Risk Assessment In Practice To Manage Risk And Enhance Patient Care

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Introduction Of The Responsibility Of The Nurse Is To Use Evidence-Based And Person-Centred Care, Assignment
Critical understanding of the safety and quality of care in nursing

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Introduction Of The Responsibility Of The Nurse Is To Use Evidence-Based And Person-Centred Care, Assignment

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Risk assessment in nursing practice is defined as identifying, analysing, and mitigating risks, which may negatively influence the patient. The responsibility of the nurse is to use evidence-based and person-centered care, which can help the person to cure quickly. This also helps to manage the risk of critical patients. Gathering proper knowledge on the topic can be helpful for registered nurses to implement the strategies in their professional life. Therefore, In this assessment, the discussion is done on the patient-centered and evidence-based nursing care for Pressure Ulcers. A literature review is performed by collecting and analysing information from the different existing literature on this specific topic. Various methods and approaches of nursing care and risk assessment are considered here, especially for pressure ulcers. The findings from the literature review can be used in the professional nursing practice of hospitals.

Literature review

Overview of Pressure ulcer

A pressure ulcer is an injury to the skin and underlying tissue, which is caused by prolonged pressure on the skin (Lechner et al. 2022). A pressure ulcer is also commonly known as bedsore. This disease can happen to anyone. However, people who sit or lie down in bed or use a wheelchair are most susceptible to this disease. This disease can affect any body part of a human being. According to Rutherford et al. (2018), generally, hips, elbows, the base of spines, and heels are more susceptible to the issues. There are many symptoms of the disease, which help to identify the problem. One of the first and most common symptoms is the discoloration of the body parts. Blue or purple patches are seen in people who have dark skin and for people with pale skin, the color of the patches is red (Saleh et al. 2019). When pressure is given to the patches, the body part does not turn white. The spongy or hard texture of the skin, pain, and itchiness can also be seen. Based on the severity of the condition, the patient needs to check up with the clinician.

Stages of pressure ulcer

(Source: Rutherford et al. 2018)

The above symptoms can be considered the category 1 pressure ulcer. Blister or open wound is seen in category 2 of ulcer pressure (Lechner et al. 2022). In category 3, the wound reaches the deeper layer of the skin. In the 4th category, the wound reaches the bone and muscle. According to experts like Rutherford et al. (2018), medical attention is needed on an emergency basis when category 2 can be seen in the patient otherwise it can lead to a serious and life-threatening infection like blood poisoning. The medical professional uses a dressing in the wound for the speedy recovery of the infection (Saleh et al. 2019). Moving and changing positions are needed regularly. Using static or foam mattresses can be helpful to reduce the symptoms of the disease. Generally, people who are aged around 65-70 are prone to the disease. However, patients who are suffering from paralysis or confined in bed for surgery or other illness are also prone to the disease (Lechner et al. 2022). Hence, regular changes of the clothes, and bed sheets, and disinfecting those is important to be performed on a regular basis. Besides, medical professionals also suggest medicine to control the symptoms and healing of the wound.

Critical understanding of the safety and quality of care in nursing

Some fundamental definitions should be discussed in order to understand patient safety and quality care in medical practice. Various studies show that nurses take a key part in the patient's safety and provide them quality care in the hospitals. In order for a speedy recovery of the patient, both safety and quality care is needed. Many researchers said that quality care is the "overarching umbrella" and the safety of the residents under that (Al-Jabri et al. 2021). In the 21st century, there are some key components that help to measure the quality of care, those are "patient-centered, safe, timely, efficient, effective and equitable". Any health practice, which follows these six components, can be called quality care.

