Nurses’ Challenges in Pressure Ulcers Prevention

Subject: Nursing
Pages: 11
Words: 3335
Reading time:
14 min
Study level: Master


There are hundreds of studies on healthcare interventions in the literature, and the number is expanding yearly. There are numerous studies for persons involved in providing care to identify and evaluate when making decisions in most healthcare areas; this topic also. The nursing staff has a critical role in pressure ulcer prevention and care. Pressure ulcer treatment is an essential component of nursing practice since all patients are at risk of acquiring one (NICE, 2014). Pressure ulcers are frequently avoidable and are produced by tissue harm sustained by inadequate blood flow to a skin region as a result of severe pressure (NICE, 2014). They have become a global issue for healthcare professionals, with the yearly cost of treating PUs and related consequences exceeding $2.1 billion (Dealey et al., 2012). This suggests that this problem is more urgent than ever, and medicine should take action.

Nevertheless, decision-makers who were previously intimidated by the amount of individual research have now been confronted with a deluge of evaluations. These evaluations will likely be of varying quality and scope, with multiple published studies on essential issues. Conducting a literature review of the issue in question, permitting the results of independent studies to be compared and contrasted, and therefore giving healthcare decision-makers the required data is a logical and suitable next step. Researchers can explain the validity of this scientific basis, summarize and evaluate the review’s findings, and analyze the strength of these conclusions after going through the process of identifying and evaluating all published reviews.

The goal and motivation for doing a comprehensive analysis of studies should be stated clearly at the outset of the process. This will likely impact the methodologies employed in determining the scope of the study; the Integrated design framework may be helpful. It can aid investigators in clearly delineating if they want to compare and summarize systematic literature reviews that look at the same therapy, a single treatment for a population or disease, or a range of therapies for persons with a specific ailment. The methods for conducting a systematic review of reviews, similar to the planning for a systematic review of individual studies, require consideration of the following aspects: sources, review selection, quality assessment of reviews, presentation of results, and implications for practice and research.

Clinical treatments for PU prevention include a comprehensive examination, hazard identification, and preventative strategies (NICE, 2014). Pressure ulcers afflict approximately 700,000 people in the United Kingdom each year, with 180,000 of them developing for the first time (Wood et al., 2019). It is critical to employ specialized facilitators in order to enhance the implementation process. It is essential to aim for a preventive mentality. The need to develop an implementation strategy with an outcome and a process assessment should be emphasized. It is critical to provide regular feedback to workers on the quality of treatment and to set aside time for conversation and contemplation on such occasions. The patients’ discharge condition should be evaluated to avoid PU, and any continence difficulties should be treated. Skincare should be performed regularly to control perspiration and clean dirty or damp skin. If necessary, nurses should obtain guidance from a continence adviser.

Research Question

By offering a way through the research and writing process, research questions assist authors in focusing their research. A well-developed research question’s specificity assists authors in avoiding the “all-about” paper and working toward establishing a precise, arguable conclusion. At some point throughout their degree, a student will most likely be expected to develop their own research question. The research question identifies the precise topic or problem that will be addressed in the project. It also describes the work that they must perform.

Reflective thinking and reflective assessment are crucial skills in development and learning because they aid in the quick study and assessment of professional events, allowing people to benefit from their experiences. They may assess their own weaknesses, strengths, and learning, which they can then use in their growth plans and job accomplishments. To date, there is enough literature on bedsores to carefully study this problem. It so happened that the problem has always been relevant, but few people talked about it due to the fact that there are more ambitious problems. Minuses in the literature were not found since most of the resources provide an analysis of this problem in total, which allows you to describe it in your work in full. To improve my own competence, this topic was chosen by me because I want to become a qualified nurse and understand my job entirely in order to succeed in all its aspects.

Education of patients, families, caregivers and healthcare providers is the key to a proactive program of prevention and timely, appropriate interventions (Erwin-Toth and Stenger, 2001). Wound management involves a comprehensive care plan with consideration of all factors contributing to and affecting the wound and the patient. No single discipline can meet all the needs of a patient with a wound. The best outcomes are generated by dedicated, well-educated personnel from multiple disciplines working together for the common goal of holistic patient care (Gottrup, Nix & Bryant, 2007).

For quality work, you should write a research question; in my case, the question will be what challenges do nurses in the United Kingdom face in the prevention of pressure ulcers? At first glance, this question may seem simple, but it carries all the necessary criteria for the preparation of quality work. First of all, the question speaks about the problem, emphasizing that this medical situation is a problem and should be addressed. Further, it is said about the one who experiences these problems professionally, namely the nurse. Since I want to become a nurse, this will be especially relevant and useful for me.

