 60% of the HAIs such as pressure ulcers, there would be an average reduction of up to seven days of extended length of stay in hospital (Lyder, et al., 2012). The provision of quality care is determined by lower costs for both patients and the hospital where they receive care and at a time when care quality is pegged on cost-effectiveness, the institution may as well make a reputation as a provider of quality care. This in essence will be reflected in the incentives received from several entities such as Medicare and Medicaid programs which are based on the provision of quality care and efficient use of available resources. On the other hand, since the change process is guided by research recommendations, the institution may as well get more research sponsors from the private and public sector which will ultimately help in seeking better methodologies to improve the care process Sullivan and Schoelles, 2013).
Discuss how you would involve key stakeholders in the decision to change the process ort procedure or to comply with the recommended change
As with any other change process, the key stakeholders play a role in the planning, designing, implementation, testing and evaluation phases. In this regard, they will play a key role in the decision to make the change where there is a proposal to integrate skin assessment in the pre-op and post-op procedures. Stakeholders determine the success rate of the proposed change and it is through gaining their approval that one can expect less resistance as well as unrivalled support across board (Lyder, et al., 2012). The major stakeholders in this case are outlined below and the strategies employed to making them feel involved described in detail;
The team in charge of the change process: As the team tasked with the change process, the major role is to formulate a policy that seeks to integrate the skin assessment procedure in the pre-op and post-op process. The policy framework will outline why the change is necessary and constantly lobby other key stakeholders in supporting the policy as is or if need be, incorporating their views in the policy.
The chief surgeon: The chief surgeon plays a critical role in the recovery process since he is in charge of the pre-op, post-op and surgery theater teams. In order to have the involvement of the chief surgeon, the team tasked with ensuring the change process will constantly communicate with the chief surgeon to notify him or her of the intended change. This continued communication will help garner the support and approval of the chief surgeon since it is their department that is targeted by the proposed change (Sullivan and Schoelles, 2013).
Surgeons and staff in the surgery department: This group will be directly affected by the policy change. In order to avoid possible resistance, it will be vital for this group to be fully involved in all activities leading to the change. Thus, to ensure their support and participation so that they do not feel as though they are being subjected to an alien policy, the team tasked with the change process will constantly send letters to seek their views and support of the intended change. The letters will also urge the surgeons and surgical unit staff to begin testing the application of skin assessment in their procedural task to make an understanding of the importance of the intended policy.
Patients: patients are the direct recipients of the intended policy and procedure change and it is essentially meant to help their recovery process. in this case, the team tasked with the change process will focus on educating patients on the importance of skin assessment during the whole surgery process so that they can demand or better request the surgical unit staff to perform this procedure before they are taken through surgery and before they are hospitalized after surgery. With direct patient involvement, the institution may feel instigated to integrate the skin assessment as preferred by the patients.
Organizational leadership and management: The leadership and management at institutional level will always play a key role in many all change process that may take place in the institution. This is essentially because they hold the authority over resources and the decision making process. Thus, gaining their support and approval is the key to success of the intended change process. The strategy is to ensure a high level of constant communication through letters informing them of the intended change and reasons for the proposal.
Nurse educators: The dissemination of knowledge across all levels of healthcare plays a key role in how policies are adopted and implemented. Nurse educators thus have to be involved in making sure that the nurses understand the importance of the integrating the skin assessment procedure in the surgical process. Through their wide academic knowledge, the nurse educators will act as the agents of change and this will be made possible through constant communication with them and more importantly, involving them in formulating and reviewing the change process.

Section B

Discuss the possible barriers you could encounter in attempting to institute a change in procedure, based on your evidence-based study. 
Introducing research into hospital procedures amounts to introducing a change within the setting. In any organization change is received differently by different people within the organization. While others may embrace the change, others may feel threatened or uncomfortable with the change. As such one of the barriers to incorporating research into practice is resistance from within the healthcare setting. This resistance will majorly emanate from sectors within the healthcare setting that may feel inconvenienced by the change. At times when workers are accustomed to a certain norm or routine of doing things, introducing a change in routine may be interpreted as a threat since it pulls people out of their comfort zones which is associated with the ease of doing things in a routine manner (Appelbaum et al., 2012). On the other hand, it takes the good will of the hospital managers and the stakeholders to support a change.
Considering that a comprehensive skin assessment is considerably expensive and time-consuming, managers and stakeholders may feel unobligated to support the change, say, materially, financially or moral support. Fear of the uncertainty may be another barrier towards incorporating this research into practice. It is human nature to fear the uncertain and resistance may originate from the organizational members who feel that the research promises fewer prospects than the current standards that are put in place. Incorporating this change requires additional resources and perhaps, extra human resource since it is comparatively time-consuming. This means that more nurses will be required to undertake a comprehensive skin assessment and more financial resources will be directed towards a comprehensive skin assessment due to the need of obtaining new equipment and changing infrastructure. Operating with this fact, it is feasible to believe that in this profit-driven era, where many healthcare settings a struggling to maximize profits, resistance or delays may arise.

