Skin care, a fundamental componentof basic care, reflects on the overall quality of care that apatient receives in hospital. Quality care aimed at preventing and minimizingskin breakdown andpressure ulcers has been identified as one of the nursing research priority. Pressure ulcer isa common problem in nursing practice and entails great expenses for the patients as wellas for the health care service. 1 Thepressure level that closes capillaries in healthy people is 25–32 mm of Hg. When pressure applied to the skin isgreater than this pressure in the capillary bed, it can impair cellularmetabolism.
It decreases blood supply to the tissue and eventually causestissue ischemia, this reduction in blood flow causes blanching of the skin. Thelonger the pressure lasts, the greater is the risk of skin breakdown and developmentof pressure ulcer. 2 Pressureulcers are a common, painful and costly condition. Results of a 1991 study intothe knowledge among Dutch hospital nurses on the usefulness of measures toprevent pressure ulcers showed moderate knowledge. Results were confirmed bysubsequent studies. 3 “National Pressure Ulcer AdvisoryPanel” (NPUAP) of the United States of America defines Pressure Ulcer as’lesions caused by unrelieved pressure against soft tissues, usually over thebony prominences. Risk factor for pressure ulcer include moisture, nutritionaldeficits, shear, stress, friction, alterations in mobility etc.
4 They cause great pain and are asource of serious systemic disease in some and seriously impair health in othersystems. They cause extra work for nursing staff and are also the cause offeelings of guilt and distress. They delay other patients care by a long stayin hospital, sometimes 10-12 weeks for a grade four pressure sore.
5 2 Rosemary Crow stated thatdespite the mass of information on pressure sores, nurses are still failing torespond to the challenge of their preventive. For those who involved in patientcare, the real challenge of pressure sores is to stop them appearing in thefirst place. 5 NEED FOR THESTUDY: Pressure ulcershave implications for the quality and cost of health care. Patients experiencepain and discomfort if they develop a pressure ulcer: in extreme cases tissuedamage interferes with rehabilitation and contributes to mortality. Theindividual patient who develops an established pressure ulcer will increase thecosts of health care through the additional time spent in hospital, the needfor support services, and will occupy a bed for longer, thus reducing patientthroughput. 6 In the domiciliarysituation, the patient who has an established pressure ulcer is a drain on thecommunity health service, requiring extra visits by the domiciliary nursingteam in addition to special equipment. Thus nurses, who provide 24 hr carefor patients in hospital and take accountability for the nursing care ofpatients at home, have a legal, moral and social obligation to prevent pressureulcers.
6 Under thesecircumstances it is not surprising that more has been written about pressureulcers than almost any other nursing topic and considerable research has beenundertaken. 6 Studies haveexamined the epidemiology and pathophysiology of pressure ulcers and much hasbeen written about prevention. The tissues are damaged either through theeffects of ischemia arising from externally applied pressure or from shearingforces resulting in mechanical stress and today it is considered that in mostcases such damage is preventable. 6 Pressure ulcers orpressure sores not only cause suffering to the patients but also increases theworkload on health care professionals. Pressure ulcers have been described as oneof the most costly and physically debilitating complications in the 20thcentury.
Pressure ulcers are the third most expensive disorder after cancer andcardiovascular diseases. In addition, about 57–60% of all pressure ulcers occurwithin hospitals. Up to 13% of patients develop pressure sores while beingtreated in an intensive care unit.
73 A cross sectionalstudy was conducted among a total of 445 hospitalized patients in medical andsurgical wards for the estimation of prevalence of pressure ulcers in auniversity hospital at Varanasi, India. They were examined in a single day andthe results of this study proved that there is a high prevalence of pressureulcers that is 4.94% among the selected group and the morbidity due to pressureulcers in the long stay wards such as neurology wards was exceptionally highthat is 40.9%. 8 The above statedfacts indicate the need for study primary nursing responsibility of identification of patients at risk for developmentof Pressure ulcer and implementing pressure ulcer prevention strategies forthose identified at risk.