Further, it is said that the place where the United Kingdom of Great Britain was taken as the zone in which this problem will be studied. Moreover, the crux of the matter is to prevent the occurrence of pressure ulcers in patients. This issue will be explored from the moment the decubitus ulcer is identified to statistics and the study of how this problem can be prevented. With this question, various sources will help in identifying essential points, and ways to prevent them, as well as providing statistics.

Search Strategy

For this work, the most extensive base with scientific research Google Scholar was selected. It meets all research needs and has the right amount of resources and coverage for this work. The limitations of the questions posed are not so significant; geographically, the work tells about the United Kingdom, which narrows the number of studies, although significantly, but also helps to choose the most necessary. The language of the research is English; this restriction does not in any way affect the search for information since this language is currently an international language of communication, and most of the works are written or translated in English. The limitation of the topic of pressure sore prevention helps identify the right and valuable resources. The type of research will be mixed since it is best to integrate not only statistical data but also informative ones in the form of primary or additional definitions. The analysis method will be analytical and statistical so that the problem of pressure ulcers can be fully covered.

Nurses face massive difficulty in preventing pressure ulcers (Blenman and Marks-Maran, 2017); its occurrence is thought to be a sign of inadequate treatment quality (Gunningberg and Stotts, 2008). Pressure ulcers are painful and hard to heal, as patients and their families are aware (IHI, 2012). Advanced age, immobility, incontinence, poor nutrition and hydration, neuro-sensory deficit, device-related skin pressure, numerous comorbidities, and circulatory irregularities are all risk factors for the development of pressure ulcers and injuries. (Coleman et al., 2014). Pressure ulcers may be avoided in 95% of cases (Downie et al., 2013). To do this, nurses should undergo additional training.

According to the pretest, most nurses maintain skincare, turn patients with a pillow, promote exercise, utilize an air mattress for immobile patients, and do pain evaluations. According to Downie et al. (2015), 93.8 percent of nurses maintain skincare while 56.2 percent of patients had no PU redistribution issues. On the other hand, nurses exhibited a poor degree of practice in most nursing care activities aimed at preventing PU. Seventy-four percent of participants were not competent in heel protection through offloading pressure, 72 percent were elevated to the head of bed higher than 30 degrees, which increases shear forces and leads to deep tissue injury, 60 percent massaged central boney area, which is contrary to recent recommendations, 43 percent did not document findings, and 39 percent did not protect skin during patient transfer, which is contrary to recent recommendations. Downie et al. (2015) revealed that half of the patients in their research did not have heel protection by offloading pressure, whereas more than 90% protected patient skin during transfer.

The high rate of PU is a reflection of the level of care given. As a result, a number of strategies have been implemented to reduce PU rates and improve patient care quality, including healthcare provider education, the availability of PU guidelines, and the deployment of PU-reducing technologies (Barker et al., 2013). The majority of PUs may be prevented by adhering to PU guidelines, which can adequately identify at-risk populations (El Enein & Zaghloul, 2011). There are already a lot of well-known and well-accepted PU preventive guidelines. Regrettably, the PU guidelines are not often followed (Waugh, 2014). According to research, nurses’ knowledge of pressure ulcers is inadequate (Iranmanesh et al., 2011). Furthermore, nurses’ capacity to correctly diagnose and record PU is essential to PU prevention, yet, several studies have revealed a gap in nurses’ comprehension of PU classification and documentation (Thomas, 2012). Additional pressure ulcer drills should be conducted as the problem is being dealt with very slowly.

Yn et al. (2012) stated, “PU education program as a powerful tool for nurses to improve understanding of PU, keep abreast of current knowledge on PU, and eliminate patient’s suffering.” A PU preventive education program increases staff awareness and leads to a considerable drop in PU incidence. Another barrier to putting PU prevention into practice for nurses is a lack of interdisciplinary initiative. To contribute to good care, PU prevention necessitates interdisciplinary efforts and collaboration (Yn et al. 2012). PU preventive practice is not only the responsibility of nurses, but it is also an essential component of critical care nursing.