On the other hand, the safety of the patient discusses some concrete essential components. Any kind of prevention from harm to the patient can fall under patient safety in the healthcare industry. As stated by De Moissac and Bowen, (2019), the risk to the patient is described along with the complexity of the procedure of treatment. On the other hand, many risks are associated with the diagnosis, measurement, human errors, and others. The role of the nurses is to reduce the amount of error as much as possible. Lack of safety in the healthcare sector has many devastating consequences including life threats. Besides, various legal obligations are also there. According to Escudero, Silva, and Corvetto, (2019), patient safety is considered a global priority by the world health organization.

Improvement of patient safety

(Source: Ocloo et al. 2021)

Nursing professionals are always linked with defining and measuring quality in care. Significant reduction in the mortality rate can be seen when nursing professionals perform proper hygiene practices. In previous times, the quality of care and patient safety were considered for the prevention of patient fall and medical error (Ocloo et al. 2021). However, the breadth and width of these two terms are far more than that. In the hospitals, the nurses perform coordination and integration of various aspects of quality in order to maintain the quality of care. As stated by De Moissac and Bowen, (2019), the process has become much more complex than before as the key component of quality care and safety has increased a lot.

Fewer complications and low mortality rates are the results of safety and quality care. Various researchers have argued about the roles of nurses in these. According to Al-Jabri et al. (2021), surveillance and monitoring of the hazards before the deterioration of patients is one of the major roles of nurses in healthcare practice. Few studies have also argued that nursing surveillance is not enough whether the clinician does not do the treatment decision and cognitive diagnosis correctly (Ocloo et al. 2021). Hence, maintaining the safety and quality of the care is not a single task rather it is a combination of processes by all the healthcare staff of the hospital. On the other hand, some researchers discuss the role of communication in safety. According to Escudero, Silva, and Corvetto, (2019), nurses are considered the important communication link in the health care practice. Besides, they are also responsible for the coordination of different aspects of the treatment. Hence, this helps to improve the health status with low morbidities and mortalities.

Methodologies and approaches to assess and minimize risk in pressure ulcer

Recognition of the patient who is in a high chance of developing pressure uncle is the first stage of the prevention care pathway. Prevention of pressure ulcers is also included in the assessment and management of risk. Those risks need to be identified in the first place for reducing the possibilities of life-threatening harm (Mitchell, 2018). The nursing professional for the assessment of risk uses various risk assessment tools. These tools are useful to find the numeric result, which states the level of risk. After analysing the score of the tools, the level of the risk is identified by the nurses. The higher score in the tools indicates higher risk of the disease. As stated by Liao, Gao, and Mo, (2018), people who do not have any sensation or mobility have higher chances of having a pressure ulcer. However, stating this can oversimplify the risk of the disease, as these two are not the only reason for developing the pressure ulcer. Such as patients, who are suffering from dementia have the ability to move. However, they are unable to recognize the pain in a specific body part. The first signal associated with the pressure ulcer is pain (Bowers, and Franco, 2020). Hence, the risk of the disease increases.

Risk management in pressure ulcer

(Source: Saleh et al. 2019)

There are many tools associated with formal assessment. Among them, Norton Scale, Braden Scale, and Water low Scale are widely used (Biçer et al. 2019). Braden scale is commonly used in the United States, which consists of 6 elements: those are "activity, mobility, friction, moister, sensory perception and shearing. On the Norton scale, five elements are used such as "mental condition, incontinence, physical condition, activity and mobility" and this tool is widely used in the UK (Saleh et al. 2019). In case of the "Water low scale”, there are nine elements which are discussed by the experts. Some factors in each tool overlap, which add heterogeneity to the scales. Various nursing associations in terms of assessing and managing the risk provide various guidelines. However, there is not much evidence that supports the use of these tools accurately in a pressure ulcer.