Identify at least two strategies that you and your team could use to overcome these barriers to change. 

As explained, the major barrier in incorporating this research into practice is resistance. As such, any strategy employed should be aimed at reducing or neutralizing resistance. The Kotter’s eight step change model will come in handy in implementing change into practice. The first stage under the Kotter’s change model is to create urgency or the need for change. This will be done through explaining to the organizational members why there is the need to replace the current standard with a more effective one. As such, data on mortality, hospital stays and hospital-acquired wound infections will be used to demystify why the current standard or protocol is insufficient. The next step is to identify the influential people within the healthcare setting, notably, the leaders such as the nurse managers and heads of departments and solicit support from them. At the end of this stage, a sound change-driven coalition should be formed and undertake the role of reinforcing the need for change in all the strategic corners of the organization. This will create a vision for change and prepare all members for the impending change.
Communication is an integral part of any change and as asserted by Kottler in his change model, failure to communicate effectively can be major drawback to the intended change (Appelbaum et al., 2012). As such, different forms of communication will be utilized in a bid to explain why the change is important for the organization and how the change will be implemented. The communication phase will also seek to explain the feasibility of the change, including the economic feasibility. In the modern-day healthcare, patient satisfaction has become paramount since it directly affects funding and hence the financial and resource stability of an organization. While the fruits of this change may not be felt by the setting immediately, in the long-run it will have positive effect on the organization.

Explain how you can apply your findings to guide the implementation of improvements to the procedure. 

Once the change has been implemented, evaluation of the effectiveness of the change is an integral aspect. Evaluation is very important since it shows whether the primary goals of the change are being achieved with time and if need be introduce changes or adjustments. The sole purpose of conducting an evaluation is to identify weaknesses of the skin assessment procedures and subsequently working on those weaknesses and identifying the strengths and leveraging on them (Appelbaum et al., 2012). As such variables such as levels of patient satisfaction with the new procedure and incident rates of pressure ulcers during hospitalization and post-hospitalization periods will be used to rate the success rates of the change. On the other hand, the success of this change is tied to the staff or nurses’ morale and motivation. It is human nature to incline to methods that promise more satisfaction. In this sense, the satisfaction levels of the nurses and staff members will be used as another variable to rate the success rates of the new procedure. As such, evaluation will be done after every three months to determine whether the skin assessment on admission is reducing the long hospital stays and patient dissatisfaction that characterize the existing protocol. On the other hand, comparisons with the records of the existing standard in terms of hospital stays, occurrence rates of pressure ulcers will be used to show whether there are any comparative benefits that accrue to the new standard.

Work cited

Berlowitz, D., et al. "Preventing pressure ulcers in hospitals: a toolkit for improving quality of care." Agency of Healthcare Research and Quality, Rockville, MD (2011).
Lyder, Courtney H., et al. "Hospital‐Acquired Pressure Ulcers: Results from the National Medicare Patient Safety Monitoring System Study." Journal of the American Geriatrics Society 60.9 (2012): 1603-1608.
Sullivan, Nancy, and Karen M. Schoelles. "Preventing in-facility pressure ulcers as a patient safety strategy: a systematic review." Annals of internal medicine158.5_Part_2 (2013): 410-416.
McGuinness, Janice, et al. "How to reduce hospital-acquired pressure ulcers on a neuroscience unit with a skin and wound assessment team." Surgical neurology international 3 (2012).
Appelbaum, Steven H., et al. "Back to the future: revisiting Kotter's 1996 change model." Journal of Management Development 31.8 (2012): 764-782.