In pressure ulcer prevention, it is essential to check patients’ skin regularly to discover skin irregularities (Yn et al. 2012). Skin evaluation is a critical component of the SSKIN care package for minimizing pressure ulcers. This acknowledges that skin changes communicate greater risk and may anticipate the development of more severe pressure injuries even in the absence of a systematic risk assessment. Non-branch able erythema (NBE) is a clinically significant skin abnormality that should be discovered as part of a complete skin examination. National and worldwide pressure ulcer prevention recommendations state that indicators of worsening skin status should be used to develop personalized pressure ulcer management programs. Patients with NBE are more prone than those without to develop new pressure ulcers; thus, physicians should perform regular skin evaluations and take preventative measures if NBE is present.

Pressure ulcer risk assessment tools assist doctors in determining a patient’s risk of getting pressure ulcers. Risk assessment methods used by community practitioners include the Waterlow Score, Purpose T, Walsall Community Risk Score Calculator, and the Braden Scale. These techniques should not be used to replace a practitioner’s clinical judgment but rather to supplement it. The SSKIN bundle is a set of evidence-based treatments that are given to patients who have pressure ulcers or who are at risk of acquiring pressure ulcers on a regular basis. On each visit, nurses, caregivers, and other healthcare workers evaluate several elements of the SSKIN bundle.

The information gathered from the sources is used to provide evidence, findings, and recommendations. Given the enormous volume of material to review, many people may find the literature search overwhelming. However, creating a systematic search strategy before beginning the literature search is critical to proper and successful information extraction—this planning aids in meeting the systematic review’s standards and evaluating the study questions. The extent of the search, its completeness, and the time available to do it must be considered when establishing a search strategy. The goal is to provide a comprehensive, thorough, and objective a systematic review of reviews.

Community patients are increasingly presenting with considerably more complicated clinical requirements as a result of improvements in medicine, longevity, and closer-to-home care. These demanding requirements are frequently connected with an increased risk of skin damage. Skin, like any other organ, can fail towards the end of life (European Pressure Ulcer Advisory Panel, 2009). Some of these individuals have severe physiological abnormalities that make their skin prone to breakdown if they are not adjusted on a frequent basis. In such instances, social workers must examine the patient, the patient’s familial support networks, and the community resources accessible to the patient, their caregivers, and family.

The literature search phrases should be stated in detail and information on their relevance to the study issue. Furthermore, search phrases should be concentrated such that they are broad enough to collect all vital data while still being restricted enough to avoid capturing useless literature, which could result in wasted time and effort reviewing irrelevant publications. Contacting specialists in the field and examining articles that cite individual research relevant to the topic might help supplement the literature search. This could be useful for discovering previously published systematic reviews that are not indexed in the bibliographic databases examined and ongoing systematic reviews that are nearing conclusion.

More than one hundred threat elements for strain ulcers were recognized withinside the literature. Some physiological and non-physiological threat elements that can pose a threat of growing strain ulcers in adults are diabetes mellitus, peripheral vascular sickness, cerebrovascular infarction, sepsis, and hypotension (Lyder et al., 1998). These physiological threat elements are hypothesized to pose a threat to patients because of the deterioration of the affected person’s microcirculation system. Microcirculation is managed in elements via way of means of sympathetic vasoconstrictor impulses from the mind and localized endothelial molecular secretions (Lyder et al., 1998). The affected person can be extra vulnerable to ischemic organ harm because neural and endothelial manipulation of blood glide is compromised at some point of a sickness state (Bliss, 1998). Because the patient’s brain and endothelial regulation of blood flow are compromised during sickness, the patient may be more vulnerable to ischemic organ damage.

Because of the large number of risk variables reported in the literature, nurses have found risk assessment tools to be valuable adjuncts in identifying patients who may be at high risk (Bliss, 1998). Preventative necessitates continuous risk assessment, evaluation of causal variables, application of prevention initiatives, and adequate pressure releasing equipment. When a patient is identified as being at risk of pressure injury as a result of an evaluation, treatments should be done as soon as possible.

Pressure ulcers are described as localized damage to the skin and underlying tissue caused by pressure alone or in conjunction with shear, generally over a bony prominence. (European Pressure Ulcer Advisory Panel, 2009). They commonly occur in patients with limited mobility, such as those in hospitals or long-term care settings. Pressure ulcers are thought to afflict up to 3 million individuals in the United Kingdom (Lyder, 2003). In the United Kingdom, the prevalence is predicted to range from 0.4 percent to 38 percent in acute care hospitals, 2 percent to 24 percent in long-term care nursing institutions, and 0 percent to 17 percent in-home care settings (Catherine VanGilder et al., 2009). Pressure ulcers were identified as a cause of mortality in approximately 115 000 people between 1990 and 2001, with more than 21 000 being listed as the underlying cause of death (Redelings et al., 2005). The estimated cost of treating each case of pressure ulcers ranges from $37 800 to $70 000 (Kuhn and Coulter, 1992). A growing industry has developed to market various products for pressure ulcer prevention.