As stated by Liao, Gao, and Mo, (2018), conducting physical inspection by nursing professionals is also useful to assess the risk factors. The nursing professionals can identify the reduction in mobility or immobility. The longer the pressure on the bony prominence, the rate of pressure is higher. As a result, the blood flow in that place is reduced or sometimes totally stopped. Tissue hypoxia or tissue death can also be seen due to the reduction in blood flow (Mitchell, 2018). Pain is also a major signal, which indicates that the pressure is there for too long a period. Lack of sensation is also considered the symptom, which helps to identify the risk. When a lack of sensation is seen, the patient is not aware of the pain. Hence, people suffering from spinal cord injury, cerebrovascular accidents, and multiple sclerosis are prone to the disease (Bowers, and Franco, 2020). Marking in the skin is also an early sign of the disease.

The mattress needs to be changed periodically where the patient lies or sits for a long term is very effective to manage the risk of pressure ulcer. This is applicable not in the home and in the hospitals. It has been seen that the use of gels, polymers, and air products helps to reduce the symptoms of pressure ulcers (Saleh et al. 2019). Nursing professionals also need to suggest to the patient to change positions frequently. However, patients with paralysis may not be able to do so. In that case, nursing professionals help the patient to move and change position in bed or wheelchair. Foam dressing is another popular method for the prevention of risk. As stated by Liao, Gao, and Mo, (2018), a combination of foam dressing and silicone is used to set the surrounding tissues of the bed shore.

Principles and theories of improvement methodologies

Quality improvement in the healthcare sector is not easy due to the complex procedure of the different types of patients in the hospitals. However, various research studies have discussed the five guiding principles of the improvement methods, which can be applied by the healthcare institution. In that aspect, wasteful spending by healthcare organizations can be reduced. As stated by Vaismoradi et al. (2020), the first principle of the improvement method is the "Facilitate Adoption through Hands-on Improvement Projects". This principle states that discussing the case studies is not enough to motivate healthcare professionals to facilitate improvements in the quality of care. Healthcare professionals can apply quality improvement theory when hands-on improvement work is applied to them (National Association of School Nurses, 2020). Applying this in the actual clinical environment is helpful. The second principle is "Define Quality and Get Agreement". The use of a quality framework defined by the "institute of medicine or IOM" is suggested in this principle (Gilster, Boltz, and Dalessandro, 2018). There are six aims in the "quality framework": those are: effective, safe, timely, efficient, patient-centered, and equitable". It is necessary to find what is important for the patient. Hence, patient-centered care is most important to find whether the patient is getting the best care for the disease or not. According to Selekman, Shannon, and Yonkaitis, (2019), the third principle is "Measure for Improvement, Not Accountability". Most clinicians think about the improvement measurement as increasing performance. Accountable data is not enough to understand the improvement of healthcare of the patient as healthcare is a complex process of physical and mental improvements. The fourth principle suggests the use of "Quality Improvement Framework and PDSA Cycles' ' (Gilster, Boltz, and Dalessandro, 2018). Various frameworks are developed for the measurement of quality. Among them, the “six sigma DMAIC model” is very useful for analyzing the existing process (Vaismoradi et al. 2020). There are three fundamental queries asked by the clinician as suggested by the "quality improvement framework". Answering those questions helps to set goals, aim and use the intervention of high value. According to Selekman, Shannon, and Yonkaitis, (2019), "PDSA cycle" is considered the backbone of the quality improvement, which comprises "plan, do, study and act". After the completion of each cycle the quality care team assesses the improvement in each step. Finally, yet importantly, the last principle is "Learn from Variation in Data". Variation of different data and understanding the reason behind the variation by the professional is necessary in this case. Various tools such as a run chart, Pareto chart, and scatter plots are used to measure the variation (National Association of School Nurses, 2020). These principles are related to clinical supervision and are maintained by the professionals in all the hospitals to improve the quality of the outcome.

However, there are certain things as well, which can also influence patient improvement, such as the leadership and management strategy of the nursing professionals. Most nurses use “Transformational Leadership theory" in hospitals (Weiss, Tappen, and Grimley, 2019). In this style, the lead nurse induces other nurses to take responsibility for their own job and think creatively rather than perform what they are asked to do. They also promote the quality of care. It is very common in hospitals that some patients to eat in a vulnerable state. Due to the management and leadership quality of the nurses, they can improve the outcome of the patient by ensuring safety and sticking to the protocol. According to Mejia et al. (2020), constant education and up gradation of the skill is also the result of proper leadership and management. Hence, quality improvement is possible in the hospitals as the nurse leaders examine the quality indicator regularly and done modifications when needed.

