Introduction
The client is a sixty-five-year-old male, who suffered a condition, which left him bedridden. Due to impaired mobility, he cannot leave the bed. The patient currently resides in a nursing home, where all his basic needs are attended to by the nursing staff and healthcare assistants. The lack of movement increases the risk of developing pressure ulcers.
The problem under the focus is the pressure ulcer. It is a skin condition, which manifests in the form of tissue damage. They are caused by “sustained mechanical loading and deformation of the skin and subcutaneous layers between internal stiff anatomical structures and external surfaces or devices” (Kottner et al., 2018, p. 62). There are four levels of pressure sores, depending on the severity. All of them are accompanied by pain, the difference is the skin layer affected (DerSarkissian, 2020). Starting with stage 3, sores dig into the second layer, while stage 4 affects muscles.
Considering the condition of the client, without the proper prevention measures, there is a high probability of this type of skin damage. Therefore, there are two aims of the research. The first is understanding what causes and exacerbates pressure ulcers. The second aim is ascertaining the proper prevention protocol corresponding to the condition of the client.
Holistic Needs
Physical Needs
Being constantly bedridden, the client experiences difficulties with elimination needs, maintaining personal hygiene, and repositioning. The client is dependent upon the assistants to empty their catheter bags and waste containers. Subsequently, he is not able to wash, thus, necessitating outside help. Third, the client needs other people to help him reposition the body.
Emotional Needs
Naturally, the client is depressed due to his health condition. The awareness of the fact of complete dependability on other people causes anxiety and depression. Moreover, the client believes that old age impairs his ability to regenerate. Therefore, there is a definite need for positive reimbursement and encouragement.
Social Needs
On the one hand, the client feels isolated due to being alone in a room with no other people. On the other hand, the client has regular visits by nurses, healthcare assistants, and family. The client speaks with them once a week. Communication in the meantime is handled via electronic devices and online messaging.
Rehabilitation and Recreational Needs
There is no direct need for pressure ulcer rehabilitation as no pressure sores are evident. However, there is a substantial risk of developing them, therefore, preventative measures are necessary.
Intellectual Needs
The client is capable of answering questions, solving test puzzles, and realizing his needs. If there is discomfort in some part of his body, he reports it to the assistant and the nurses. The client’s memory shows no symptoms of damage since he remembers all details of his medical condition and treatment. When the client is requested to do anything, he understands and either proceed with it or explains why he is not able to do it.
Spiritual Needs
The client is a Baptist Christian. Due to his condition, he does not visit churches or attend mass services. The only available method of expressing faith is praying, which he does each day.
Level of Assistance
Repositioning
The client is not capable of repositioning the body on his own. Every two hours, the assistant visits to remind the client of the necessity to readjust body position. When the client is ready, the assistant adjusts the bed and instructs the client to move those limbs that he can on his own. The assistant also checks that those body parts that cannot be moved stay undisturbed.
Manual Handling
The patient’s bed is equipped with mechanics that allow the assistant to lower and lift it. As the client himself cannot reach the corresponding mechanism, outside assistance is required. Mechanical aids allow the assistant to distribute the client’s body pressure. The assistant considers the amount of time spent on one position and the need to shift the pressure to other body parts.
Diet
Two factors are essential in planning the client’s diet: nutrition and fluid intake. The client’s organism has a high need for protein, amino acids, and Vitamins A, C, and E because these substances are essential in nourishing the body during the healing of bedsores (Saghaleini et al., 2018). At the same time, regular hydration maintains skin integrity and repairs tissue damage.
Observations
Each day the assistant checks the client’s skin, looking for signs of emerging sores. The body parts that are least mobile and most pressured are prioritized. Also, the assistant analyzes the client’s behavior. If he exhibits any unusual pain or discomfort symptoms, the assistant interprets them as signs of insufficient pressure relief measures.
Pressure Relieving Equipment
The patient’s bed is equipped with a special pressure mattress. It is made of rows of air cells, which rise and fall according to the pre-set sequence, which is controlled by a pump. The bed itself can be turned up and down and from one side to another. This way, the assistant does not have to physically lift the client to reposition him. Finally, fleece protectors are placed at the points of contact between the body and the mattress to smooth friction.
Infection Control
The assistant changes the client’s sheaths every three days. The client is washed in a bed bath, which removes bacteria and eliminates the threat of skin contamination. Fleece protectors are also changed regularly as constant contact with skin can pollute them with sweat. The catheter is cleaned to minimize the risk of urinary tract infections. In case a pressure sore develops, this spot is isolated to prevent any further contact with bacteria and viruses.