Decision-makers who were previously frightened by the volume of individual research are now inundated with evaluations. These reviews will most likely be of diverse quality and scope with several published research on critical subjects. A reasonable and appropriate next step is to conduct a literature review of the topic in question, allowing the results of independent research to be compared and contrasted, thereby providing the necessary evidence to healthcare decision-makers. Decision-makers who were previously frightened by the volume of individual research are now inundated with evaluations. These evaluations will undoubtedly be of varying quality and scope, including multiple published studies on essential topics. Conducting a literature review of the topic in question is a practical and suitable next step since it allows the results of independent studies to be compared and contrasted, providing the required evidence to healthcare decision-makers. After discovering and assessing all published reviews, researchers can explain the legitimacy of this scientific basis, summarize and evaluate the review’s results, and analyze the strength of these conclusions.

At the commencement of the process, the purpose and motivation for conducting a complete review of research should be expressed clearly. This will almost certainly impact the approaches used to determine the scope of the study; the Integrated Design Framework may be helpful in this regard. It can help researchers distinguish whether they wish to compare and summarize systematic literature reviews that look at the same therapy, single treatment for a population or disease, or various therapies for people with a particular ailment. Similar to the planning for a systematic review of individual studies, the methods for conducting a systematic review of reviews require consideration of various aspects: sources, review selection, quality assurance of reviews, demonstration of results, and repercussions for research and practice.

According to the preliminary evaluation conducted before the educational intervention, nurses have a good attitude toward PU prevention. Nurses agreed that all patients were at risk of developing PU and that regular and thorough assessments gave information regarding patient risk. Most nurses feel that most PU are avoidable, that all patients should have their risk assessed, and PU prevention is a top priority. Furthermore, nurses were worried about PU prevention in their practice and were interested in learning more about it. The discovery was in accordance with (Strand & Lindgren, 2010). Clinical judgment and the use of risk assessment tools should be incorporated, according to nurses.

The majority of nurses, according to this survey, lack the necessary expertise to avoid pressure ulcers. The PU knowledge ratings of nurses who read publications and went to training indicated a substantial change. Nurses’ challenges to practicing PU prevention included a shortage of pressure-relieving equipment, a lack of personnel, a strict schedule, and insufficient training. Providing access to PU prevention materials, in-service training, regular training, integrating and prioritizing pressure ulcer prevention into nursing curricula, and establishing recommendations are important ways to improve nurses’ understanding of pressure ulcer prevention. More observational studies are needed to assess the actual practice of PU prevention rather than its perception.

The multimodal intervention strategy, as well as the positive attitudes of the participants, appeared to be critical for altering knowledge and functioning more preventatively. The techniques employed and the facilitators’ abilities must be adapted to the challenges surrounding the environment. Feedback talks among employees about the outcomes of the treatment delivered tends to be essential as well. The data support the hypothesis that the intervention and implementation process transformed people’s perceptions and approaches to pressure ulcer prevention, shifting them from treating to preventing. This was made feasible because ‘new understanding allows for altered behaviors – through one’s own performance and reflection on pressure ulcer avoidance.’ A shared perspective on pressure ulcer avoidance, easy availability to pressure-relieving equipment, and external and internal facilitator assistance were critical elements in changing habits. Bedside assistance, comments, and conversations about present outcomes raised awareness of needed changes.

Reference List

Barker, A., Kamar, J., Tyndall, T. J., White, L., Hutchinson, A., AKlopfer, N., & Weller, C. 2013. ‘Implementation of pressure ulcer prevention best practice recommendations in acute care: An observational study’. International Wound Journal, 10(3), pp. 313–320.

Bliss MR. 1998. ‘Hyperaemia’. J Tissue Viability, 8, pp. 4–13.

Bergstrom, N., Horn, S., Rapp, M., Stern, A., Barrett, R., Watkiss, M., & Krahn, M. 2014. ‘Preventing pressure ulcers: A multisite randomized control trial in nursing homes’. Ontario health technology assessment series, 14(11), pp. 1-32.

Blenman, J., & Marks-Maran, D. 2017. ‘Pressure ulcer prevention is everyone’s business: the PUPS project’. British Journal of Nursing, 26(6), pp. 16-26.