Discussion on evidence-based person-centered nursing care

Hospitals are uncomfortable and frightening places for most people due to anxiety, fear of disease or treatment, and others. Hence, healthcare professionals use patient-centered care where they take the responsibility for comforting the patient and rescuing them in each step of the treatment. According to Avsar et al. (2022), the "Patient-centered care model" is very important in the healthcare industry. As a result, the patient is ultimately responsible for the dissection. Healthcare professionals can suggest or request treatment. However, a patient is the only person who can accept and refuse that suggestion or treatment. Therefore, the patient must have knowledge about the types of treatment they are going to receive especially for the complicated treatment (Feng et al. 2018). On the other hand, evidence-based practice is used as the problem-solving strategy in the healthcare setting. The recent and best research evidence is combined with the value of the patient, which delivers the most effective care.

Understanding the needs and requirements of each patient is the most important part of evidence-based practice. Nurses try to understand what is the most important for the patient and what is the preferences of the patient when they are going through their treatment process. However, as stated by Gethin et al. (2020), despite the benefits of evidence-based care, there are several constraints faced by nursing professionals. Nurses are considered the largest proposition in most healthcare settings. The first challenge is that nurses are generally trained as caregivers, not as researchers. Hence, as a caregiver, they are prone to use the available intervention techniques to improve the health of the patient. Besides, the workload of nurses is huge in hospitals as they are the ones who stay in touch with the patient most of the time (Pokorná et al. 2019). Hence, lack of time does not allow them to analyse critically the current literature for finding the recent and best evidence.

Impacts of person-centered nursing care on pressure ulcer

As discussed above, the aim of patient-centered care is to provide improved and quality treatment. Besides, the involvement of the patient, family, and service provider is necessary for the decision-making process. Hence, the patient can achieve an effective and positive health care experience. According to Avsar et al. (2022), the reason for the development of pressure ulcers is different for each person. Besides, the health conditions and the need are also different. In patient-centered care, the nurse understands the need of the patient suffering from pressure ulcers rather than forcing them for the service. A collaborative approach is taken here as the involvement of the patient and the nurses both are important (Feng et al. 2018). However, the problem appears when the patient does not want to share the need for how they feel about the treatment. Hence, the role of the nursing professionals is to increase the knowledge about the patient about the pressure ulcer, and the benefits of treatment.

The health of the person is the most important part of any healthcare. Hence, the safety and comfort of the patient are important. Especially, for diseases like pressure ulcer pain and discomfort is very common (Pokorná et al. 2019). Due to patient-centered care, it is possible to provide treatment that is more comfortable to the patient. Besides, an ethical code of conduct is also maintained by "patient-centered care". This describes the standard of performance, where the nurses need to ensure the treatment is non-judgemental, respectful, fair, and non-prejudicial. Besides, According to Avsar et al. (2022), nurses encourage the person suffering from pressure to lead a healthy lifestyle, which brings back their nutritional balance in them.

Conceptual framework

(Source: Self developed)

Findings

Conducting the literature review helps to generate many findings. Various findings are found, which are discussed in this section. Some common aspects of each research paper are taken into consideration and analysed.

Risk assessment in the first stage of pressure ulcer helps to reduce the complication

Pressure ulcers have many stages of infection. As stated by Gefen (2018), the disease affects most elderly people, and people with no sensitivity, there is a high chance of ignorance in the first place. Pain is the most common and first symptom of the disease. However, when a person is paralyzed they cannot recognize the pain of a specific body part. Besides, people who are bedridden for a long time due to surgery take painkillers to reduce the pain of surgery (effective healthcare.ahrq.gov, 2022). Hence, it is difficult for them to identify the other pain at the same time. As a result, pressure ulcers are often ignored or remain unidentified in the first stage. The complication of the disease increase from the second stage and the management of the disease become difficult for the patient as well as for the health care professionals. According to Coleman et al. (2018), the infection and the complication start to increase from the second stage onwards.

