Study Aims/Purpose
This study investigates the barriers to implementing evidence-based interventions to prevent Decubitus ulcers among bedridden patients. This study will focus on identifying the barriers that impede evidence-based practice in preventing Decubitus ulcers among bedridden patients. This study examines the current evidence-based interventions available to prevent Decubitus ulcers among bedridden patients and determines the barriers to their implementation. In addition, this study will explore the perceptions of healthcare providers on b to implementing evidence-based interventions to prevent Decubitus ulcers among bedridden patients.
Literature Review
Decubitus ulcers are a significant source of morbidity and mortality among bedridden patients and are caused by prolonged pressure on the skin, leading to tissue damage and infection. (Wessel et al., 2020) Decubitus ulcers can be prevented by implementing evidence-based interventions, such as pressure redistribution, patient repositioning, nutrition, skincare and hydration, and infection control. However, despite the availability of evidence-based strategies, Decubitus ulcers remain a significant problem among bedridden patients. (Delvand, et al., 2018)
Prevalence and Predisposing Factors
Decubitus ulcers are a common problem among bedridden patients, particularly those immobilized for an extended period. The prevalence of Decubitus ulcers varies widely, ranging from 2.3% to 30% depending on the study setting (Moore et al., 2019). The Predisposing factors for Decubitus ulcers include immobility, incontinence, malnutrition, age, and chronic illnesses such as diabetes and orthopedic patients on traction (Delmore et al., 2019). Other Predisposing factors include impaired circulation, impaired tissue oxygenation, and decreased sensation
Decubitus ulcers are a common and costly problem in healthcare settings, affecting approximately 20% of bedridden patients (National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, & Pan Pacific Pressure Injury Alliance, 2019). These wounds result from prolonged pressure on the skin, which can cause tissue damage and lead to severe complications such as infections, sepsis, and even death (Moore et al., 2015).
Evidence-based interventions have been developed to prevent Decubitus ulcers among bedridden patients. These interventions include pressure-relieving devices, repositioning, pressure-relieving devices, skincare, and nutritional interventions (Moore et al., 2019). Repositioning involves changing the patient’s position to relieve pressure on the skin. Pressure-relieving devices include cushions, mattresses, and overlays that distribute pressure evenly across the body. Nutritional interventions aim to provide adequate nutrition to promote the excellent immunity required for wound healing. Pressure area care involves keeping the skin clean and dry to prevent damage. (Atkinson & Callum, 2018) Education programs aim to increase awareness of the Predisposing factors for Decubitus ulcers and the importance of prevention. However, despite these interventions’ availability, Bed sores still need to be solved in healthcare settings, with high incidence and prevalence rates (Mitchell, 2018).
Barriers to Implementation
A variety of barriers often hinders the implementation of evidence-based interventions to prevent Decubitus ulcers among bedridden patients. Several studies have identified various factors that contribute to the underutilization of these evidenced-based interventions, including organizational, environmental, and individual factors.
Organizational barriers:
Organizational barriers to implementing evidence-based interventions to prevent Decubitus ulcers include a lack of resources, inadequate staffing, and insufficient training and education for healthcare providers on pressure ulcer management. In a study by Maki et al. (2018), nurses reported needing more time and resources to provide adequate pressure areas care to their patients. Similarly, other studies have found that nurses lack the knowledge and skills to prevent Decubitus ulcers effectively (Huang et al., 2012); (Delvand et al., 2018). These organizational barriers can lead to inadequate utilization of evidence-based protocols and ultimately contribute to developing Decubitus ulcers.
Environmental barriers:
Environmental barriers refer to the physical conditions of the healthcare setting that can affect the prevention of Decubitus ulcers. These barriers include insufficient support surfaces and equipment, poor hygiene, and inadequate lighting. A study by (Huang et al. (2023); found that the quality of mattresses and support surfaces was inadequate in most healthcare setups, leading to an increased risk of Decubitus ulcers. Similarly, other studies have found that some hospitals often have poor hygiene practices, which can increase the risk of infections and exacerbate the development of Decubitus ulcers (Maki et al., 2018)
Individual barriers:
Individual barriers to implementing evidence-based interventions to prevent Decubitus ulcers include healthcare providers’ perceptions, attitudes, and beliefs about pressure ulcer prevention and their motivation to provide appropriate and holistic care. Studies have found that some healthcare providers have negative attitudes toward pressure ulcer care and prevention and do not believe that Decubitus ulcers are preventable (Huang et al., 2023). These attitudes can lead to inadequate utilization of evidence-based interventions and ultimately contribute to the high prevalence of Decubitus ulcers.
References
Atkinson, R. A., & Cullum, N. A. (2018). Interventions for pressure ulcers: a summary of evidence for prevention and treatment. Spinal Cord, 56(3), 186–198. doi:10.1038/s41393-017-0054-y
Delmore, B., Deppisch, M., Sylvia, C., Luna-Anderson, C., & Nie, A. M. (2019). Pressure injuries in the pediatric population: A national pressure ulcer advisory panel white paper: A national pressure ulcer advisory panel white paper. Advances in Skin & Wound Care, 32(9), 394–408. doi:10.1097/01.asw.0000577124.58253.66
Huang, L., Yan, Y., Huang, Y., Liao, Y., Li, W., Gu, C., … Li, C. (2023). Summary of the best evidence for preventing and controlling pressure ulcers on support surfaces. International Wound Journal. doi:10.1111/iwj.14109
Mäki-Turja-Rostedt, S., Leino-Kilpi, H., Korhonen, T., Vahlberg, T., & Haavisto, E. (2021). Consistent practice for pressure ulcer prevention in long-term older people cares A quasi-experimental intervention study. Scandinavian Journal of Caring Sciences, 35(3), 962–978. doi:10.1111/scs.12917
Mitchell, A. (2018). Adult pressure area care: preventing pressure ulcers. British Journal of Nursing (Mark Allen Publishing), 27(18), 1050–1052. doi:10.12968/bjon.2018.27.18.1050
Moore, Z., Avsar, P., Conaty, L., Moore, D. H., Patton, D., & O’Connor, T. (2019). What does the European data tell us about the prevalence of pressure ulcers in Europe: a systematic review. Journal of Wound Care, 28(11), 710–719. doi:10.12968/jowc.2019.28.11.710
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