Catherine VanGilder, M., Amlung, S., Harrison, P. and Meyer, S., 2009. ‘Results of the 2008–2009 International Pressure Ulcer Prevalence™ Survey and a 3-year, acute care, unit-specific analysis’. Ostomy Wound Manag, 55, pp. 39-45.

Coleman, S., Nixon, J., Keen, J., Wilson, L., McGinnis, E., Dealey, C., Nelson, E. A. 2014. ‘A new pressure ulcer conceptual framework’. Journal of advanced nursing, 70(10), pp. 2222-2234.

Dealey C, Posnett J, Walker A. 2012. ‘The cost of pressure ulcers in the United Kingdom’. J Wound Care, 21(6), pp. 261–266.

Downie F, Guy H, Gilroy P, Davies S. 2013. ‘Are 95% of hospital-acquired pressure ulcers avoidable?’. Wounds UK, 9(3), pp. 16–22.

European Pressure Ulcer Advisory Panel. 2009. ‘National Pressure Ulcer Advisory Panel’. Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide.

El Enein, N. Y. A., & Zaghloul, A. A. 2011. ‘Nurses’ knowledge of prevention and management of pressure ulcers at a Health Insurance Hospital in Alexandria’. International Journal of Nursing Practice, 17(3), pp. 262–268.

Erwin-Toth, P., & Stenger, B. 2001. ‘Teaching wound care to patients, families and healthcare providers’. In D. L. Krasner, G. T. Rodeheaver & R. G. Sibbald (Eds.), ‘Chronic wound care: A clinical source book for healthcare professionals’. Wayne, PA: HMP Communications. 3rd ed., pp. 35-41.

Gunningberg, L., & Stotts, N. A. 2008. ‘Tracking quality over time: what do pressure ulcer data show?’. International Journal for Quality in Health Care, 20(4), pp. 246-253.

Gottrup, F., Nix, D. P. & Bryant, R. A. 2007. ‘The multidisciplinary team approach to wound management’. In R. A. Bryant, & D. P. Nix (Eds.), ‘Acute & chronic wounds: Current management concepts’. St. Louis, MO: Mosby. 3rd ed., pp. 23-38.

Institute for Healthcare Improvement (IHI). 2012. ‘IHI improvement map: prevention of pressure ulcers’.

Iranmanesh, S., Rafiei, H., & Foroogh Ameri, G. 2011. ‘Critical care nurses’ knowledge about pressure ulcers in the southeast of Iran’. International Wound Journal, 8(5), pp. 459–464.

Kuhn, B.A. and Coulter, S.J., 1992. ‘Balancing the pressure ulcer cost and quality equation’. Nursing economic$, 10(5), pp.353-359.

Lyder C, Preston, Ahearn D, et al. 1998. ‘Medicare Quality Indicator System: Pressure ulcer prediction and prevention module: final report’. Bethesda, MD: Qualidigm/US Health Care Financing Administration.

Lyder, C., 2003. ‘Pressure ulcer prevention and management’. Jama, 289(2), pp. 223-226.

National Institute for Health and Care Excellence. 2014. ‘Pressure ulcers: prevention and management’. Clinical guideline 179.

Redelings, M.D., Lee, N.E. and Sorvillo, F., 2005. ‘Pressure ulcers: more lethal than we thought?’. Advances in skin & wound care, 18(7), pp. 367-372.

Strand, T., & Lindgren, M. 2010. ‘Knowledge, attitudes, and barriers towards prevention of pressure ulcers in intensive care units: A descriptive cross-sectional study’. Intensive and Critical Care Nursing, 26(6), pp. 335–342.

Thomas. A. 2012. ‘Assessment of nursing knowledge and wound documentation following a pressure ulcer educational program in a long-term care facility : a capstone project’. Wound Practice and Research, 20(3), pp. 142–158.

Wood J, Brown B, Bartley A. 2019. ‘Reducing pressure ulcers across multiple care settings using a collaborative approach’. MJ Open Quality, 8:e000409.

Waugh, S. M. 2014. ‘Attitudes of Nurses Toward Pressure Ulcer Prevention : A Literature Review’. MedSurg Nursing, 23(5), pp. 350–357.

Yn M, Saleh JAM, Anthony D. 2012. ‘An interventional study on the effects of pressure ulcer education on Jordanian registered nurses ’ knowledge and practice’. Procedia Soc Behav Sci. 47, pp. 2196–2206.