When the ulcer progresses enough it starts to damage the tissue. Besides, there are high chances of osteomyelitis, which is known as the infection of underlying bone (mayoclinic.org, 2022). Infection can also happen in the sinus tract. Hence, the key aspect is to assess and treat the disease in the first phase. Hence, healthcare professionals determine the best ways to prevent the disease before it worsens. Evaluation of nutritional status is another important point in this case. According to Anrys et al. (2019), the family member or the caregiver can perform physical infection for the assessment of the first stage. However, it is also cost-effective for the patient and their family. When a patient has a lack of sensitivity and is bedridden due to surgery, this involves huge expenditure. Adding new problems can increase the expenditure.

Besides, risk assessment is not a complicated process. It is just an inspection, which can reduce the harm. The aim is to make sure that the person does not get a pressure ulcer. As nursing professionals already know the patients who are susceptible to the disease (Ferris, Price, and Harding, 2019). Therefore, they can frequently check for discoloration in the specific body part. The issues can worsen when the patient is suffering from other diseases such as diabetes. This disease does not allow to reduce infections in the body. Hence, ignorance in the first place will lead to higher levels of infection and life-threatening conditions. According to Coleman et al. (2018), blood poisoning is also a life-threatening problem caused due to the higher level of infection of pressure ulcers. Hence, the caregiver and the family need to identify the disease in the first place. The patient can also be informed about the symptoms, and whether they are in the condition of identifying those symptoms.

Physical inspection and use of tools are helpful for risk assessment

As pressure ulcers have some major threats to health, proper assessment of the risk is necessary for the healthcare provider. There are many processes of assessment found in the literature review. According to Anrys et al. (2019), health care workers use physical inspection and tool-based inspection for the disease. The common symptoms of the first stage pressure ulcer are pain and discoloration of the specific place, which are prone to excessive pressure (mayoclinic.org, 2022). The role of a nurse is to prevent the disease by performing the risk assessment in the first stage. The risk assessment should be done both for the patients who are in the hospitals or who are at the home. In the case of a home, the family member could spot the symptoms by conducting a physical inspection. However, the physical inspection must be patient-centered. As stated by the experts Coleman et al. (2018), a person who sits in a wheelchair for the whole day is supposed to get an ulcer in the "Tailbone or buttocks". On the other hand, a person who is bed ridden supposes to get an ulcer in the back or hills.

As discussed by many researchers’ nutrition deficiencies in the body are seen especially in the lack of Vit D and essential amino acids (Ferris, Price, and Harding, 2019). Hence, assessment of the nutritional deficiency can also lead to the problem. Various tools and tests are needed to find the deficiency. On the other hand, some tools named as "Norton Scale, Braden Scale, and Waterlow Scale" are commonly used for understanding the severity of the disease (Anrys et al. 2019). However, according to some researchers, there is not much evidence about the accuracy of these tools. Besides, only physical inspection is not enough to detect the issues. A combination of physical inspection, tools, and tests is effective to find the disease. Some researchers argue that, despite the identification, the nurses cannot diagnose the disease. However, differentiating the wound etiologies and pressure ulcer falls within the domain of the registered nurse (effective healthcare.ahrq.gov, 2022). On the other hand, the mortality rate of this disease is as high as 60% for people who are above 70 (mayoclinic.org, 2022). Hence, clinicians need to be involved in the case of complications in the disease.

