The March 2012 issue of the Journal of Clinical Nursing studies trends in pressure ulcer prevention in skilled nursing facilities in its article titled “Registered Nurses’ Attention to and Perceptions of Pressure Ulcer Prevention in Hospital Settings.” Pressure ulcers continue to be a major problem in nursing homes and yet, many facilities fail to prioritize the prevention of these wounds, although they are one of the greatest sources of unnecessary suffering among the elderly. The study reaffirms this problem and observes that Registered Nurses (RNs) typically undervalued the importance of pressure ulcer prevention techniques.
Before reporting the actual procedures and results of the study, however, the article first discusses important prevention techniques that it would be considering when observing nursing homes and their ability to effectively prevent pressure ulcers. First off, pressure ulcer prevention must be administered from an early stage. The study reports that identifying and treating the problem early on can actually decrease the chances of the development of a pressure ulcer by 50%. Some common and effective prevention methods include repositioning and usage of support surfaces, such as foam or air mattresses. Nutrition was also found to be important. Patients who took nutritional supplements were able to successfully lower their chances of developing pressure ulcers.
The study consisted of two parts. The first portion involved an interview with the RNs. Highlights of these interviews reveal a heavy reliance of RNs upon their assistant nurses. Instead of providing direct care themselves, RNs delegated many duties to assistant nurses, admitting that they did not have time to implement or supervise these activities themselves. This confession presents the widespread issue of understaffing in skilled nursing facilities. Even when staff as a whole is sufficient in numbers, nursing homes are often lacking in their employment of RNs. Previous studies have confirmed that direct care from RNs specifically is especially important in the prevention of pressure ulcers, as well as many other health complications that are encountered in nursing homes. With regard to quality of staffing, the truth of the matter is that assistant nurses are much more prevalent and highly staffed than RNs in skilled nursing facilities. This reality makes it especially important for you to ensure that these nurses are well-educated and trained to provide your loved one with the care that he or she needs.
In addition to being knowledgeable of pressure ulcers, and other health-related issues that the elderly may encounter, nurses must also possess basic administrative, organizational, and communication skills in order to allow for the smooth operation of a skilled nursing facility. Many nurses who participated in the study admitted that they felt that the documentation of procedures and treatments was an unnecessary, cumbersome step in the caretaking process. RNs trusted that their assistant nurses were implementing prevention techniques, even if there was no documentation of them. However, careful and accurate documentation of medications, treatments, and health problems is absolutely necessary in optimizing the quality of care that a patient receives. By keeping a patient’s medical files organized, physicians and other third parties can more easily assess the condition of the patient, and thus prescribe the most effective treatments.
Proper documentation also contributes to the formation of an effective care plan. Nurses who participated in the study, however, claimed that no specific care plans were necessary in caring for patients suffering from or at high risk for pressure ulcers. RNs said that pressure relief was done automatically and that no specific policy was necessary because the nursing staff already knew what to do. If a patient showed signs of a pressure ulcer, then assistant nurses were simply to reposition the patient often and report the pressure ulcer to RNs. Such a mentality truly undermines the individual needs of each patient. No two patients are exactly alike. Therefore, it is absolutely necessary that each patient has a care plan that has been specifically tailored to suit his or her needs.
From its observations, the study concluded that prevention techniques were typically undervalued on an RN’s list of priorities. It also concludes that assistant nurses were unable to recognize risk factors or diagnose the stages of a pressure ulcer as accurately as RNs. This fact further attests to the importance of direct care from RNs. If your loved one’s nursing home is not providing your loved one with proper preventative measures for pressure ulcers, as a result of staffing issues, he or she may be a victim of nursing home neglect.