Role of Healthcare Assistance: Privacy and Dignity
Independence/Autonomy
As the client has to be constantly monitored, their privacy is substantially restricted. The client needs outside help for personal hygiene. However, intimate processes, such as mealtime and elimination, are carried out by the client alone. Unless there is a specific need for the assistant’s presence, the client’s privacy is expected. Familial visits are also a private affair, which means that no nurses or assistants are present.
Self-Esteem
The client recognizes his dependability on other people to meet his basic needs. Regular hygienic procedures make the client feel fresh and washed, which boosts overall confidence. The client reads and watches TV, which helps him shift his attention away from his disabilities. Finally, regular communication with family and friends via the Internet makes him feel needed and cared for.
Client Safety
Any changes in the client’s condition are immediately recognized and addressed. Regular checks help the assistant ensure the absence of skin deterioration. If there are signs of damage, corresponding measures are taken, whether it is the change of the mattress or fleece protectors or repositioning the client to isolate the vulnerable skin spot. As nourishment is essential in treating bedsores, the client is monitored for signs of allergy. In case his body negatively reacts, the meal plan is corrected.
Confidentiality
The assistant is not allowed to disclose the client’s personal information, including the details of his medical condition, to anyone excluding the supervisor and the client’s family. Any mail addressed to the client is conveyed to him without interference. Unless the client gives explicit permission, he cannot be used for research or educational purposes. No camera, photo, or audio recordings are allowed without proper consent.
Privacy/Dignity
During intimate moments, such as bed bathing and skin checks, the assistant closes the window and shuts the door. The assistant ensures that the client’s body parts are revealed only for the duration of the necessary procedures. The assistant keeps their voice low while talking about sensitive issues to minimize the client’s discomfort. Any potential odors and stains, which may be the result of the procedure, are immediately removed. The client’s personal information is not displayed in public areas unless it is required for his safety.
Recommendations
Prevention of Development of Pressure Sores
Two essential measures should be implemented. According to Barker et al. (2013), “Key pressure ulcer prevention best practice guidelines recommendations include screening patients’ skin integrity risk on admission to hospital, daily reassessment of risk and timely application of prevention strategies” (p. 318). Therefore, the most important prevention measure is to regularly check the patient’s skin, starting from the moment of admission. It will provide the healthcare assistant and the nurses with a clear account of the skin transformations throughout the client’s stay in the nursing home.
Importance of reporting changes in clients’ condition to supervisor/nurse in charge
The second measure is using online messaging for regular updates. The assistant does daily checks of the client’s skin, however, they may not be qualified enough to recognize the signs of developing pressure ulcers (Bruton et al., 2016). This is why the supervisor should receive reports of any changes. Making a simple message a part of daily routine will reduce the risk of missing warning symptoms of pressure ulcers.
Evaluation
Overall, studying pressure ulcers has been an illuminating experience. It is alarming how fast such a disease can develop, considering the amount of pain and discomfort it can cause. As with any illness, it is easier to prevent it than to treat it. Therefore, I believe that keeping the client’s skin condition diary is essential. It would contain a written account of changes in color, smoothness, and other skin properties.
Current intervention measures are centered around constantly repositioning the client and changing their sheaths and fleece protectors. In my opinion, a greater emphasis should be put on the client’s nutrition and water intake. If the body receives enough vitamins and fluid, it will be able to resist any adverse developments without the need to change the body position every two hours. As a result, the client will be less concerned about the violation of his privacy, while adequate regular checks will still be performed.
Finally, positive emotions are essential for recovery and prevention. The client needs constant reimbursement, which can be accomplished via talking, family visits, and online messaging. It is also important to distract the patient’s mind by reading, watching TV, and forms of entertainment to prevent depression. Combined with proper food and fluid intake, skin diary, and less disturbance, emotional reimbursement can increase the client’s satisfaction and the quality of healthcare.
Reference List
Barker, A.L. et al. (2013). ‘Implementation of pressure ulcer prevention best practice recommendations in acute care: an observational study’. International Wound Journal, 10(3), pp. 313-320.
Bruton, J. et al. (2016). ‘Nurse handover: patient and staff experiences’. British Journal of Nursing, 25(7), pp. 386-393.
DerSarkissian, C. (2020) What are the stages of pressure sores? Web.
Kottner, J. et al. (2018) ‘Microclimate: a critical review in the context of pressure ulcer prevention’, Clinical Biomechanics, 59, pp. 62-70.
Saghaleini, S.H. et al. (2018) ‘Pressure ulcer and nutrition. Indian journal of critical care medicine’, Indian Journal of Critical Care Medicine, 22(4), pp. 283-289.
Taylor, P. et al. (2020) ‘Oral hygiene effects verbal and nonverbal displays of confidence’, The Journal of Social Psychology, pp. 1-15.