Person-centered and evidence-based care to reduce risk and improve the quality of care

Evidence-based and person-centered care is available for many diseases. However, those are not always used in care delivery. According to the researchers Garrett (2018), in traditional practice, the research is focused on data analysis to find the safety of the patient. However, that research does not discuss the implementation. One of the aims of EBP or evidence-based practice is to put those research findings into practice (Anrys et al. 2019). Hence, this leads to improved quality of care and enhances patient safety. However, implementing evidence-based practice or patient-centered practice is not an easy task. The process is difficult and needs various strategies to reduce the complexity of care. Using research practice is very useful nowadays both for nursing professionals and other healthcare workers (Mitchell, 2018). Besides, the major leadership qualities of the nurses are helpful to apply the research findings in care practice.

According to the author Garrett (2018), EBP is also defined as the judicial-based practice, which combines clinical expertise and the current research result in the healthcare decision. Empirical evidence from different randomized control trials develops new ideas and perspectives on the specific treatment. Hence, evidence-based practice can also be implemented for Pressure ulcers. New EBP of the pressure ulcer suggests that using "static mattresses' ' for the patient who is at risk of pressure ulcer can reduce the risk (Mitchell, 2018). New research has also found that the use of "alternating-air mattresses'' is not effective and it does not reduce the risk. Hence, due to the findings of new research clinics are able to use those in practice and reduce risk.

The same is applicable to person-centered care as well. The aim of patient-centered care is to increase the safety of the treatment and improve quality. As stated by Gethin et al. (2020), It is demonstrated by patient-centered care that each person has unique needs in each stage of life. Providing value to the need or choices of a patient leads to outcomes that are more successful. The patient is the center of this type of treatment and is responsible for taking all the decisions about the treatment (Corazzini et al. 2019). Therefore, the clinician and nurses had to explain the disease, treatment process, costs, and others to the patient so that individuals can make decisions based on their preferences. As the collaboration between patients and healthcare workers increases it leads to more successful treatment and outcomes. However, a randomized control trial performed by Gethin et al. (2020), found that PPC improves the quality of life as knowledge of the patient increases. Though the clinical outcome is not directly linked with the PPC, it can potentially improve customer satisfaction and increase prevention because of the improved knowledge of patients.

Following guiding principles of improvement methods by nurses is crucial for quality improvement

Quality improvement in nursing is a broad area to discuss. There are three main aspects, which are included in quality management: those are "quality improvement, problem resolution, and quality assurance" (Vaismoradi et al. 2020). Maintaining these three key attributes can improve the overall quality of care. Besides, there are five guidelines principles, which are followed by nurses from the overall world to enhance the quality of treatment. There are a number of nursing associations and healthcare organizations, which promote those principles. As healthcare is a complex industry, where the quality cannot be determined by using numeric data (Sloane et al. 2018). Hence, applying those principles and the quality improvement methods is difficult. However, the area of action and the strategy should be based on the objectives of the patient and the healthcare organization. As discussed by Li, Cao, and Zhu, (2019), evidence-based practice is very much beneficial for quality improvements. The same is stated in the principle as well.

The principle also stated the role of "hands-on" in the improvement work. The second principle is aligned with "patient-centered care", which discusses providing individual care by understanding the needs of the person. Besides, the focus is given to the PRO or patient-reported outcome (Vaismoradi et al. 2020). Hence, this provides an accurate idea about the improvement of the patient. The principles also suggest the use of a quality management framework. Following a scientific framework is useful to analyse the existing process and it shows the way to achieve the aim of the healthcare professionals.

The complexity of the healthcare system is huge. Hence, following a quality improvement framework is a distant possibility for some researchers. However, quality improvement is achievable when the outlined principles are taken as a guide. As explained by the authors like Li, Cao, and Zhu, (2019), using the framework, which is based on scientific methodology, is able to change the dynamic of quality improvement. Besides, improvement of quality is directly linked with improved safety, which can minimize the risk. It is also possible to achieve the desired outcome in the care practice.

Process of implementation in the clinical area

Application of the findings is a major part of the nursing professionals in the clinical area. "Leeds Teaching Hospital is an NHS hospital trust which resides in West Yorkshire, England. In order to Work in a clinical place like "Leeds Teaching Hospital,'' the nurses need to maintain some professional practice in order to help the hospital to achieve its objectives.

Professional nursing practice implementation in Leeds Teaching Hospital

Various important aspects of the nursing professional's practice have been found in the findings of the literature review.

Evidence-based practice can be the first implementation of professional nursing practice in hospitals. Due to the literature search, the importance and the process of evidence-based care have been found. Hence, the nurse can use the EBP for pressure ulcers in the Leeds Teaching Hospital. According to Haavisto et al. (2022), current research on pressure ulcers has shown the importance of static mattresses in order to reduce the risk of the disease. Hence, the nurse can implement these research findings and use a static mattress for the patient who has the potential risk of developing a pressure ulcer. However, before implementing those the nurses need to involve in different research activities or learn from the recently published research papers (Mitchell, 2018). Management of time is a concern here as the workload is huge for the nurses. However, the development of proper time management skills can allow them to manage patients and learn new research data both.

Another important implementation is patient-centered care. Patient-centered care is focused on understanding the needs of the patient or focusing completely on the patient (Taylor, Mulligan, and McGraw, 2021). PPC has a crucial role in the management of risk. In this process, the nurses are responsible for sharing all the information related to the treatment and complications of the disease. As a result, patients become aware of the risk of the disease. According to Haavisto et al. (2022), the assessment and management of risk become easier by following PPC. The aim of the Leeds Teaching Hospital is also proper management of the risk. When the nurse can implement the learning, it improves the professional practice of the nurse as well as improves the brand value of the hospital.

It has also been found that proper risk assessment can reduce the impact of pressure ulcers on the patient. There are some specific reasons to develop pressure ulcers, which have been found in the existing research papers. Hence, the nurses should perform routine risk assessments on all the patients, who are prone to the disease (Borojeny et al. 2020). The risk assessment methods are also explained by different readers, among them physical inspection and tools-based inspection are widely used. The nurse can use any of them to assess the risk. However, physical inspection is preferable as nurses are able to differentiate between a pressure ulcer and a normal wound.

Monitoring and treatment are necessary for the patient who has already been diagnosed with pressure ulcers by clinicians. Pressure ulcer has many stages and they can be life-threatening for some patients due to blood poisoning (Lechner et al.2022). Hence, proper monitoring is required to assess the effects of treatment. Nurses can also identify whether the wound is healing or not. Clinicians are responsible for prescribing medicine. As stated by Vaismoradi et al. (2020), the role of a nurse is to give medicine on time, dressing of the wound, and change the mattress as per need. The nurse of the Leeds Teaching Hospital can implement all of these in professional practice.

Two important components of the nursing profession are leadership and ethics. Nurses generally followed transformational leadership (James et al. 2021). In this leadership, they motivate other nurses to work properly and add innovation to their work. Besides, they allow the innovation in work and perform specific monitoring of the other nurses. Besides, as transformational leader understand the perspective of the team members, it is useful to reduce the workload of the nurses. Hence, error in work reduce, which leads to more safety of the patient. The lead nurse of the Leeds teaching hospitals can follow this leadership style, because this leadership style is very effective to enhance the performance of staff nurses. Hence, providing quality care and management of risk is possible. Ethics is also an important aspect of the nursing profession, which needs to be implemented by the nurses. As described by author Zhang et al. (2019), the nursing "code of ethics" allows the nurse to understand the patient's needs from a different perspective. Besides, this also makes the nurse treat each patient equally without being judgemental. Protection of privacy also falls under this. Hence, the overall experience of the treatment becomes better for the patient with a pressure ulcer.

Professional obligations of the registered nurse in the implementation of evidence-based care

Prevention of pressure ulcers is a "multidisciplinary responsibility". Despite that, nurses play a major role. Hence, analysis of the professional obligation in terms of evidence-based care of pressure ulcers is helpful. According to Parisod et al. (2022), the first obligation of the nurses is the assessment of risk. The frequency of assessment and the type’s tools to use for identifying risk is a crucial part of risk management. Various tool-based assessment is performed by the nurse for the patient who is at high risk of developing bedsore. Research shows that "Braden Scale and Norton Scale" are better than other tools and those have shown higher sensitivity (Haavisto et al. 2022). However, poor assessment value is a concern. Hence, a combination of tools and physical inspection is helpful.

Implementation of the prevention plan also relies upon the professional obligation of the nurses. Evidence-based research shows that repositioning every two hours is helpful to prevent excessive pressure on a specific body part (rch.org.au, 2022). Besides, the nurses also perform the use of a specific mattress. The static mattress is very beneficial for the pressure ulcer patient as found by current research. The role of nurses is to collect information and learn new effective prevention plans.

The role of nurses is huge in the treatment of pressure ulcers. Though the clinician prescribes the treatment, nurses are responsible for following that. They assist the clinician to close the ulcer as soon as possible. As stated by Parisod et al. (2022), nurses know that excessive moisture in the skin will lead to further breakdown and clean, dry skin will reduce irritation and improve healing as the recent research. Hence, the nurses based on the EBP also plan specific skincare and bathing schedules.

Conclusion

It can be concluded that pressure ulcer is a very common disease. However, this disease can be life threatening for some patients when proper risk assessment and treatment are not done. In that aspect, the role of the nurses is crucial to reduce the risk of pressure ulcers. The nurse uses various principles in order to improve the quality of health care. Evidence-based and patient-centered care is more useful. In evidence-based care, nurses develop their skills from different research and implement those to perform their professional obligation. Patient-centered care is also useful for the assessment of risk and preventing infection. Nurses also assist the experts in the treatments of the pressure and perform dressing, give medicine, change mattresses, and others. Hence, a nurse is the one who keeps in touch with the patient mostly. As a result, evidence-based practice of the nurse is very beneficial for the management of risk in pressure ulcers at the Leeds teaching hospital.

References

Books

Garrett, B., 2018. Empirical nursing: the art of evidence-based care. UK: Emerald Group Publishing.

Selekman, J., Shannon, R.A. and Yonkaitis, C.F., 2019. School nursing: A comprehensive text. Philadelphia:FA Davis.

Weiss, S.A., Tappen, R.M. and Grimley, K., 2019. Essentials of nursing leadership & management. Philadelphia:FA Davis.

Journals

Al-Jabri, F., Kvist, T., Sund, R. and Turunen, H., 2021. Quality of care and patient safety at healthcare institutions in Oman: quantitative study of the perspectives of patients and healthcare professionals. BMC health services research, 21(1), pp.1-8.

Anrys, C., Van Tiggelen, H., Verhaeghe, S., Van Hecke, A. and Beeckman, D., 2019. Independent risk factors for pressure ulcer development in a high?risk nursing home population receiving evidence?based pressure ulcer prevention: Results from a study in 26 nursing homes in Belgium. International wound journal, 16(2), pp.325-333.

Avsar, P., Budri, A., Patton, D., Walsh, S. and Moore, Z., 2022. Developing Algorithm Based on Activity and Mobility for Pressure Ulcer Risk Among Older Adult Residents: Implications for Evidence?Based Practice. Worldviews on Evidence?Based Nursing, 19(2), pp.112-120.

Biçer, E.K., Güçlüel, Y., Türker, M., Kepiçoglu, N.A., Sekerci, Y.G. and Say, A., 2019. Pressure ulcer prevalence, incidence, risk, clinical features, and outcomes among patients in a Turkish hospital: a cross-sectional, retrospective study. Wound Manag Prev, 65(2), pp.20-8.

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Website

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